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Urologoical Pathology Flashcards

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1
Q

How common are urinary calculi?

A

Incidence is up to 15%

M:F 3:1

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2
Q

How many main types of urniary stones are there?

A

3

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3
Q

What is the most common type of renal stone?

A

75% calcium oxalate
Most related to absorptive hypercalciuria (gut)
Some have renal calciuria, where calcium absorption from proximal tubule is impaired

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4
Q

What is the second most common renal stone?

A

15% magnesium ammonium phosphate aka triple stones

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5
Q

What are triple stones formed as a result of?

A

Infections with urease-producing organisms e.g Proteus
Ammonia alkalises the urine and promotes precipitation of stones
Can form staghorn calculi.

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6
Q

What is urease?

A

An enzyme that catalyses urea into carbon dioxide and ammonia, the ammonia is alkaline.

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7
Q

What is the 3rd most common type of renal stone we see?

A

Uric acid 5%
Forms with rapid cell turnover, eg gout.
Most patients don’t have hyperuricaeima/ increased urinary excretion of uric acid.
They may have a tendency to form slightly acidic urine

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8
Q

How do small stones present?

A

If confined to the kidney, they are asymptomatic, or picked up after ix of haematuria or recurrent UTI

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9
Q

What can larger stones in the kidney cause?

A

Obstruction and gradual loss of renal function

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10
Q

What can small stones or stone fragments do in the ureter?

A

They impact and cause ureteric colic.

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11
Q

What are the common points of impaction?

A

PUJ
Pelvic brim
VUJ

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12
Q

What may be the outcome of small stones?

A

Pass of their own accord, give analgesia

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13
Q

What can happen to larger stones?

A

May be removed by endoscopic or percutaneous methods or shattered using acoustic pulses (shock wave lithotripsy)

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14
Q

What will happen to very large renal stones?

A

If they are obstructing the kidney with infection, it may require removal of the entire kidney

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15
Q

What leads to hydronephrosis?

A

Staghorn calculi. Kidney becomes atrophied.

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16
Q

What are the benign renal neoplasms?

A

Papillary adenoma,
Oncocytoma
Angiomyolipoma

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17
Q

What is a papillary adenoma?

A

Benign renal epithelial tumour with a papillary or tubular architecture
size of 5mm or less
Well circumscribed cortical nodules

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18
Q

When are papillary adenoma found?

A

Found incidentally in nephrectomy specimens

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19
Q

What is the histology of papillary adenoma?

A

Bland epithelial cells growing in a papillary or tubulopapillary pattern

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20
Q

What is an oncocytoma?

A 
Benign renal epithelial neoplasm, lots of cytoplasm 
Discovered incidentally 
Some associated with genetic syndromes 
No capacity for spread 
Mahogany brown
Central area of scarring
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21
Q

What is an angiomyolipoma?

A

Benign mesenchymal tumour of the kidney
Variable amounts of fat, smooth muscle, thick walled blood vessels
Small proportion assoc. with tuberous sclerosis in younger patients

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22
Q

How can angiomyolipoma present?

A

With flank pain, due to haemorrhage into the tumour

Fat is diagnostic radiologically

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23
Q

What are the malignant renal neoplasms?

A

RCC x 3

Nephroblastoma

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24
Q

What is renal cell carcinoma?

Study These Flashcards
A

Malignant epithelial tumour arising in the kidney
2% cancers worldwide
10/10000 or 3/10000 women

25
What are the recognised risk factors for RCC?
``` Smoking Hypertension Obesity Environmental chemical Long term dialysis Genetic syndromes- von Hippel Lindau ```
26
What is von Hippel Lindau syndrome?
X
27
How does RCC present?
Half present with painless haematuria Remainder is incidental Small proportion present with met spread
28
What are 3 main histological types of RCC?
Clear cell Papillary Chromophobe
29
What is the histology of clear cell renal cell carcinoma?
70% of all RCC Grossly appear as golden yellow tumours with haemorrhagic areas Nests of epithelial cells with clear cytoplasm set in delicate capillary vascular network Loss of chromosome 3p
30
What is the second most common RCC?
``` 15% of RCC Friable brown tumours Epithelial with a papillary or tubulopapillary growth pattern, less than 5mm in size Trisomy of chromosome 7 and 17 Often filled with foamy macrophages ```
31
What is the least common RCC?
Chromophobe 5% of RCC Macroscopically appear as solid brown tumours, paler than oncocytoma Sheets of large cells, distinct borders, thick walled vasculature Extensive chromosomal loss
32
What the general outcomes for RCC?
Overall 5 year survival rate, 60% Stage and grade most important prognostic factors Fuhrman grading system based on degree of nuclear atypia
33
What is a nephroblastoma? (Wilm's tumour)
Malignant childhood renal neoplasm | 1 in 8000 (second most common childhood malignancy)
34
How does Wilm's present?
2-5 years with abdo mass Undifferentiated small round blue cells, with areas of more differentiated epithelial stromal components Excellent prognosis with tx
35
What are urothelial carcinomas?
Transitional cell carcinoma Epithelial neoplasms, arise in urothelial tract Most arise in bladder, anywhere from pelvis onwards Smoking increases risk, carcinogens dwell longest in the bladder
36
What can urothelial carcinomas be divided into?
Non-invasive papillary urothelial carcinomas | Invasive urothelial carcinomas
37
How do non invasive papillary urothelial carcinomas present?
Present with haematuria Appear as frond like growths projecting from the surface of the bladder mucosa Multi focal in bladder
38
What is the grading prognosis for non invasive papillary urothelial carcinoma?
Low or high grade tumours | Low grade- low grade nuclear atypia, low risk of progression into invasion (
39
What are the non invasive papillary urothelial carcinomas treatment?
Complete resection +/- intravesical chemo | Regular cystoscopies, due to high incidence of multifocality and recurrence
40
How does infiltrating urothelial carcinoma present?
Haematuria Solid mass, invading carcinoma nests Capacity for metastic spread
41
What is the tx and prognosis of infiltrating urothelial carcinoma?
Depends on stage of disease Lamina propria- resection and intravesical chemo Detrussor muscle- radical treatment with cystectomy +/- radiotherapy +/- systemic chemo
42
What is the most common problem of the prostate?
BPH
43
What is BPH?
Enlargement of the prostate gland due to an increase in cell number Common Affect 3% aged 45-49, rise to 25% by 80 Increased androgens critical to pathogenesis
44
How does BPH present?
``` Lots of nodules form on prostate, Lower UTI symptom UTI, acute urinary retention Renal failure Smooth muscle of detrussor becomes hyper plastic too ```
45
What are treatment options for BPH?
Alpha blockers eg doxazosin 5 alpha reductase inhibitors eg finasteride If medical treatment fails then TURP Is treatment of choice
46
What is the next most common problem with the prostate?
Malignant epithelial neoplasm arising in the prostate Most common malignancy in men Many behave indolently
47
What are the risk factors for prostate cancer?
Race genetic- GST-pi, PTEN, AMACR, p27, E-cadherin. Red meat Arises from precursor lesion prostatic intraepithelial neoplasia
48
How does prostatic carcinoma present?
Majority are asymptomatic, diagnosed when needle biopsy is performed for raised PSA LUTS Symptoms of mets
49
What is the prognosis like for prostate cancer?
Gleason score indicator, calculated by adding 2 most common gleason patterns present in the tumour Can range form 6-10
50
What is pattern 3-5 Gleason?
``` 3- individual glandular units 4- fusing glands. Poor gland formation 5- solid sheets of tumour. Score 6- small volume, will die with disease not from it 8-10- high volume, mets and death ```
51
What are the treatment options for prostate cancer?
Active surveillance Radical prostatectomy Radical radiotherapy
52
What are testicular germ cell tumours?
Malignant tumours of testis arising from germ cells Account for more than 90% of all testicular tumours Aged 20-45
53
What is the risk factors for testicualr germ cell tumour?
Cryptorchidsim- increase risk 3-5 fold Low birth weight Small gestational age Most arise from intratubular germ cell neoplasia Likely that disease process begins in fetal life, then further genetic aberrations lead to malignant transformation
54
How does testicular germ cell tumours?
Most present with painless testicular lump 10% present with met symptoms Embryonic/fetal and or adult tissues
55
What are the types of germ cell tumours?
``` Seminoma- resembles germ cells Embryonal carcinoma- embryonic tissue Yolk sac Immature teratoma- fetal tissue Mature teratoma- adult tissue Choriocarcinoma ```
56
What is the prognosis for testicular germ cell tumours?
Excellent- 5 year survival rates of 98% | High sensitivity of germ cell tumours to modern platinum based chemo
57
Paratesticular disease
X
58
Penile disease
X
59
What are urinary calculi?
Crystal deposits that precipitate in the renal collecting ducts but can be deposited anywhere in urinary tract.

Histopathology (4 decks)

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