Renal

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Prostate/Kidney Tumor Pathology

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Peripheral zone & Transitional zone major zones affected
ABP MCC = E. coli (G neg bacteria)
Micro: acute inflammatory infiltrate in the acini and stroma of prostate

CBP mainly monocyte inflammation in acini and stroma

BPH:
Pathogenesis = DHT made in stromal cells from Testosterone by 5a-reductase Type 2 --> DHT makes growth factors in stroma and epithelium
Pathology: BPH begins in submucosa of transitional zone compressing walls of urethra resulting in obstruction; NOT A PREMALIGNANT LESION but may cause renal failure due to urinary obstruction complications

AdenoCA of prostate = PIN (in situ)
most arise from peripheral zone and spare the periurethral zone
Microscopic: single layer of uniform neoplastic cells w/o a basal layer & presence of prominent nuclei
Invasion and mets: Contiguous spread w/ perineural invasion and seminal vesicle involvement; Lymphatics w/Obturator/iliac/periaortic nodes; Hematogenous to bone/lungs/liver
Gleason grading: best tumors have 2, worst have 10


Kidney Tumors:

Benign: renal adenomas >3cm tend to mets
Renal Oncocytoma = completely benign with oncocytes containing abundant eosinophilic cytoplasm and small round nuclei w/large nucleoli; no mets; well-encapsulated
angiomyolipoma: well differentiated fat, smooth m., blood vessels in relation w/Tuberous Sclerosis
Mesoblastic nephroma: in infants, must be differentiated from Wilm's tumor

Malignant:
Renal Cell Carcinoma: smoking is biggest risk factor
hereditary = von Hippel-Lindau disease which also has hemangioblastomas of cerebellum and retina

Clear cell is most common type: renal vein involvement, abundant granular or clear cytoplasm from glycogen and lipids and well differentiated w/nuclear atypia
Manifestations: hypercalcemia from cytokine release by tumor (PTHlike substances)

Wilm's tumor: in kids from embryonal nephrogenic elements
4th MC malignancy, MC abdom malignancy, MC renal tumor
Manifestations: Unilateral Abdominal mass

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Renal Mnemonics

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Dialysis indications:
AEIOU = Acidosis, Electrolyte imbalance, Intoxication, Overload, Uremia
WAGMA DDx:
AMPLE SUDS = Alcohol, Methanol, Paraldehyde, Lactate, Ethylene glycol, Starvation, Uremia, DKA, Salicylates

NAGMA:
HARDUP = Hyperalimentation, Acetazolamide, RTA, Diarrhea, Uretersigmoidostomy/ureteroiliostomy, Pancreatic fistulae

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Acid/Base

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mixed metabolic disorders --> calculate deltagap: calculated AG - 12
then add starting bicarb
if >24 it's mixed alkalosis and acidosis metabolic
if <24 it's mixed nl and WAG metabolic acidoses

Urine AG:
if >0 it's a renal dysfxn
if <0 it's a GI dysfxn

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Genital Pathology

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Hypospadia = opening of urethra onto ventral surface; associated w/cryptochordism/abnl descent of testes
Epispadia = opening onto dorsal surface; less common

Tumors:
Benign:
Condyloma acuminatum = no evidence of invasion, BM intact
caused by HPV 6&11
koilocytosis pathognomonic
Giant condyloma (Buschke-Lowenstein tumor) = rare but resembles condyloma microscopically
invasive/recurrent and can destroy penis

Malignant:
Carcinoma in situ (caused by HPV serotypes):
1. Bowen's dz (called erythroplasia of Queyrat): MC form, gray white plaque w/shallow crusting ulcer on skin of shaft of penis
usually > 35y.o.
intact BM!
progression to invasive SCC ~10%
2. Bowenoid papulosis: sexually active young men
almost never invades and sometimes spontaneously regresses
3. Erythroplasia of Queyrat: one or more shiny red, raised velvety plaques

Squamous Cell Carcinoma:
Frequency - rare in US, highest rate in uncircumcised
Macroscopic - Papillary resemble condyloma acuminata; flat have thick epithelium w/graying & fissuring of mucosal surface
Pathology - locally invasive irregular mass; mets confined usually to regional nodes


Testis:
Cryptochordism - descent is under control by hormonal factors there is no hormonal disorder!
1. Transabdominal phase = Mullerian-Inhibiting substance dependent
2. Inguinoscrotal phase = Androgen dependent
In most cases the undescended testis is in the inguinal canal
Clinical: surgical before 2 y.o.; Orchiopexy doesn't guarantee fertility

Testicular tumors:
Clinical General features of Seminoma and NSGCT = painless enlargement of testis
neoplastic unless proven otherwise
Bx carries risk of tumor spillage
Standard mgmt = radical orchiectomy (but may be sensitive to chemo)
Histology of mets may be different from the testicular lesion (b/c germ cell tumors have the ability to differentiate!)

GCT = classic seminoma and yolk sac
1. Seminoma = MC germ cell tumor
not found before puberty
micro: clear cytoplasm from abundant glycogen
prog: sensitive to radiation (high survival w/this therapy)
2. Yolk sac (endodermal sinus tumor/infantile embryonal carcinoma) = MC GCT of infants

Sex Cord/stromal tumors = Leydig cell tumor
1. Leydig = interstitial cell tumors
hormonally active secreting androgens, estrogens, corticosteroids
80% benign
micro: Reinke crystals
prog: precocious puberty and feminization/gynecomastia in adults