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25 Cards in this Set
- Front
- Back
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Different types of benign tumours of the kidney
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- papillary adenoma
- fibroma - oncocytoma - angiomyolipoma |
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describe papillary adenoma (5)
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- small tumour < 0.5 cm in diameter
- non-encapsulated, in renal cortex - papillary growth pattern: arise within small cyst - small uniform epi. cells, granular cytoplasm, uniform round to oval nuclei - distinguished from RCC: mild cytologic appearance, low mitotic activity, lack nuclear pleomorphism, absence of local invision |
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describe medullary fibroma
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- small white nodules in medulla, lacking capsule
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describe oncocytoma (3)
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- tumor from intercalated cells in collecting duct
- oncocyte: large eosinophilic cells w. small, round, benign-appearing nuclei w. large nucleoli - tan, mahogany brown, rel. homogeneous, well encapsulated |
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describe angiomyolipoma (2)
Sx (1) Dx (2) |
- rare: made of BV, smooth, fat cells
- multiple, bilteral 就 tuberous sclerosis (autosomal dominant w. benign tumors in multiple organs: AML in kidney/liver, astrocytic tumour in brain, rhabdomyoma in heart) - Sx: renal mass, hematuria, retroperitoneal hemorrhage - Dx: CT (high fat contents), histology: (no capsule, BV ensheathed by SM cells, lobules of adipose cells) |
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RCC
- derived from (1) - Epi (2) |
- from lining of PCT
- <2% malignant tumors in adults - most common type of kidney cancer |
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predisposing factors to RCC (3)
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1. smoking
2. cadmium, asbestos 3. von Hippel-Lindau disease - rare, autosomal dominant - predispose RCC, cerebellar hemangioblastoma |
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Sx of RCC
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- Classic triad (10%): HAEMATURIA, LOIN PAIN, MASS
- paraneoplastic: Fever, polycythemia ∵↑EPO |
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Gross appearance of RCC (5)
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- irregularly lobulated, roughly spherical, >5 cm ø
- well delineated, not encapsulated, - from one pole of kidney - variegated appearance: yellow, orange, haemorrhagic areas - permeation into renal veins |
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TYPES of RCC (4)***
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1. Clear cell (70-80%)
2. Papillary (10-15%) 3. Chromophobe (5%) 4. CD carcinoma (rare) |
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Describe RCC features (4)
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- (sheets, solid alveoli, trabeculae)
- clear cytoplasm (lipid, glycogen) - VHL on chromosome 3p inactivated - hello sarcomatoid changes (5%): resembles fibrosarcoma/leiomyosarcoma and = dedifferentiation of RCC. Worsens prognosis |
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Precursor genetic lesions of renal cell carcinoma (3)
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- Clear cell: inactivation of VHL gene on chromosome 3p
- Papillary: trisomies 7, 16, 17 - Chromophobe: multiple chromosome loss |
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Spread of RCC (3)
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- hematogenous: Renal vein→lung, liver, bone
- lymphatic: regional LN - locally to adjacent organs |
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what is Nephroblastoma (Wilms' tumor)? (3)
(2 on genetics) (symptom (1)) |
- embryonic tumour w. metanephric blastema (mesodermal origin)
- cancer of children, 20% malignant childhood tumors - highest incidence 3 (rare beyond 7) - deletion/mutation on WT-1/WT-2 gene (chromo 11p) - transcription factor on metanephric tissue cap - abdominal mass ± haematuria, pain |
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Gross (2), and histology (6), of Wilm's tumour
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- large, fleshy, white
- focal necrosis, hemorrhage Cell types - undiff. round cell → solid clusters - sarcomatoid (like epi & mesen) spindle cells → mass - epithelial tubules (columnar epithelium) Growth patterns - tubular (epithelial tubules, various size) - glomeruloid - solid islands & sheets |
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Growth (3) and,Spread (3) of Wilms' tumour
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- tubular, glomeruloid, solid islands/sheets
- local, lymphatics, blood born to lungs/liver/brain |
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Tx of Wilms' tumour
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radiosensitive, tends to recur after resection
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Urothelial tumours: site (1) and origins (1)
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- arise from urothelium (transitional), tumors essentially SAME in all regions
- usually multicentric - most common: urinary bladder (less common: pelvis, ureter) |
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Sx of urothelial tumours
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painless gross haematuria
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Risk factors of urothelial tumours
(6) |
- occupational exposure of organic dyes (aniline, benzidine, rubber)
- smoking (2-naphthylamine) - analgesic (phenacetin) nephropathy - food additives (artificial sweeteners) - TCM: aristolochic acid - renal stones |
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describe benign papillary neoplasm (3)
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Papilloma:
- pedunculated tumor of fine papillae - covered by few layers of transitional cell Inverted papilloma (uncommon) - inverted growth pattern: closely packed, interconnected clumps of transitional cells in polypoid growths Papillary urothelial neoplasm, low malignant potential - non-invasive, 似 exophytic urothelial papilloma - ↑cellularity, exceed thickness of normal urothelium |
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Describe papillary urothelial carcinoma, low grade & high grade
- gross (3) - histology (3) - spread (2) |
- non-invasive (not beyond BM)
- analogous to villous adenoma of large intestine - larger than papilloma, less orderly - fibrovascular stalk not well maintained - when high grade; ↑cellularity, disturbed cellular polarity, nuclear pleomorphism - spread within UT by implantation - potential to local reccurence/progression to invasive carcinoma |
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Describe the main malignant tumor of the urinary tract (2)
- staging (2) - spread (4) |
Invasive urothelial carcinoma
- poorly differentiated, cytologically higher grades - PROMINENT CELLULAR PLEOMORPHISM [cohesive sheets, isolated clusters, strands, cords] Staging: - depth of invasion (T1: lamina propria, T2/T3: muscularis (detrusor) - tumour grading Spread: implantation, local invasion, lymphatic, blood |
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What 'Other tumours' are there for UT (4)
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- SCC
- adenocarcinoma (asso w. bladder exstrophy) - sarcoma: embryonal rhabdomyosarcoma - malignant lymphoma |
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How to detect genetic abnormalities in urothelial carcinoma, and mol. detection of tumour cells in urine?
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- screen urinary tumor or FU after resection
- low sensitivity for low grade urothelial Ca Bladder Cancer Kit - FISH: loss of 9p21, aneuploidy for chromo 3, 7, 17 (low grade→diploid, high grade→aneuploid) |
