Urology Path Flashcards Preview

Renal/Skeletal > Urology Path > Flashcards

Flashcards in Urology Path Deck (72)
Loading flashcards...
1

Urothelial papilloma:
Benign • 2% to 3% of tumors • Exophytic or inverted
• Microscopically: papillary fronds lined by normal urothelium.
• On cystoscopy: single lesion, 2 to 5 cm in diameter

Below: normal urothelium

2

Inverted papilloma:
Rare • Nodular mucosal lesions • Trigone area
• Microscopically: cords of urothelium descend into the lamina propria covered by normal urothelium

3

Aggressive Carcinoma in situ

Can be adjacent to papillary carcinoma.
• Multiple, red, velvety, flat patches.
• Microscopically: marked cytologic atypia
• Architecturally: flat, variation in nuclear polarity and discohesion
• Associated with subsequent invasive carcinoma

4

Bladder specimen- incidental finding (outgrowth of bladder wall)

Diagnosis? Risk for malignancy?

• Papillary Urothelial Neoplasms of Low Malignant Potential (PUNLMP)

Urothelium= translitional epithelium

The least dysplastic with rare mitosis and organized architecture
Lack of potential for invasion

• Can progress to carcinoma

- 4th most common cancer
- 3:1 M:F
- Rare <40
- Median age 65 - medical comorbidities
- Often multifocal
- Can involve the urothelium from the renal pelvis to the urethra

Cytogenic abnormalities:
- Deletion of chromosome 9 (9p- or 9q-), 11p, 13p, 14q, or 17p

Risk factors:
- Cigarettes
- Arsenic exposure

Treatment:
TURBT: transurethral resection of bladder tumor;
- Low risk: observe
- Intermediate: chemo, BCG/maintenance
- High risk: BCG/maintenance
* Recurrence--> radical cystectomy

Chemo: Cisplatin

Surgery:
- urinary diversion: ileum connected to ureters
- Neobladder/continent diversion: patients may have to self-catheterize

5

Bladder papillary frond removed from bladder following hematuria. What is risk of progression/diagnosis? Treatment?

Low Grade Papillary Urothelial Carcinoma (LGPUC)

Some mitosis
Some disorganized architecture
Some cytologic atypia

- 4th most common cancer
- 3:1 M:F
- Rare <40
- Median age 65 - medical comorbidities
- Often multifocal
- Can involve the urothelium from the renal pelvis to the urethra

Cytogenic abnormalities:
- Deletion of chromosome 9 (9p- or 9q-), 11p, 13p, 14q, or 17p

Risk factors:
- Cigarettes
- Arsenic exposure

Treatment:
TURBT: transurethral resection of bladder tumor;
- Low risk: observe
- Intermediate: chemo, BCG/maintenance
- High risk: BCG/maintenance
* Recurrence--> radical cystectomy

Chemo: Cisplatin

Surgery:
- urinary diversion: ileum connected to ureters
- Neobladder/continent diversion: patients may have to self-catheterize

6

Bladder papillary frond removed from bladder following hematuria. What is risk of progression/diagnosis? Treatment?

High Grade Papillary Urothelial Carcinoma (HGPUC)

The most dysplastic
• Frequent mitosis
• Disorganized architecture Nuclear atypia similar to Urothelial Carcinoma In Situ

- Most common high grade tumor of urothelium

Clinical features:
- Hematuria
- 15% of the cases have regional or distant metastases at presentation

- 4th most common cancer
- 3:1 M:F
- Rare <40
- Median age 65 - medical comorbidities
- Often multifocal
- Can involve the urothelium from the renal pelvis to the urethra

Cytogenic abnormalities:
- Deletion of chromosome 9 (9p- or 9q-), 11p, 13p, 14q, or 17p

Risk factors:
- Cigarettes
- Arsenic exposure

Treatment:
TURBT: transurethral resection of bladder tumor;
- Low risk: observe
- Intermediate: chemo, BCG/maintenance
- High risk: BCG/maintenance
* Recurrence--> radical cystectomy

Chemo: Cisplatin

Surgery:
- urinary diversion: ileum connected to ureters
- Neobladder/continent diversion: patients may have to self-catheterize

 

7

Squamous cell carcinoma:

Associated with Schistosomiasis

Non-urothelial forms of bladder cancer are RARE

8

Bladder specimen in young man who had a patent urachus at birth. He has developed hematuria. What is his diagnosis?

Adenocarcinoma of bladder:

originates from urachal remnants in the bladder dome

Non-urothelial forms of bladder cancer are RARE

9

Neuroendocrine carcinoma resembles small cell lung carcinoma of the lung, and can be combined with urothelial carcinoma.

- Salt and pepper chromatin

Non-urothelial forms of bladder cancer are RARE

10

Rhabdomyosarcoma of bladder
Sarcoma botryoides (Children)

Non-urothelial forms of bladder cancer are RARE

11

Urethral carcinoma:
Uncommon
• Elderly women 6th and 7th decades
• Distal urethra: Squamous cell carcinoma (seen more in males)
• Proximal urethra: Urothelial carcinoma
• Most tumors have spread at presentation

- Worst presentation= ulceration

12

Penis carcinoma
Uncircumcised men • 60 year-old • Uncommon in the USA • Pathogenesis:
– Human papillomavirus (HPV) types 16 and 18
– Phimosis and smegma
• Squamous Cell Carcinoma

 

13

Penile intraepithelial neoplasia: squamous cell carcinoma in situ

Bowen disease
– Shaft
– Solitary, sharply demarcated, erythematous (red) or grayish white plaque

14

Eythroplasia of Queyrat: Penile intraepithelial neoplasia

Glans and foreskin

manifests as Solitary or multiple, shiny, soft, erythematous (red) plaques.

Histo: nuclei remain large, pleomorphic, with abnormal maturation

15

Bowenoid papulosis:
Bowenoid Papulosis of the penis is not a carcinoma
• Young, sexually active men
• HPV type 16 in 80% of patients
• Multiple brownish or violaceous papules

Histo:
 Microscopically: sharply demarcated from normal epidermis and thus resembles HPV-induced warts.
• Lesions regress spontaneously and do not progress to invasive carcinoma

16

Invasive squamous cell carcinoma of penis

Ulcer, crater, friable hemorrhagic mass
• Exophytic, fungating
• Glans or prepuce and less commonly the penile shaft

Histo:
• Microscopically: well- differentiated keratinizing
• Invasive tumors have a dense chronic inflammation in the dermis

17

Verrucous carcinoma of penis

Low-grade Squamous Cell Carcinoma
• Slow-growing
• Exophytic
• Locally aggressive but seldom metastasizes
Not related to HPV
• Surgical removal is curative

18

“Giant Condyloma Acuminata of Buschke and Löwenstein”

Benign condyloma in the anogenital area
• Glans penis
• HPV 6 and 11 (occasional HPV 16 - 18) and p53 overexpression
• Slow growing verrucous plaque
• Locally destructive but seldom metastasize
• Recurs

19

Prostatic intraepithelial neoplasia:
PIN is the noninvasive neoplastic transformation of the lining epithelium of preexisting prostatic ducts and acini
• Divided into low grade and high grade (HGPIN)
• PIN precedes invasive cancer by two decades
• 20% median risk of cancer
• Microscopy:
– Dilated branching glands with intraluminal papillary projections
– Lined by crowded, enlarged cell with prominent nucleoli

20

Prostate adenocarcinoma

Multicentric on the peripheral zone
Trans-rectal biopsy
Grossly: irregular, yellow– white, indurated nodules

Histo: Glands with conspicuous “nucleoli” that infiltrate the stroma
• Lack architectural organization
Immunohistochemical stain: used to prove that this biopsy is cancer
- Benign glands will have basal cell layer
- Basal cell layer markers are absent in cancer and present in benign glands and HGPIN
- Alpha-methylacyl-CoA racemase (AMCAR) is present in prostate cancer and HGPIN
- "PIN cocktail"
- Use "Gleason grading system" to stage cancer

21

Metastatic Prostatic cancer= blastic

Prostate Metastasizes to lymph nodes, bone, lung, and other
“Osteoblastic” bone lesions in the vertebral column, ribs and pelvic bones (white on X-ray, vs most carcinomas= osteolytic, dark on x-ray)
• Painful and present a clinical problem
• Prostate specific antigen (PSA) and Prostate Specific Acid Phosphatase (PSAP) immunohistochemical stains used to confirm diagnosis

22

Below is a nephrectomy specimen from a 2-year old boy with a palpable abdominal mass. What is his diagnosis and what would the histology reveal?

Wilm's tumor= Nephroblastoma
Embryonal tumor from nephrogenic nests
Abdominal mass does not cross midline
Chromosome 11 (11p); WT1 and WT2 genes overexpressed
- 85% of pediatric renal tumors

Associated with dysmorphic tumor syndromes in 10% of the cases:
– Wilms-Aniridia-genital anomaly-retardation syndrome
– Beckwith-Wiedemann syndrome (abdominal wall defect, macroglossia,macrosomia)
– Hemihypertrophy
– Denys-Drash syndrome (pseudohermaphroditism glomerulopathy)
– Familial nephroblastoma

Gross: Large round demarcated tumor with tan-grey, fleshy, hemorrhagic surface

Histo: Mixture of immature renal elements
Hematoxylin-Eosin (H&E stain): Blastema, Stroma and Epithelia.
- Blastema= small blue cells in solid nests.
- Hypocellular stroma with myxoid spindle cells.
- Epithelia arranged in tubules

23

Congenital Mesoblastic Nephroma (CMN)= 2% congenital renal tumors

- Also known as fetal, mesenchymal, or leiomyomatous hamartoma
- t(12;15)(p13;q25) with the ETV6-NTRK3 fusion gene
- Most CNM are benign with 5 -10% recurrences and metastases

Macroscopy: solitary, tan, bulgy, soft mass similar to leiomyomas

Microscopy H&E stain: spindle cells with mitosis on the cellular pattern

24

Clear cell sarcoma of kidney: 3.5% pediatric renal tumor
Aggressive malignant sarcoma also known as bone-metastasizing tumor
• Late recurrence and bad prognosis.

Macroscopy: large, located in the medulla

Microscopy H&E stain: epithelioid with
clear cytoplasm and clear nucleus, arranged in sheets with arborizing blood vessels in a myxoid stroma

25

Rhabdoid tumor= 2.5% pediatric renal tumors
- Deletion or mutation of IN11 gene, chromosome 22q11
• Despite the histology it does not have muscle differentiation
• Highly malignant with poor prognosis.

Associated with a brain tumor:
Atypical Rhabdoid Teratoid Tumor
• (Below cytology smear H&E stain showing rhabdoid appearance of the cell with excentric nucleus, prominent nucleoli, and abundant eosinophilic cytoplasm)

Macroscopy: pale, poorly circumscribed and often has satellite nodules

Microscopy H&E stain: high-grade, round cell with abundant cytoplasm

26

Oncocytoma: 6-9% renal cancers in adults
Macroscopy of an Oncocytoma: well circumscribed mahogany brown mass with a central scar

 Renal oncocytoma is thought to arise from the intercalated cells of collecting ducts of the kidney.

27


 

Metanephric adenoma
• Macroscopy (Upper left): gray-tan, well circumscribed but unencapsulated
• Microscopy H&E stain (Upper right): tumor (dark color) sharply demarcated (arrow) from the benign (pink); (Left) cells are small, uniform, dark; form branching tubules, papilla or glomeruloid structures in an acellular stroma

28

Papillary Adenoma:
Macroscopy: gray-tan, less than or equal to 0.5 cm

Microscopy H&E stain: papillary projections of small, bland, basophilic cells or eosinophilic cells. Insert: Psammoma bodies

29

This is a nephrectomy specimen from a 32 year old female with abdominal pain. Paracentesis demonstrated blood. At laparotomy, a renal neoplasm was discovered. What is her diagnosis and how should she be treated?

Angiomyolipoma:
Female
Associated with tuberous sclerosis
Co-express melanocytic and muscle markers

Should be removed due to risk of hemorrhage

Gross: yellow (resembling fat) or tan, large and well-circumscribed
Microscopy H&E stain 3 components: blood vessels + muscle + fat

30

Tuberous Sclerosis Complex: Mutation on TSC1, TSC2, Chromosomes 9 and 16

- Increased risk of angiomyolipoma (below)