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Nonneoplastic Diseases of the Prostate

Embryology and Fetal-Prepubertal History The prostate is derived from the urogenital sinus. During the first 10 weeks of gestation, testosterone from the embryonic testes stimulates ingrowth of epithelial buds into urogenital sinus mesenchyme through a feedback loop. The mesenchyme induces the urogenital sinus epithelium to undergo ductal morphogenesis and differentiation in which the buds grow out into the surrounding mesenchyme and go through the processes of…

Urine Cytology

Introduction Examination of urine is one of the oldest medical tests, used by Samarians, Babylonians, Egyptians, Indians, and Greeks in their traditional medicine. It was not until after Papanicolaou and Marshall published the first article in 1945 that urine cytology was used to detect urothelial carcinoma. Subsequently, Koss, Melamed, and colleagues characterized urine cytology and histology in 1960. Numerous classification systems have been introduced, and those…

Neoplasms of the Urinary Bladder

Carcinoma of the urinary bladder is the fourth most common malignancy in men, accounting for an estimated 60,490 new cases and 12,240 cancer deaths in the United States in 2018. Significant progress has been made in the diagnosis and treatment of bladder cancer. Bladder cancer is morphologically heterogeneous; more than 90% of bladder cancer cases are urothelial (transitional cell) carcinoma, whereas primary squamous cell carcinoma, adenocarcinoma,…

Nonneoplastic Disorders of the Urinary Bladder

Embryology and Anatomy Embryology The common excretory ducts (the dilated segments of the mesonephric ducts distal to the ureteral buds) become absorbed into the urogenital sinus after the fourth week of gestation. Their epithelium merges toward the midline and forms a triangular patch that will become the trigone of the urinary bladder. The ends of the developing ureters implant there. The anterior abdominal wall closes with…

Fine Needle Aspiration of the Kidney

Introduction Fine needle aspiration (FNA) of the kidney is a useful technique for diagnosing a specific subset of renal lesions. Most renal lesions in adults are either benign cysts (based on their radiographic appearance) that can be left alone or are sufficiently worrisome that resection is indicated regardless of the results of FNA. It is estimated that only 10% to 30% of all renal masses are…

Renal Pelvis and Ureter

The renal pelvis and ureter are muscular conduits lined by urothelium that function to propel urine from the renal calyceal system to the urinary bladder. The ureter and renal pelvis are affected by developmental, reactive, and neoplastic disorders. The developmental disorders are a group of closely related entities that include abnormalities in ureteral number, ureteral location, and structure and function of pelvic and ureteral muscularis propria.…

Neoplasms of the Kidney

The first renal neoplasm was reported nearly 200 years ago. In 1953, about eight renal tumors were described in a well-known textbook on surgical pathology. As a consequence of the contributions of numerous investigators over many decades, the most recent World Health Organization (WHO) classification of renal neoplasms includes about 50 well-defined and distinctive renal tumors, as well as various miscellaneous and metastatic tumors. In addition,…

Nonneoplastic Diseases of the Kidney

“Study with me, then, a few things in the spirit of truth alone so we may establish the manner of Nature’s operation. For this essay which I plan, will shed light upon the structure of the kidney. Do not stop to question whether these ideas are new or old, but ask, more properly, whether they harmonize with Nature. I never reached my idea of the structure…

Central and peripheral nervous systems

Common Clinical Manifestations of Central and Peripheral Nervous System Disease Pathological basis of neurological signs and symptoms Sign or symptom Pathological basis Headache Intracranial cause Raised intracranial pressure Constriction and dilatation of intracranial vessels (migraine) Irritation or inflammation of meninges Extracranial cause Referred from paranasal sinuses, cervical or temporomandibular joints, teeth, ears, etc. Giant cell temporal arteritis Reflexes Exaggerated Impaired Upper motor neurone lesion Lower motor…

Osteoarticular and connective tissues

Open full size image Common Clinical Problems From Osteoarticular and Connective Tissue Disease Pathological basis of clinical signs and symptoms of bone, joint and connective tissue diseases Sign or symptom Pathological basis Bone disease Pain Stimulation of nerve endings in bone by: inflammation trauma (fracture) tumour pathological increased bone resorption (e.g. Paget disease) Fracture after trivial injury Bone weakening due to: congenital disorders of bone integrity…

Skin

Common Clinical Problems From Skin Disease Pathological basis of dermatological signs Clinical sign Pathological basis Scaling Parakeratosis Erythema Dilatation of skin vessels Blisters Separation of layers of the epidermis or epidermis from dermis Bruising Leakage of blood into dermis Pigmentation Increased activity of melanocytes Increased numbers of melanocytes Endogenous pigment, e.g. ochronosis Exogenous pigment, e.g. tattoo Plaques Increase in epidermal and dermal thickness with cells Macules…

Blood and bone marrow

Common Clinical Problems IN Blood and Bone Marrow Disease Pathological basis of haematological signs and symptoms Sign or symptom Pathological basis Tiredness, dyspnoea Reduced oxygen-carrying capacity of blood due to anaemia Mucosal pallor Anaemia Glossitis (sore mouth, smooth tongue) Mucosal effects of haematinic deficiency Spoon-shaped nails Due to iron deficiency Jaundice Bilirubin accumulation from haemolysis Abnormal tendency to infections Neutropenia, e.g. in leukaemia or aplastic anaemia…

Lymph nodes and extranodal lymphoid tissue, spleen and thymus

Common Clinical Problems Arising From Diseases of Lymph Nodes, Extranodal Lymphoid Tissues, Spleen and Thymus Pathological basis of signs and symptoms attributable to lymphoid, splenic or thymic disorders Sign or symptom Pathological basis Enlarged lymph nodes Hyperplasia of lymphoid components responding to infection or other antigenic stimulation (e.g. Epstein–Barr virus [EBV] in infectious mononucleosis) Granuloma formation in response to persistent antigens (e.g. tuberculosis, toxoplasmosis, sarcoidosis). Neoplastic…

Kidney diseases

Common Clinical Problems From Kidney Disease Pathological basis of renal symptoms and signs Symptom or sign Pathological basis Proteinuria Increased permeability of the glomerular capillary wall to macromolecules Reduced tubular reabsorption of filtered proteins Uraemia Renal failure: reduced glomerular filtration rate (GFR) Haematuria Glomerular injury (red cell casts on urine microscopy) Urinary tract tumours, stones or trauma Urinary casts Hyaline casts Formed in tubules as a…

Urinary and male genital tracts

Common Clinical Problems From Diseases of the Male Genitourinary Tract Pathological basis of clinical signs and symptoms in the male genitourinary tract Sign or symptom Pathological basis Abnormal micturition Dysuria (pain) Inflammation of the urethra, often accompanying a urinary tract infection Hesitation, poor stream and dribbling Obstructed urinary outflow, usually due to prostate gland enlargement Frequency Incomplete bladder emptying due to obstructed urinary outflow Urinary retention…

Female genital tract

Common Clinical Problems From Female Genital Tract Disease Pathological basis of signs and symptoms in the female genital tract Sign or symptom Pathological basis Vaginal bleeding In pregnancy Postcoital Postmenopausal Haemorrhage from placenta (e.g. placenta praevia), placental bed (e.g. miscarriage) or decidua (e.g. ectopic pregnancy) Haemorrhage from lesion on cervix (e.g. carcinoma) Haemorrhage from uterine lesion (e.g. polyp, carcinoma) Abnormal bleeding (timing or volume of loss)…

Breast

Common Clinical Problems From Breast Disease Pathological basis of breast signs and symptoms Sign or symptom Pathological basis Lump Diffuse Fibrosis, epithelial hyperplasia and cysts in fibrocystic change Discrete Neoplasm or solitary cyst Mobile Benign neoplasm (usually fibroadenoma) Tethered Invasive neoplasm (carcinoma) Skin features Oedema (peau d'orange) Impaired lymphatic drainage due to carcinoma Puckering and tethering Invasion of skin by carcinoma Erythema Increased blood flow due…

Endocrine system

Common Clinical Problems From Endocrine Disease Pathological basis of endocrine signs and symptoms Sign or symptom Pathological basis Signs or symptoms of hormone excess (hyperfunction) Endocrine gland hyperplasia caused by increased trophic stimulus to secretion Functioning neoplasm of endocrine gland Signs or symptoms of hormone deficiency (hypofunction) Endocrine gland atrophy due to loss of trophic stimulus to secretion Destruction of endocrine gland by inflammation, ischaemia or…

Liver, biliary system and pancreas

Common Clinical Problems From Liver and Biliary System Disease Pathological basis of hepatic signs and symptoms Sign or symptom Pathological basis Jaundice Haemolysis (increased formation of bilirubin), liver disease (impaired conjugation and/or excretion) or biliary obstruction Dark urine Conjugated hyperbilirubinaemia (water-soluble) due to failure of bile excretion Pale faeces Bile duct obstruction causing lack of bile pigments in faeces Spider naevi, Gynaecomastia Secondary to hyperoestrogenism, failure…

Alimentary system

Open full size image Common Clinical Problems From Alimentary System Disease Pathological basis of gastrointestinal signs and symptoms Sign or symptom Pathological basis Dysphagia (difficulty in swallowing) Impaired neuromuscular function (e.g. multiple sclerosis) Obstruction (intrinsic or extrinsic) Heartburn (indigestion) Oesophageal/gastric mucosal irritation, often with inflammation and ulceration Abdominal pain Visceral Peritoneal Spasm (colic) of muscular layer in gut wall Irritation or inflammation of peritoneum Diarrhoea Excessive…