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29 Cards in this Set

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Renal adenoma

-characteristics
-orgin
--common incidental findings in kidneys, rarely diagnosed clinically

--arise from renal tubular epithelium

-diagnosis is restricted to low grade, papillary lesions < 5mm
pg 54
Renal oncocytoma

-epidemiology
--5% of kidney tumors in adults
--wide age range; 3:1 M:F
--majority are asymptomatic
pg 54
Renal oncocytoma

-pathological features
-orgin
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
pg 54/55
Renal cell carcinoma

-epidemiology
--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%
pg 55
Renal cell carcinoma

-genetic mutation in clear cell
3p deletion -- von Hippel Lundau gene
pg 55
Renal cell carcinoma

-clinical features
--hematuria
--flank pain
--mass
--constitutional -- weight loss; fever; HTN; night sweats; malaise
pg 55
Renal cell carcinoma

-pathology (gross and micro)
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
pg 55
Renal cell carcinoma

-prognostic indicators
--best predictor is stage
--nuclear grade is important
--chromophobe and papillary variants have better prognosis
--sarcomatoid is highly aggressive; fatal in 80%
pg 55/56
Renal angiomyolipoma

-associated condition
-histologic characteristics
--occurs in patients with tuberous sclerosis
--triphasic tumor histologically; thick walled vessels + smooth muscle + fat
pg 56
Renal tumors in children

-most common tumor and its characterisitcs
--Wilms tumor; triphasic tumor consisting of blastemal + mesenchymal + epithelial components
pg 56
Urinary bladder tumor

-most common tumor
--urothelial carcinoma
pg 57a
Urothelial (transitional cell) carcinoma

-epidemiology
-classification (3 groups)
--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)
pg 57a
Papillary urothelial tumors --(TCC)

-classification (4)
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
pg 57b
Papillary urothelial tumors --(TCC)

-microscopic pathology
-grading
--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
|
|
Papillary urothelial carcinoma, high-grade has bizarre cells with complete loss of normal architecture and frequent mitoses
pg 57b
Papillary urothelial tumors --(TCC)

-tumor behavior
--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
pg 57b
Carcinoma in situ (TCC)

-epidemiology
-symptoms
--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)
pg 58
Carcinoma in situ (TCC)

-microscopic pathology
-behavior
--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
pg 58
Non-papillary invasive (TCC)

-microscopic pathology
--small nests or islands of malignant cells
--vast majority are high grade
pg 58
Bladder cancer

-staging
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)
pg 59
Squamous cell carcinoma of the bladder

-epidemiology
--rare in North America
--common where Schistomiasis is endemic (Egypt)
pg 59
Primary adenocarcinoma of the bladder

-epidemiology
-orgin
-diagnosis
--uncommon, 2% of invasive bladder cancers
--50% arise in the urachus, remainder in bladder
--diagnosis requires exclusion of orgin elsewhere
pg 59
Most common bladder tumor in children
--rhabdomyosarcoma; grow as gelatinous polypoid masses

--small blue cells histologically
pg 59
Prostate cancer

-most common tumor
--adenocarcinoma
pg 59
Adenocarcinoma of the prostate

-presumed precursor lesion
--prostatic intraepithelial neoplasia (PIN)

--proliferation of cytologically malignant cells within prostatic ducts
pg 60
Adenocarcinoma of the prostate

-histology
--small, uniform, round glands
--single layered epithelium
--cells have prominent nucleoli
pg 60
Adenocarcinoma of the prostate

-predictors of tumor behavior
-cutoff score for bad prognosis
--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
pg 61
Prostate cancer

-staging criteria
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)
pg 61
Prostate tumors

-urothelial carcinoma
--can involve the prostate, most often in association with bladder cancer
pg 61
Most common sarcoma of the prostate
rhabdomyosarcoma, usually occurs in children
pg 61