Practical Pathology Pathology of

Urinray and Male Genital TractM.Asgari MD

Tehran University of Medical Sciences

H-Nejad Kidney Center

• Ａ　 45 year old man

• Presented with hematuria from 3 months ago

• No Dysuria or Frequency

• No pain

• Physical examination is normal

1. What is the most common cause of painless hematuria?

Urine Analysis

• Color yellow• Appearance clear• PH 5• SG 1.015• Protein Neg• Glucose Neg• Blood Pos (+)• Ketone Neg• Bilirubun Neg

• WBC 2-3 /hpf• RBC 8-10/hpf• Ep Cells 2-3

/hpf• Bacteria Neg• Crystals Neg• Casts Neg• Mucus Neg

• No dysmorphic RBCs were seen in his urinary sediment

Hematuria

• According to the American Urological Association, the presence of three or more red blood cells (RBCs) per high-powered field (HPF) in two of three urine samples is the generally accepted definition of hematuria.

Common Causes of Hematuria

Glomerular causes

• Familial causes• Fabry's disease• Hereditary nephritis (Alport's syndrome)• Nail-patella syndrome• Thin basement-membrane disease• Primary glomerulonephritis• Focal segmental glomerulonephritis• Goodpasture's disease• Henoch-Schönlein purpura• IgA nephropathy (Berger's disease)• Mesangioproliferative glomerulonephritis• Postinfectious glomerulonephritis• Rapidly progressive glomerulonephritis• Secondary glomerulonephritis• Hemolytic-uremic syndrome• Systemic lupus nephritis• Thrombotic thrombocytopenic purpura• Vasculitis

Renal causes

• Arteriovenous malformation• Hypercalciuria• Hyperuricosuria• Loin pain-hematuria

syndrome• Malignant hypertension• Medullary sponge kidney• Metabolic causes• Papillary necrosis• Polycystic kidney disease• Renal artery embolism• Renal vein thrombosis• Sickle cell disease or trait• Tubulointerstitial causes• Vascular cause

Common Causes of Hematuria

Urologic causes

• Benign prostatic hyperplasia• Cancer (kidney, ureteral, bladder,

prostate, and urethral)• Cystitis/pyelonephritis• Nephrolithiasis• Prostatitis• Schistosoma haematobium

infection• Tuberculosis• Other causes• Drugs (e.g., NSAIDs, heparin,

warfarin [Coumadin], cyclophosphamide [Cytoxan])

• Trauma (e.g., contact sports, running, Foley catheter)

Microscopic examination may detect:

• RBC casts

• Dysmorphic RBCs.

• What is Dysmorphic RBCs?

Urine Cytology

Cystoscopy

Bladder Biopsy

TUR-B

Cystectomy

• 63-year-old man

• was found to have microscopic hematuria on urinalysis.

• The remainder of the urinalysis was normal, as was the physical exam.

• The patient did not complain of any fever, weight loss, pain, malaise, weakness, or urinary tract symptoms.

• Laboratory results showed the following:– Electrolytes: normal 　– Hct57%Hb19 g/dL– BUN12 mg/dLCreatinine0.7 mg/dL– WBC7,450/mm3 with a normal differential– Urine cytology: negative

• Work-up for the hematuria was begun with:

• noninvasive imaging studies, which included a renal ultrasound examination and an intravenous pyelogram. A mass was seen in the left kidney with both imaging studies.

• A CT scan has been performed

• The patient underwent nephrectomy.    

Fuhrman Nuclear grading system

Primary Tumorstage

Graphic Representation Description

T1

•Tumour is confined to the kidney (i.e. no penetration through the capsule) and ≤7 cm in greatest dimension

T2

•Tumour is confined to the kidney (i.e. no penetration through the capsule) and is >7 cm in greatest dimension

T3a

•Tumour penetrates through the kidney capsule into the surrounding fat or the adrenal gland or renal sinud, but not through Gerota's fascia .

T3b orT3c

•Tumour extends into the renal vein or into the vena cava. -T3b indicates that the tumor thrombus does not extend above the level of the chest diaphragm. -T3c indicates that the tumor thrombus extends above the level of the chest diaphragm .

T4 •Tumour penetrates through Gerota's fascia .

AJCC 2002

• A 30 year old male presented with a 6 month history of painless enlargement of left testicle.

• Testicular ultrasound revealed a solid mass with increased vascularity suspicious for a neoplasm.

EMBRYONAL CARCINOMA

Seminoma

• A 63 year old man with frequent urination and interruption in the urinary stream

SEMINOMA

Benign Prostatic Hyperplasia

Adenocarcinoma of Prostate