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44 Cards in this Set
- Front
- Back
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Embryonal renal neoplasms
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Nephroblastoma
Congenital mesoblastic nephroma Solitary multilocular cyst |
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Renal cell carcinoma epidemiology
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1-3% of adult malignancies
>85% of kidney malignancies M 2 > 1 F Peaks incidence in 60s |
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Risk factors for RCC?
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Urban environment
Tobacco Chemical agents |
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Old school presentation of renal cell carcinoma
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Hematuria
Pain Flank mass Now only 15% of presentations Many are found incidentally |
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Systemic signs possible in RCC
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Anemia
Fever Hepatic dysfnc Amyloidosis |
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RCC paraneoplastic syndromes
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polycythemia - epo
hypercalcemia - PTHRP HTN - renin Cushings - ACTH-like |
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Gross pathology of RCC
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Mostly unilateral
Anywhere in renal parenchyma Symptoms related to size If symptomatic Avg is 5-8 cm 40% through capusule 35% in renal vein 40% with distant mets Variegated appearance Yellow to gray Hemorrhage |
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Clear cell RCC
Histology |
Majority of RCC
Fine but abundant capillary network Clear from vacuoles full of neutral lipids and glycogen |
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Sarcomatoid differentiation in RCC
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Cells are elongated
Spindle like Poor prognostic |
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Staging RCC
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I - contained in capsule
II - perinephric fat III - into renal vein, IVC, regional nodes IV - adjacent organs or distant mets |
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Natural history of RCC
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Unpredictable
May be slow or rapid growing Periods of quiescence Rare spontaneous regression Oligometastatic disease my be curable |
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Metastatic locations for RCC
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Lung - 50%
Bone -30% LNs Liver Adrenal Brain |
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Renal adenomas
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Same histology as RCC
Just < 2-3 cms Less likely to be malignant |
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Nephroblastoma epi
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AKA Wilms
Rare tumor 50% in < 3 years old 90% in < 10 years Male = female Associated with sporadic aniridia, hemihypertrophy, others |
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Gross pathology of neprhoblastoma
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Large
Pseudoencapsulated Encephaloid -- looks like brain |
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Histology of nephroblastoma
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Three types of cells
Stroma Epithelium (tubules/glomeruli) Blastema cells - primitive cells |
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Nephroblastoma pathogenesis
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Persistent remains of metaneprhic blastema
These multipotent nests of cells in fetal kidney usually disappear by 4-5 months gestation |
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Treating nephroblastoma
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Surgery
XRT Chemo - vincristine, daptomycin |
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Prognostics for nephroblastoma
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All have a good prognosis ~90% cure in all comers
Poor prognostics: Older pt Higher stage within stg 1--anaplastic histo |
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Anaplasia in RCC
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Defines a pop of cells likely to be resistant
Multipolar mitotic features Big nuclei |
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Urothelial tumors
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Arising from epi anywhere along the tract
Similar histo/staging/prognosis |
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Multicentricity of urothelial tumors
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More than one focus of tumor concurrently
Field change of dysplasia Important for surgical decisions |
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Bladder cancer
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Presents as hematuria, pain, frequency, dysuria
M 5 > 1 W 60-80 year olds Diagnose w/ cytology or cystoscopy |
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Risk factors for developing bladder ca
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Smoking
Aromatic amines (dye industry) Beta-naphthylamine 4-Aminobiphenyl Chlornaphazine Suspected: Shistosomiasis, stones, arsenic |
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Structures of urothelial lesions
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Papillary - majority
In situ (flat) Either can invade, but in situ does more frequently |
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Histology of low grade papillary urothelial carcinoma
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Fine, delicate, non-fused papillary fronds with uroepithelium
Relatively evenly spaced tumor cells |
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Histology of high grade papillary urothelial carcinoma
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Papillary fronds are bulky and overlapping
Tumor cells are dark, enlarged, disordered in maturation |
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Bladder cancer prognosis
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Stage (duh)
but also correlates well with tumor grade |
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Treating bladder cancer
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Topicals - BCG, thiotepa, mitomycin C
XRT Surgery - transuretheral or radical cystectomy (includes urethrectomy, distal ureterectomy) with conduit Chemo |
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How often are ureter/urethra involved in bladder cancer
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15% of time for each
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Upper tract urothelial cancers
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1/4 as prevalent as RCC
60s-70s, M 5 > 1 F Hematuria Nephrouterectomy with bladder cuff rxn |
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What malformation coexists with polycystic kidneys?
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Liver cysts (33%)
Berry aneurysms (15%) |
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What's associated with juvenile polycystic kidneys?
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Congenital hepatic fibrosis
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Horseshoe kidney
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Failure to to separate poles of kidney
Leads to a failure to rotate into normal position hilum lies anteriorly |
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Medullary sponge kidney
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Cysts at tips of papillae
Pretty benign |
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Dysplastic kidney histology
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Scattered cysts
Disorganized parenchyma Cartilage common |
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Medullary cystic kidney disease
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Dysplastic kidney disease
Cysts confined to medulla |
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Dominant vs recessive PKD on pathology
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Dominant - big, bulging cysts
Juvenile - cyst filled kidney, more internal, enlongated, linear pattern |
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Most common presentation of renal dysplasia
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Cystic kidney in kid
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Renal adenomcarcinoma aka
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Renal cell carcinoma
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5 year prognosis in RCC?
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50%
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Presentation of nephroblastoma
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Abdominal mass in child
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Uremic medullary cystic kidney disease
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Rare
Adolescents and young adults Cysts at cortiocomedullary jct Severe uremia |
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Developmental things that can go wrong with the ureteric bud
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Failure to develop - agenesis
Abl position of wolffian - ureterocele, diverticula, ectopic ureter Splitting - bifid, duplex ureters Excessive absorption into bladder - increased reflux |
