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23 Cards in this Set
- Front
- Back
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http://o.quizlet.com/i/E1FKsAIZBUDRByANtIeVIg.jpg
Presentations of transitional cell carcinomas |
TCC can occur any where throughout the urinary tract, including the urethra, bladder, ureter, and renal pelvis.The most common location for TCC is the bladder, so that much of this discussion pertains to TCC involving the urinary bladder. Bladder tumors most commonly present with hematuria.The papillary lesions are usually easy to see by the urologist when he performs a cystoscopy.Many of the papillary lesions are cytologically low grade, they often recur but < 10% progress and become invasive.The flat noninvasive carcinomas, simply referred to as carcinoma in situ (CIS), are cytologically high grade lesions and are more likely to become invasive than the papillary lesions.The CIS lesions are also harder to spot on cystoscopy.The CIS lesions are reddened areas that may be a little granular appearing and somewhat thickened.On cystoscopy without a biopsy, they can easily be mistaken as merely areas of inflammation. CIS is therefore of more concern to urologists than the papillary lesions
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Grading of urothelial tumors
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Urothelial papilloma
PUNLMP papillary urothelial carcinoma, low grade papillary urothelial carcinoma, high grade Grading system for urothelial (transitional cell) tumors. Grading of urothelial tumors is important. < 10% of low grade tumors invade, whereas 80% of high grade tumors are invasive at the time of diagnosis. Low grade papillary lesions (papilloma, PUNLMP & papillary carcinoma, low grade) have a 98% 10-year survival rate, whereas high grade lesions have a 75% 10-year survival rate. WHO = World Health Organization ISUP = International Society of Urological Pathology |
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Staging of bladder carcinoma
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TNM staging for carcinoma of urinary bladder. Although grading is important for urothelial carcinomas, staging is still the best predictor of the patient's outlook. If the patient has no more than a T1 tumor, they can be treated conservatively. However, if they have a T2 (invasion into muscularis propria) or higher tumor, then they would usually be treated with a radical cystectomy. Once the tumor has invaded into the muscularis propria, there is a 30% 5-year mortality rate. http://o.quizlet.com/i/VwjWg5TEmkoRfAhSVdrQbQ.jpg
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Carcinoma in situ - flat urothelial carcinoma of bladder
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Carcinoma in situ (CIS), a.k.a. "flat urothelial carcinoma" of urinary bladder - low power. The yellow arrow is pointing to an area where the transitional epithelium is involved by CIS. CIS is often multifocal and can involve extensive areas of the bladder mucosa http://o.quizlet.com/i/S7EXDOMrcY89WZc8EGeOsA.jpg
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Carcinoma in situ of bladder
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Carcinoma in situ (CIS) of the urinary bladder - high power. These lesions are cytologically high grade and are much more likely to become invasive than a low grade papillary urothelial (transitional cell) carcinoma. Untreated, 50-75% of CIS cases will progress to invasion of the muscularis propria http://o.quizlet.com/i/VBHBctCZXlDWARYKff7Xjw.jpg
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urothelial papilloma
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The papillary fronds are lined by normal appearing transitional epithelium. Urothelial papillomas comprise only about 1% of bladder tumors. These lesions rarely recur or progress to a high grade lesion http://o.quizlet.com/i/0liBxkwvhRc00XmSfW-KwA.jpg
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PUNLMP
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Papillary urothelial neoplasm of low malignant potential (PUNLMP). The transitional epithelium lining the papillary structures is thicker than normal, but does not exhibit any cytologic atypia and only rare mitotic figures are noted. Urothelial neoplasms of low malignant potential may recur, but are only rarely associated with invasion. http://o.quizlet.com/i/OIkl0_zWjoQ8q5Yebwugzg.jpg
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Papillary urothelial carcinoma- LOW grade
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The transitional epithelium lining the papillae is thickened, and there is evidence of mild cytologic atypia, with scattered hyperchromatic nuclei and mild nuclear peomorphism. Ocassional mitotic figures are noted. These tumors may recur, but < 10% become invasive. http://o.quizlet.com/i/Ynis6iLhSSgvxb8MdkS5uQ.jpg
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Urothelial carcinoma of bladder - HIGH grade
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The yellow arrow is pointing at the tumor mass which is about 3cm in greatest diameter. The flat reddened areas (the purple arrow is pointing to one of these) are most probably areas involved by CIS. http://o.quizlet.com/i/0XwkCxUK3hICleenmoqBqw.jpg
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Urothelial carcinoma of bladder- high grade
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Invasive high grade urothelial carcinoma of urinary bladder, low power view. Judging from the thickness of the neoplastic transitional epithelium on the surface, this is most likely a papillary urothelial carcinoma, which has become invasive. The papillary fronds in this lesion have largely fused, so that the tumor has a more solid appearance. The yellow arrow is pointing to an area where the tumor has invaded into the lamina propria. http://o.quizlet.com/i/LFuKi8faTMUTEPuZh_JOfQ.jpg
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urothelial carcinoma of bladder, high grade
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Invasive high grade urothelial carcinoma, high power view. Note the nuclear pleomorphism and presence of nucleoli. The yellow arrow is pointing to a mitotic figure. Mitotic figures are frequently seen and are often atypical in invasive high grade urothelial carcinomas. http://o.quizlet.com/i/HnqPbVqJXLyjWKSDJmMyNw.jpg
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invasive squamous cell carcinoma of the bladder
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Invasive squamous cell carcinoma of the urinary bladder. Squamous cell carcinomas comprise about 3-7% of bladder cancers in the United States. They are, however, much more common in countries where urinary schistosomiasis is endemic, such as Egypt. Approximately 70% of patients with squamous cell carcinoma of the urinary bladder are dead within a year http://o.quizlet.com/i/OMj78ewOcCJvoV4_yMsbRg.jpg
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Positive urine cytology smear
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Positive urine cytology smear. Note the presence of cells with enlarged hyperchromatic nuclei, some of which have a very high n/c ratio (arrow is pointing to one of these cells). This patient was found to have a high grade urothelial (transitional cell) carcinoma of the urinary bladder. Urine cytology is helpful in diagnosing urothelial carcinoma of the bladder, as well as other sites in the urinary tract. Urine cytology is also very useful in following patients who have been treated for urothelial carcinoma of the bladder. http://o.quizlet.com/i/FdB3meY3fZnjYNBzTRSV-g.jpg
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urothelial carcinoma of the ureter
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The proximal portion of the ureter is dilated (hydroureter) and the tumor has caused obstruction of the ureter. http://o.quizlet.com/i/OOPwPoXTToUKuj25jTA6sQ.jpg
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Urothelial papillary carcinoma, low grade of the URETER
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Papillary urothelial carcinoma, low grade arising in the ureter. Urothelial carcinomas, regardless of where they arise within the urinary tract, histologically look the same and are therefore graded the same way http://o.quizlet.com/i/56aOLcvXnaoeYZImwtl1aQ.jpg
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Renal cell carcinoma
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Renal cell carcinomas arise from the epithelium of the renal tubules, and are therefore in effect adenocarcinomas. There are three major types of renal cell carcinoma: clear cell, papillary and chromophobe types. The major risk factor for renal cell carcinoma, as well as for transitional cell carcinoma, is a history of tobacco smoking, especially cigarettes. Renal cell carcinomas unfortunately often remain asymptomatic until late in their course. They therefore often have attained a large size, and have already given rise to metastases by the time they are diagnosed. The lungs are the most common site for metastases. Renal cell carcinomas are known as one of the great "mimics" in medicine, since they can secrete numerous different products resulting in a wide variety of paraneoplastic syndromes. http://o.quizlet.com/i/b7Usnfw6buTj6a-us8NdgA.jpg
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Renal cell carcinoma- clear cell type
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Renal cell carcinoma (RCC) - clear cell type. This is the most common type of renal cell carcinoma, comprising ~ 80% of renal cell carcinomas. The cytoplasm of these tumor cells contains abundant lipid and glycogen. In ~ 98% of these tumors, there is a deletion/loss of the Von Hippel-Lindau (VHL) gene on chromosome 3p. The VHL gene is a tumor suppressor gene. http://o.quizlet.com/i/vp5EKrTqL0JL65DveoK_Fw.jpg
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RCC- papillary type
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RCC - papillary type. The most common cytogenetic abnormalities in these tumors are trisomies 7,16 and 17, and loss of the Y chromosome in male patients. Trisomy 7 is the most common cytogenetic abnormality in the familial form. The trisomies in these tumors are the result of nondysjunction of homologous chromosomes occurring during mitosis. The gene for the familial form is the MET protooncogene on chromosome 7. The MET protooncogene encodes for a growth factor receptor. Somatic cells with trisomy 7 exhibit overexpression of the MET protooncogene due to a gene dosage effect. Patients with the familial form of papillary RCC, probably inherit a mutation in a protein, which then predisposes to the development of trisomy 7 during mitosis http://o.quizlet.com/i/cn4KS4SpLnYC7Kq9y-pYUw.jpg
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RCC - chromophobe type
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These tumors arise from the intercalated cells of the collecting ducts. They have a much better prognosis than the clear cell and papillary types. On cytogenetic examination, these tumors exhibit multiple chromosome losses resulting in marked hypodiploidy. http://o.quizlet.com/i/X0VLuUyCg7Itp7uWDR9bYw.jpg
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Urothelial cell carcinoma (transitional cell) of renal pelvis
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Urothelial carcinoma (transitional cell carcinoma) of the renal pelvis. 5 to 10% of kidney tumors arise within the renal pelvis. These tumors usually present with hematuria. Approximately 50% of patients with transitional cell carcinoma of the renal pelvis have had a preexisting or have a concomitant transitional cell carcinoma of the urinary bladder. There is an increased incidence of urothelial carcinomas of the renal pelvis and bladder in individuals with analgesic nephropathy. Infiltration of the wall of the pelvis and calyces is common, for this reason, the prognosis for these tumors is not good. The reported five-year survival rates vary from 50 - 100% for low grade noninvasive tumors to only 10% for high grade invasive tumors. http://o.quizlet.com/i/Np2Bs60CN_diWoI6aRH8nw.jpg
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Wilms tumor (nephroblastoma)
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Wilms Tumor (Nephroblastoma). Wilms tumors are the most common primary renal tumors in children. The tumors arise from undifferentiated embryonal cells derived from the metanephric blastema. Approximately 90% of Wilms tumors are sporadic. The sporadic tumors are usually solitary. On cut section, Wilms tumors are usually well-circumscribed and tan to gray in color with foci of hemorrhage and cyst formation, such as seen here. http://o.quizlet.com/i/CGrupAwGOm9xQcz3rwDimQ.jpg
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Multicentric wilms tumor
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-In this kidney removed from a young child, three distinct Wilms tumors are present. In patients with familial Wilms tumors, the tumors are often multicentric and/or bilateral. http://o.quizlet.com/i/kMOINcaqWKfDzXA3QeLyZA.jpg
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Wilms tumor-histo
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This histologic section is from a Wilms Tumor exhibiting the classic triphasic pattern. There are nests of small blue round cells (blastema) accompanied by a loose mesenchymal-like stroma. Occasional epithelial elements (in this case tubules) are also noted (arrow points to a tubule). Tumors having more epithelial elements and less blastema have a better prognosis. Epithelial elements such as tubules are indicative of some degree of differentiation, and are therefore associated with less aggressive behavior on the part of these tumors. Conversely, areas exhibiting anaplasia (large hyperchromatic pleomorphic nuclei, abnormal mitoses, etc.) are associated with a poor prognosis. http://o.quizlet.com/i/vxiW0jmLJuOF36bSXki4fA.jpg
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