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23 Cards in this Set

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renal cortical adenoma
from renal tubules

yellow, small < 0.5cm

usually benign

look like RCC
angiomyolipoma
see with tuberous sclerosis

harmatomas (benign neoplasms)

see increased blood vessels, smooth muscles, adipose

bleed easily
renal oncocytoma
from intercalated cells of collecting ducts

brown, well-encapsulated, has central scar

benign but can be very large need to remove
in adullts what is the most common primary renal malignancy
renal cell carcinoma
in children what is the most prevalent primary renal malignancy
wilms tumor - nephroblastoma
which is more treatable renal or bladder cancer
bladder cancer - is found earlier
renal cell carcinoma
adenocarcinoma of the kidney

see with smoking

triad: costovertebral pain, flank mass, hematuria

no oliguria

often invades the renal pelvis and the renal vein

paraneoplastic syndromes - hypercalcemia (secretion of PTH), polycythemia (erythropoietin)

4 types:
clear cell carcinoma
papillary carcinoma
chromophobe renal carcinoma
collecting (bellini) duct carcinoma
clear cell carcinoma
most common renal cell carcinoma

originates from proximal convoluted tubules

usually unifocal

often mutations in von hippal lindau gene
papillary carcinoma
2nd most common of renal cell carcinoma

originates from distal convoluted tubule

often multifocal

mutations in MET oncogene
chromophobe renal carcinoma
3rd most common renal cell carcinoma

origin: intercalating cells of collecting duct

multiple chromosome losses, extreme hypodiploid
renal cell carcinoma sites of metastasis
lungs, bones, LN, liver...

most likely will see metastases before renal symptoms
wilms tumor (nephroblastoma)
age 2-5 years

can be bilateral

soft and easy to hemorrhage

look for blastema (small, round, blue cell), epithelium from abortive tubules, spindle cells
kidney receives metastases from
lung, breast, colon...
urothelial (transitional cell) neoplasm
usually in bladder due to longer contact with carcinogens

due to smoking, analgesic abuse

"field effect" - multifocal neoplasms because carcinogens are contantly in contact with multiple parts of the epithelium

papillary tumors are usually benign (low malignant potential)

carcinoma in situ is highly anaplatic, flat tumor
papillary neoplasm morphology
urothelium with a fibrovascular stromal core

papilloma - normal urothelium

papillary carcinoma - anaplasia of the urothelium
invasive urothelial carcinoma
urothelial carcinoma in situ finally invasion of the mucularis propria (detrusor muscle)

bad prognosis
metastatic urothelial carcinoma
after muscle invasion will invade lymphaticics

--> pelvic LN

--> liver, lungs, bone marrow
which has a better prognosis urothelial carcinoma in the bladder or in the renal pelvis/ureter
bladder has best prognosis

easier to screen
squamous cell carcinoma of urothelial origin
due to chronic urothelial irritation, chronic infection -> squamous metaplasia -> squamous cell cancer

chronic irritation from staghorn calculi

often higher risk in places with schistosomiasis (will see liver problems as well)
adenocarcinoma of urothelial origin
see with urachal remnants, intestinal (glandular) metaplasia -> adenocarcinoma
mesenchymal tumors of bladder
benign - leiomyoma is most common benign mesenchymal neoplasm in bladder and ureter

malignant:
adults - leiomyoscaroma

children - embryonal rhabdomyosarcoma (ERMS) - aka sarcoma botryoides
secondary tumors of bladder
metastases is uncommon

usually direct extension from nearby organs - uterine cervix, prostate, rectum

or

lymphoma
most frequent cause of hematuria from a malignancy
urothelial carcinoma