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93 Cards in this Set
- Front
- Back
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What is the most important aspect of studying tumors for clinicians?
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Staging
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What are 2 other ways of studying tumors that are of more importance to the pathologist?
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-Histologic type
-Grading |
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What are the 2 broad categories of Kidney Tumors?
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-Benign
-Malignant |
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What are the 3 BENIGN kidney tumors?
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RAO
-Renal papillary adenoma -Angiomyolipoma -Oncocytoma |
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What are 2 subcategories of Malignant Kidney tumors?
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-Renal cell carcinomas
-Urothelial tumors of the Renal Pelvis |
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What are 4 subclasses of Renal cell Carcinoma?
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-Clear cell
-Papillary -Chromophobe -Collecting duct |
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How are Renal Papillary adenomas different from Papillary type carcinomas?
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Just their size - less than 3cm
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What is the gross appearance and color of papillary adenomas or carcinomas?
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-Well circumscribed
-Yellow-gray |
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What does >3cm size in a papillary adenoma indicate?
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Metastatic potential - malignancy
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How are Renal papillary adenomas treated clinically?
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Just like papillary carcinomas - as early cancer; resect it.
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What are the 3 components of Angiomyolipomas?
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-Blood vessels
-Smooth muscle -Fat |
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What condition are angiomyolipomas found in, and what % of these patients?
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20-50% of patients with Tuberous Sclerosis
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What is Tuberous sclerosis?
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Tumors in the Cerebral cortex
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So what are 4 symptoms of Tuberous sclerosis?
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-Skin tubors
-Epilepsy -Angiomyolipomas -Mental retardation |
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How are Oncocytomas treated?
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With just partial nephrectomy instead of complete.
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Why are Oncocytomas just treated with partial nephrectomy?
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Because metastases are RARE
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What color are Oncocytomas?
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Tan or mahogany brown
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What do the cells that make up OncOcytOmas look like?
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Large and round with large nucleOli
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Why are Oncocytomas BROWN, and why do their large cells have granular cytoplasm on lite microscopy?
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Because of numerous mitochondria
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How can the mitochondria be best seen?
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With EM
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What % of all visceral cancers are malignant renal tumors?
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1-3%
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What type of malignancy are 85% of all renal malignant tumors?
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Renal cell carcinomas
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What is the other 15%?
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Urothelial carcinoma of the renal pelvis
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What is the predominant age at which renal cancer is seen and what is the M:F ratio?
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-60-70's
-2-3:1 - more in males |
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What are 7 risk factors for renal malignancy?
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HOSECUT
-Hypertension -Obesity esp in women -Smoking -Exposure to carcinogens -CRF and Acquired cystic dis -Unopposed estrogen therapy -Tuberous sclerosis |
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What is acquired cystic disease really?
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The cysts that develop for no known reason after hemodialysis in ESRD
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So what 3 renal diseases can lead into renal malignancy?
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-Chronic renal failure
-Acquired cystic ESRD -Tuberous sclerosis |
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What are the 2 genes to remember with Kidney tumors?
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-Von hippel lindau
-MET protooncogene |
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What chromosome is VHL on? How does it lead to cancer?
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3p - normally a tumor suppressor; when LOST leads to cancer
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What chromosome is the MET protooncogene on? How does it lead to cancer?
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Ch' 7 - it is a protooncogene that gets ACTIVATED to cause cancer.
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When the Von hippel lindau gene on Ch' 3p is lost what types of cancer develop?
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Sporadic and Familial CLEAR CELL RCC
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When the MET protooncogene on Ch' 7 is activated, what types of cancer develop?
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Sporadic and familial PAPILLARY RCC
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What is the general gross appearance of most renal cell carcinomas? Where are they located most commonly?
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-Well circumscribed masses
-In UPPER pole |
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What color are Renal cell carcinomas? Why?
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Yellow - lipid
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What is a common progression in development of Papillary carcinomas?
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1. ESRD on dialysis
2. Acquire Cysts 3. Cysts -> papillary adenomas 4. Papillary adenomas turn into Papillary carcinomas |
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What are the 2 main differences between RCC and Urothelial type carcinomas?
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RCC = yellow and in cortex
Uro = tan/brown and in medulla or renal pelvis |
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What is the architecture of the RCC's of CLEAR CELL type?
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Solid to trabecular to tubular
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What is the architecture of the RCC's of PAPILLARY type?
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Papillary fronds with foam cells within their cores
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What is a prominent finding in
-Clear cell RCC -Papillary RCC |
Clear cell = VASCULATURE
Papillary = Psammoma bodies |
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What are the cytoplasms of cells like in both RCC of clear cell and papillary types?
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Abundant and clear to Granular
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What gives the granular appearance of the cells?
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Abundant mitochondria
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What is the architecture of Chromophobe type RCC? What do the cells look like?
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Solid sheets of cells - have HPV effect of perinuclear halo and pale eosinophilia
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What is the architecture of Collecting Duct type RCC?
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Irregular channels of cells
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What do the cells look like and what do they do in CD type RCC?
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-Very atypical
-Hobnail |
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What is Hobnailling?
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Protruding into the lumen space
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What does Sarcomatoid de-differentiation in any histologic type of RCC do?
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Worsens prognosis a lot
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What is Sarcomatoid de-differentiation?
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The appearance of spindle cells
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What is the CLASSIC triad of clinical features of RCC?
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-CVA pain
-Palpable mass -Hematuria |
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What % of cases GET this classic triad of CVA pain, palpable mass, and hematuria?
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Only 10%
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What is the most COMMON symptom of renal malignancy?
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Hematuria
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What 2 features of the hematuria of malignancy help differentiate it from nephritic syndrome?
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-Microscopic (not gross)
-Intermittent |
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So what is HPVeffect seen in?
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Chromophobe type RCC
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What are renal cell carcinomas very prone to give rise to?
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Paraneoplastic syndromes!
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What is a common paraneoplastic syndrome RCC can cause? Why?
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Polycythemia - due to EPO
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What structure in the kidney do RCC's have a HIGH propensity to involve?
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The renal VEIN!
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What does the involvement of the renal vein allow for renal cell carcinoa to do?
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Metastasize widely and to often ODD sites
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What are the 2 most common sites for renal malignancy to metastasize to?
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-Lungs
-Bone |
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What are 3 treatments for kidney tumors?
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-Nephrectomy
-Partial nephrectomy -Cryoablation |
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What % of renal malignancies are Urothelial carcinomas of the Renal Pelvis?
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Only 5-10%
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What are Urothelial carcinomas similar to?
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Those of the urinary tract and bladder.
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What % of Urothelial carcinomas (UC) of the renal pelvis have concomitant or pre-existing BLADDER UC?
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50%
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What drug abuse is UC associated with?
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Analgesic abuse
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How does the size/location of UC compare to RCC?
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-UC is usually smaller and in the pelvis or calyces.
-RCC is larger and in the cortex |
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Why do urothelial cancers tend to present EARLIER?
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Bc they can break off and cause hematuria - with or without pain.
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How does the prognosis of urothelial cancers compare to RCC? Why?
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Worse - because they can become highly invasive.
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What is the 5-yr survival for low grade, superficial UC?
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50-70%
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What is the 5-yr survival for high grade invasive UC?
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Only 10% :(
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What are the 2 types of Urinary BLADDER and Ur. TRACT tumors, based on origin?
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95% - Epithelial origin
5% - Mesenchymal origin |
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What are 4 types of epithelial tumors of the Ur. Bladder and Tract?
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-SCC
-Adenocarcinoma -Small cell -Mixed |
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What are 2 types of mesenchymal tumors?
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-Leiomyomas
-Sarcomas |
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What Sarcoma would be seen in Adults with urinary bladder or ur. tract sarcoma?
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Leiomyosarcoma - smooth muscle
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What Sarcoma would be seen in Children with urinary bladder or ur. tract sarcoma?
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Rhabdomyosarcoma - skeletal mm
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What are the 2 main features to be concerned with in looking at tumors of the Ur. Bladder and Tract?
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-Papillary vs Flat
-Invasive or Not |
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What is Papillary?
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Protruding out
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What is easier to detect on microscopic exam? Why?
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Flat lesions - Papillary tumors may just be artifact.
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How would Papillary tumors be detected best?
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By cystoscopic examination
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How many cellular layers are normal in urothelium?
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Up to 7
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What are the 4 grades of Urothelial tumors?
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1. Urothelial papilloma
2. Urothel neoplasm of LMP 3. Papillary UC low grade 4. Papillary UC high grade |
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What feature is seen in just Urothelial papilloma?
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Increased cellular layers >7
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What feature is seen in just PUNLMP (papillary urothelial neoplasm of LMP)?
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Even more cells but no atypia
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What 2 features are characteristic of Low grade UC in the urinary bladder/tract?
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-Minimal but DEFINITE nuclear atypia
-A few mitotic figures |
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What makes High grade UC distinct?
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-FRANK nuclear atypia
-Many mitotic figures |
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What happens to the architecture in high grade UC?
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-Disarray
-Loss of polarity |
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What is the next step in cancer progression after high grade urothelial carcinoma?
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Carcinoma in situ
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What is CIS always?
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-Flat
-Hyperchromatic |
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What infection is SCC of the urinary bladder/tract associated with?
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Schistosoma haematobium
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What embryonic remnant is prone to developing Adenocarcinoma of the urinary bladder/tract?
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Urachus
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What type of lesion is Adenocarcinoma of the urachus typically?
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A wall lesion that grows OUT from the serosa; not the mucosa.
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What is Cystitis cystica et glandularis?
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Cystic Outpouchings of urothelium that often contain mucin-producing cells.
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What are 2 things that Cystitis cystica et glandularis is commonly caused by?
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-Transurethral resection to remove urinary tract tumors
-Post-BGC granulomatous |
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What will be seen in cystitis cystica et glandularis following transurethral resection of urinary tract tumors? on histology?
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Spindle cell nodules
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What will be seen in Post-BGC granulomatous cystitis?
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Granulomas just like you would see anywhere else.
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Is the postop spindle cell nodule in cystitis cystica et glandularis a neoplasm?
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No - it is a reactive formation following the TRAUMA of transurethral resection.
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