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28 Cards in this Set
- Front
- Back
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lecture 38
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Renal Tumors
... -Adenoma (small incidental findings) -Oncocytoma (origin from intercalated cell of collecting duct) -Angiomyolipoma (persons w/ tuberous sclerosis often have these tumors) -Fibroma (rare!) (small white nodules located in medullary pyramids) ... -Renal cell carcinoma (common – adults) -Wilms tumor (childhood) -Urothelial cell carcinoma of renal pelvis |
Benign
Malignant |
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*Angiomyolipoma*
-Less than 1% of renal tumors -Usually adults -Benign neoplasm composed of ... walled blood vessels, smooth muscle and fat -Has characteristic radiologic appearance due to ... content (very distinct w/in tumor) -Present in 25-50% of patients with ... |
thick
fat tuberous sclerosis |
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*... *
AKA hypernephroma Most common renal tumor Peak age – 60y - M:F = 3:1 Incidence increasing world wide |
Renal Cell Carcinoma(RCC)
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*Renal Cell Carcinoma*
Etiology -Cells of ... tubule Risk factors are smoking, obesity, analgesic abuse, APCKD, genetics (VHL gene, familial cases) ... syndrome -Hemangioblastoma cerebellum retina -Bilateral renal cysts -... cell type RCC – common. |
proximal convoluted
Von Hippel-Lindau Clear |
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*RCC – Clinical Features*
-Classical triad (...) (<10% have all 3 sxs) -... (50%) most common symptom -Metastases-hematogenous and local abdominal -Paraneoplastic syndromes (... (hypercalcemia), Epo, amyloid) |
hematuria, flank pain, mass
Hematuria PTH |
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*RCC - Pathology*
... tumor (generally) -often hemorrhage, necrosis, calcification and cystic change causing ... appearance ... but may have satellite nodules May extend into ... Variants -... cell (70-80%) -Papillary (10-15%) -Chromophobe (5%) |
Yellow orange
variable Circumscribed renal vein Clear |
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This is the classic histologic appearance of a renal cell carcinoma: the neoplastic cells have ... cytoplasm and are arranged in nests with intervening .... This microscopic appearance is why they are often called "... carcinomas
slide 22 (lecture 38) |
clear
blood vessels clear cell |
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*RCC*
Treatment -... is the mainstay -Chemotherapy, Immunotherapy (used to slow progress, not too effective) Prognosis -5-yr. survival 40% -Poor prognosis with metastases |
Surgery
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*... *
AKA nephroblastoma Most common pediatric renal tumor Peak age – 2.5-3.5 yo, 80%<5 yo Etiology -Embryonic renal tissue (... blastema) -Genetic abnormalities on chromosome ... --> Wilms tumor associated syndromes *WAGR syndrome - Wilms, Aniridia, Genital anomalies, Mental Retardation *Beckwith-Wiedemann syndrome *Denys-Drash syndrome |
Wilms Tumor
metanephric 11 |
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*Wilms Tumor*
Clinical features -... abdominal mass -Abdominal ... -Fever -Anorexia -Nausea/vomiting -Hematuria -No specific clinical laboratory findings -Diagnosis by radiographic techniques |
Palpable
pain |
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*Wilms Tumor*
Gross -... solitary mass -Well-circumscribed -Soft, ..., gray-white surface with focal hemorrhage, cyst formation, and necrosis. Microscopic -Triphasic *spindled ... stroma *... component - poorly formed tubules, glomeruli *... - primitive small blue cells |
Large
bulging mesenchymal epithelial blastema |
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*Wilms Tumor*
Treatment -Prompt ... with ... ± radiotherapy Prognosis -5-yr. survival 80-90% overall -Children < 2 years ... prognosis -Metastases to lung, liver, bone, brain |
resection
chemotherapy better |
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*... * formally known as transitional cell carcinoma
-5-10% of adult primary renal tumors -Originate from urothelium of renal ... -Etiology: ... abuse, ... dye -Malignant cells in urine -Desquamated tissue may cause ... of ureters --> hydronephrosis -... due to fragmentation of tumor in renal pelvis - leads to rapid diagnosis |
Urothelial Carcinoma
pelvis Analgesic radiocontrast obstruction Hematuria |
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*Urothelial Carcinoma*
Treatment -... Prognosis -5 yr. survival is 50-70% for low grade superficial lesions (mild pleomorphism) -5 yr. survival is 10% for high grade infiltrating tumors (more pleomorphic) |
Surgery
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lecture 49
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Bladder carcinogens:
Cytostatics (Cyclophosphamide) aka cytoxin is a chemo drug that causes ... |
hemorrhagic cystitis
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*Urothelial Carcinoma*
Risk factors -...– most commonly associated risk factor and accounts for about 50% of cases -occupational exposure to naphthylamine and related compounds (rubber and dye industries) -long term use of analgesics (particularly ... – used commonly in past. sometimes used to cut cocaine) -exposure to ... --> hemorrhagic cystitis -exposure to radiation -... – in Egypt and Sudan (more often squamous cell carcinomas) -Chronic inflammation -Nitrosamines |
Smoking
phenacetin cyclophosphamide Schistosoma haemotobium |
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*Urothelial Carcinoma*
Clinical features -Typically present with ... (classic) -May also have frequency, urgency, dysuria, hydronpehrosis, pyelonephritis -Many patients have ... disease at presentation (makes tx difficult. needs long term followup) Diagnosis -Urine cytology -Imaging – IVP, CT -... and ... are the mainstays of diagnosis |
painless hematuria
multifocal Cystoscopy and biopsy |
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*... *
Risk factors -chronic cystitis with squamous metaplasia -bladder exstrophy -neurogenic bladder -bladder stones -chronic indwelling catheters -prolonged cyclophosphamide treatment -... infection (Egypt/Sudan) -associated with smoking |
Squamous Cell Carcinoma
Schistosoma haematobium |
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*Bladder Cancer Treatment*
Non-muscle invasive disease -... immunotherapy (causes inflammatory response that acts against the tumor) -Interferon ... -Intravesical ... -TURBT (... resection of bladder tumor) – if single focus Muscle invasive disease -... +/- adjuvant chemotherapy |
BCG
alpha chemotherapy transurethral Cystectomy |
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A 52-year-old man has noted passing darker urine for the past 3 weeks. On physical examination there are no abnormal findings. A urinalysis shows pH 6.0, specific gravity 1.011, 2+ blood, no protein, and no glucose. A urine cytology is performed and there are atypical urothelial cells seen. A urologist performs a cystoscopy, but no mucosal lesions are noted. He has a long history of analgesic abuse as well a 60 pack year history of smoking cigarettes. Which of the following is the most likely diagnosis?
1. Adenocarcinoma of prostate 2. Urothelial carcinoma of renal pelvis 3. Acute interstitial nephritis 4. Nodular glomerulosclerosis 5. Squamous cell carcinoma of penis |
2. Urothelial carcinoma of renal pelvis
The lack of findings in the bladder, but the presence of atypical cells, suggests that the lesion is located higher. |
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A 3-year-old child has become more irritable and had a decreased appetite over the past two months. On physical examination the pediatrician notes an enlarged abdomen and can palpate a mass on the right. An abdominal CT scan reveals a 9 cm solid mass involving the right kidney. The resected mass has a triphasic microscopic appearance with small blue cells, tubular structures, and a fibrous stroma. Which of the following neoplasms is most likely in this case?
1. Angiomyolipoma 2. Renal cell carcinoma 3. Urothelial carcinoma 4. Wilms tumor 5. Medullary fibroma |
4. Wilms tumor
This is the classic age, histopathology, and location for Wilms tumor. These neoplasms, when treated properly, have a very good prognosis |
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A 55-year-old man complains of dull flank pain for the past month. Laboratory studies show microscopic hematuria but no proteinuria or glucosuria. Urine cytology shows no atypical cells. A CBC shows WBC count 7800/microliter, Hgb 21.1 g/dL, Hct 63.5%, MCV 94 fL, and platelet count 195,000/microliter. His BUN is 17 mg/dL and creatinine 1.2 mg/dL. Which of the following radiographic findings is most likely to be present in this man?
1. Hydronephrosis on intravenous pyelogram 2. Renal mass on abdominal CT scan 3. Radiopaque ureteral calculus on an abdominal plain film 4. Enlarged, multicystic kidneys on abdominal ultrasound 5. Pelvic mass below the bladder on MR imaging |
2. Renal mass on abdominal CT scan
The polycythemia suggests a paraneoplastic syndrome, and a renal cell carcinoma is a likely candidate for the primary lesion. The flank pain and hematuria can be explained by a renal cell carcinoma. |
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A 59-year-old man notes blood in his urine for the past 2 weeks. A urinalysis confirms the presence of blood, but no proteinuria or glucosuria. A urine culture is negative. A cystoscopy is performed, and a 4 cm exophytic mass is seen in the bladder. A biopsy of this mass is performed and microscopic examination reveals fibrovascular cores covered by a thick layer of atypical urothelial cells. Which of the following risk factors is most likely to have led to development of this lesion?
1. Diabetes mellitus 2. Recurrent urinary tract infection 3. Therapy with methicillin 4. Cigarette smoking 5. Tuberous sclerosis |
4. Cigarette smoking
He has a urothelial carcinoma of the urinary bladder, and smokers are at increased risk for this cancer. These cancers can be multiple and recurrent. Additional less common risk factors include exposure to aniline dyes and to beta-naphthylamine compounds. Drugs that increase the risk include phenacetin and cyclophosphamide. |
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A A 41-year-old woman has an abdominal CT scan performed because of a family history of renal neoplasms and seizures. A 5 cm right upper renal mass is present that is solid but heterogenous. A partial nephrectomy is performed. Microscopically, the mass is composed of adipose tissue with admixtures of smooth muscle and thick-walled blood vessels. Which of the following abnormalities of the nervous system is most likely to be present in this woman?
1. Encephalocele 2. Berry aneurysm 3. Auditory nerve deafness 4. Vasculitis 5. Cerebral cortical tubers |
5. Cerebral cortical tubers
The tumor is an angiomyolipoma, which is a benign tumor. Most of them are sporadic, with no associated findings, but some of them occur in patients with tuberous sclerosis. |
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A 50-year-old man has been a 2 pack per day smoker for the past 30 years. He has had a recent episode of hematuria. He has no abnormal physical examination findings. A cystoscopy is performed, and a 3 cm irregular, exophytic mass is seen in the bladder. The mass is biopsied and reveals papillary fronds lined by a thickened layer of atypical urothelial cells. There are occasional mitoses. The tumor shows scattered areas of necrosis. The underlying muscularis is invaded by the tumor. Which of the following findings would necessitate surgical treatment for this patient?
1. Presence of papillary growth pattern 2. Thickness of the epithelium 3. Necrosis 4. Presence of mitoses 5. Muscular wall invasion |
5. Muscular wall invasion
Invasion into the bladder muscular wall is an indication for surgical therapy |
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A 65-year-old man has experienced lower back pain for 6 months. On physical examination there are no abnormal findings. A urinalysis shows microscopic hematuria. An abdominal CT scan reveals a 5 cm solid mass in the upper pole of the right kidney. A right nephrectomy is performed and the grossly variegated mass is seen microscopically to be composed of nests of cells with clear cytoplasm. Which of the following laboratory test findings likely to be associated with this tumor?
1. Hypercalcemia 2. Increased catecholamines 3. Positive serology for hepatitis B surface antigen 4. Hyponatremia 5. Hyperaldosteronemia |
1. Hypercalcemia
This paraneoplastic effect can occur with renal cell carcinomas. The hypercalcemia is most likely related to elaboration of parathormone-related peptide by the neoplasm. |
