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Patho Lab Trans -butch

Patho Lab Trans -butch

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Published by: 2012 on Mar 17, 2009
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Pathology Lab 2 part 2
OS 214 Excretory Module
Pathology DepartmentLab Exam & Exam 2
March 11, 2009 | WED
Page 1 of 6LEXI-ADI-GILLIAN-BUTCH
 
OUTLINEI. Gross Specimena.Renal Cell Carcinomab.Wilms Tumoc.Renal Dysplasiad.Chronic Pyelonephritise.Nephrolithiasisf.Kidney Hydronephrosisg.Benign Prostatic hyperplasiah.Transitional / urothelial cellcarcinomaII.Microscopic Specimena.Chronic protatitisb.NPHc.Prostatic adenocarcinomad.Papillary urothelial carcinomae.Chronic cystitis
GROSS SPECIMENA.Renal Cell Carcinoma
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May arise in any portion of the kidney
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Areas of ischemic, gray white necrosis; foci of hemorrhage or discoloration; areas of softening
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Has a tendency to involve the renal veinFigure 1. Renal Cell CarcinomaNotes:
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when given a gross specimen, you have todifferentiate benign from a malignant lesion.** malignant lesions: infiltrative, irregular border,areas of necrosis, areas of hemorrhage
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specimen: infiltrative, irregular/ill-defined border,necrotic areas (pale areas which can be foundeither in the outer or inner part of the lesion, for the gross specimen shown in the lab the outer border are areas of necrosis), areas ohemorrhage (dark areas)** the bigger the tumor, the bigger the area of necrosis
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should always be correlated with clinical features
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clear cell CA – most common type** the type of CA determines management andprognosis** the type of CA cannot be determined by justlooking at the gross specimen lesion
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during nephrectomy, blood vessel sample shouldalso be taken
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invasion of gerota’s facia – malignant lesionFigure 2. Due to gross yellow appearance, thedifferential for this case is a xantho-granulomatouspyelonephritis.Figure 3. Fungating mass, nodular in appearance,which has already invaded much of the normal kidneytissue.
 
Pathology Lab 2 part 2
OS 214 Excretory Module
Pathology DepartmentLab Exam & Exam 2
March 11, 2009 | WED
Page 2 of 6LEXI-ADI-GILLIAN-BUTCH
Figure 4. The tumor has already spread to theperirenal fat.B.Wilm’s Tumor 
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Large, solitary, well circumscribed mass
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On cut sections, tumor is soft, homogenous, andtan to gray with occasional foci of hemorrhage,cyst formation and necrosis
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On microscopic sections, classic triphasiccombination of blastemic stromal and epithelialcell typesFigure 5. Wilm’s Tumor Notes:
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common in children
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specimen: smooth, homogenous lesionoccupying the entire renal parenchyma, foci of hemorrhage (minimal areas of hemorrhage ascompared to the renal cell CA specimen) andcyst
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may be triphasic (classical type): composed of blastema, epithelial cells, stroma; biphasic; or anaplasticFigure 6. Nephroblastoma, Differential is aneuroblastoma, Triphasic: stromal, epithelial andblastemic components, which can only bedifferentiated under the microscope, Circumscribed,well-demarcated, usually chromosomal, Common inchildren<5C.Renal Dysplasia
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irregular shaped, multicystic
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cysts vary in size
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due to an abnormality in metanephricdifferentiationFigure 7. Renal DysplasiaNotes:
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congenital
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presence of islets of cartilage and immaturecollecting tubulesD.Chronic Pyelonephritis
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kidneys are irregular scarred
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coarse, discrete, corticomedullary scar overlyingin a dilated, blunted or deformed calyx
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kidneys are smaller than usual
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ureter is dilated and thickened, a findingconsistent with chronic vesicoureteral refluxFigure 8. Chronic PyelonephritisNotes:
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specimen: granular surface with scarring, smallkidney, blunting of calyx (hallmark), thickening of ureter wall due to reflux
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causes: recurrent UTI and chronic obstructivediseases
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thyroidization lumen filled with colloid-likematerial
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kidney becomes nonfunctional requiring dialysis if both kidneys are affected
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Figure 9. Inflammation is usually caused byascending infections due to
E. coli.
The cortico-medullary junction has been obliterated.E.Nephrolithiasis
 
Pathology Lab 2 part 2
OS 214 Excretory Module
Pathology DepartmentLab Exam & Exam 2
March 11, 2009 | WED
Page 3 of 6LEXI-ADI-GILLIAN-BUTCH
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favoured sites of formation are within the renalcalyces and pelvis, thus causing dilatation and if multiple, may thin out the renal parenchyma
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most stone (75%) are calcium containing(calcium oxalate, calcium phosphate); 15% areso-called triple stones (magnesium ammoniumphosphate).Figure 10. NephrolithiasisNotes:
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specimen: dilated calyx, atrophic renalparenchyma which is replaced with fat
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types of stone: (1) calcium, (2) triplephosphate/magnesium ammoniumphosphate/struvite stone
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treatment: laser to convert the stone into powder 
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type of necrosis: coagulative necrosis whereinthe original morphology is retained
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urinalysis: presence of blood (hematuria) andcrystals** renal cell CA may also present with hematuria** how to differentiate renal cell CA andnephrolithiasis? conduct urine cytology (lowsensitivity)** urine cytology: centrifuge urine sample → getthe sediments stain with hematoxylin eosin(H&E)
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ureterolithiasis – kidney is still intactF.Kidney Hydronephrosis
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enlargement may be slight or massive
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kidney transformed into a thin-walled cysticstructure
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striking parenchymal atrophy
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blunting of apices of the pyramidsFigure 11. Kidney HydronephrosisNotes:
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specimen: atrophy of parenchyma replaced withfatty tissue
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cause: chronic obstruction
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kidney may rupture from trauma which may leadto peritonitis since urine is detected as a foreignbody
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treatment: pathologic kidney is usually removedG.Benign Prostatic hyperplasia
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weighs between 60 to 100 grams; even up to 200or more
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may show a well defined bulge
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almost exclusively occurs in the inner aspect of the gland, in the transitional and periurethralzones
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Nodular enlargement may encroach the lateralwalls of the urethra to compress it into a slitlikeorifice
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Figure 12. BPHNotes:
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can weigh up to 200g
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usually occur in the older age group
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specimen: nodular lesion which may displace theurethra, dilated urethra may be due to obstructionbut usually the urethra is slit-like due toimpingementH.Transitional / urothelial cell carcinoma
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gross pattern vary: may be papillary to nodular or flat
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heterogenous gross appearance
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may fungating, necrotic or ulcerative that haveunmistakably invaded deeply

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