Renal - Tumors Of Urinary Tract And Prostate

Front 1

Renal adenoma

-characteristics
-orgin

Back 1

--common incidental findings in kidneys, rarely diagnosed clinically

--arise from renal tubular epithelium

-diagnosis is restricted to low grade, papillary lesions < 5mm

Hint 1

pg 54

Front 2

Renal oncocytoma

-epidemiology

Back 2

--5% of kidney tumors in adults
--wide age range; 3:1 M:F
--majority are asymptomatic

Hint 2

pg 54

Front 3

Renal oncocytoma

-pathological features
-orgin

Back 3

GROSS:
--brown, circumscribed lesions
HISTO:
--composed of uniform cells with abundant granular pink cytoplasm (oncocytes) and a nuclues w/ or w/o prominent but small nucleus

--may arise from intercalated cells of collecting ducts

Hint 3

pg 54/55

Front 4

Renal cell carcinoma

-epidemiology

Back 4

--2:1 M:F ratio
--patients in their 50's and 60's
--increased risk with smoking and obesity in women
--clear cell type accounts for 70-80% of cases; then papillary at 15%

Hint 4

pg 55

Front 5

Renal cell carcinoma

-genetic mutation in clear cell

Back 5

3p deletion -- von Hippel Lundau gene

Hint 5

pg 55

Front 6

Renal cell carcinoma

-clinical features

Back 6

--hematuria
--flank pain
--mass
--constitutional -- weight loss; fever; HTN; night sweats; malaise

Hint 6

pg 55

Front 7

Renal cell carcinoma

-pathology (gross and micro)

Back 7

GROSS:
--large, solid to cystic, bright yellow tumors with variable amounts of hemorrhage and necrosis
MICRO:
--water-clear cells that form small solid nests with a sinusoidal vascular network

Hint 7

pg 55

Front 8

Renal cell carcinoma

-prognostic indicators

Back 8

--best predictor is stage
--nuclear grade is important
--chromophobe and papillary variants have better prognosis
--sarcomatoid is highly aggressive; fatal in 80%

Hint 8

pg 55/56

Front 9

Renal angiomyolipoma

-associated condition
-histologic characteristics

Back 9

--occurs in patients with tuberous sclerosis
--triphasic tumor histologically; thick walled vessels + smooth muscle + fat

Hint 9

pg 56

Front 10

Renal tumors in children

-most common tumor and its characterisitcs

Back 10

--Wilms tumor; triphasic tumor consisting of blastemal + mesenchymal + epithelial components

Hint 10

pg 56

Front 11

Urinary bladder tumor

-most common tumor

Back 11

--urothelial carcinoma

Hint 11

pg 57a

Front 12

Urothelial (transitional cell) carcinoma

-epidemiology
-classification (3 groups)

Back 12

--account for >90% of bladder cancers in North America
--smoking is most important risk factor
--most present with hematuria, can also have pain an irritative symptoms

1. papillary (70%)
2. non-papillary, invasive (10-15%)
3. non-papillary, non-invasive (carcinoma in situ)

Hint 12

pg 57a

Front 13

Papillary urothelial tumors --(TCC)

-classification (4)

Back 13

1. Urothelial papilloma (rare)
2. Papillary urothelial neoplasm of low malignant potential (PUNLMP)
3. Papillary urothelial carcinoma, low-grade
4. Papillary urothelial carcinoma, high-grade

Hint 13

pg 57b

Front 14

Papillary urothelial tumors --(TCC)

-microscopic pathology
-grading

Back 14

--central fibrovascular cores covered by urothelium
--tumors are graded by how much they resemble "normal" urothelium

Urothelial papilloma has fine papillary frond covered by essentially normal urothelium with no cytological or architectural atypia
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Papillary urothelial carcinoma, high-grade has bizarre cells with complete loss of normal architecture and frequent mitoses

Hint 14

pg 57b

Front 15

Papillary urothelial tumors --(TCC)

-tumor behavior

Back 15

--risk or recurrance and risk of progression increases as the tumor grade gets worse (papilloma --> papillary urothelial carcinoma, high grade)
--increased risk with larger tumors, larger # of tumors, higher grade and presence of associated abnormalities

Hint 15

pg 57b

Front 16

Carcinoma in situ (TCC)

-epidemiology
-symptoms

Back 16

--rare as a primary de novo tumor (0.3-3%); most often seen in association with invasive of high-grade papillary carcinoma

--high risk of progression to invasive disease

--characteristically have irritative bladder symptoms (frequency, urgency)

Hint 16

pg 58

Front 17

Carcinoma in situ (TCC)

-microscopic pathology
-behavior

Back 17

--there is partial or full thickness replacement of the urothelium by cytologically malignant cells
--cells tend to be discohesive so urine contains malignant cells
--de novo form has high progression rate to invasive disease
--when coexistent with papillary tumors, indicates increased risk for recurrance and progression

Hint 17

pg 58

Front 18

Non-papillary invasive (TCC)

-microscopic pathology

Back 18

--small nests or islands of malignant cells
--vast majority are high grade

Hint 18

pg 58

Front 19

Bladder cancer

-staging

Back 19

Ta: non-invasive, papillary tumor
Tis: non-invasive, flat tumor (cis)
T1: invasion of submucosa
T2: invasion of muscularis propria
T3: Invasion of perivesical tissue
T4: Invasion of adjacent structures (prostate, cervix, pelvic side wall)

Hint 19

pg 59

Front 20

Squamous cell carcinoma of the bladder

-epidemiology

Back 20

--rare in North America
--common where Schistomiasis is endemic (Egypt)

Hint 20

pg 59

Front 21

Primary adenocarcinoma of the bladder

-epidemiology
-orgin
-diagnosis

Back 21

--uncommon, 2% of invasive bladder cancers
--50% arise in the urachus, remainder in bladder
--diagnosis requires exclusion of orgin elsewhere

Hint 21

pg 59

Front 22

Most common bladder tumor in children

Back 22

--rhabdomyosarcoma; grow as gelatinous polypoid masses

--small blue cells histologically

Hint 22

pg 59

Front 23

Prostate cancer

-most common tumor

Back 23

--adenocarcinoma

Hint 23

pg 59

Front 24

Adenocarcinoma of the prostate

-presumed precursor lesion

Back 24

--prostatic intraepithelial neoplasia (PIN)

--proliferation of cytologically malignant cells within prostatic ducts

Hint 24

pg 60

Front 25

Adenocarcinoma of the prostate

-histology

Back 25

--small, uniform, round glands
--single layered epithelium
--cells have prominent nucleoli

Hint 25

pg 60

Front 26

Adenocarcinoma of the prostate

-predictors of tumor behavior
-cutoff score for bad prognosis

Back 26

--grading using the Gleason system
--adding the two most frequent patterns in the tumor to get a score
--prognosis takes a sharp dive with a gleason score >7

Hint 26

pg 61

Front 27

Prostate cancer

-staging criteria

Back 27

T1: Incidental cancer (not palpable, diagnosed after biopsy)
T2: Tumor confined to gland
T3: Tumor invades periprostatic fat or seminal vesicles
T4: Tumor invades adjacent structures (bladder, etc)

Hint 27

pg 61

Front 28

Prostate tumors

-urothelial carcinoma

Back 28

--can involve the prostate, most often in association with bladder cancer

Hint 28

pg 61

Front 29

Most common sarcoma of the prostate

Back 29

rhabdomyosarcoma, usually occurs in children

Hint 29

pg 61