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29 Cards in this Set
- Front
- Back
- 3rd side (hint)
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
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Renal oncocytoma
-epidemiology |
--5% of kidney tumors in adults
--wide age range; 3:1 M:F --majority are asymptomatic |
pg 54
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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
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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
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Renal cell carcinoma
-genetic mutation in clear cell |
3p deletion -- von Hippel Lundau gene
|
pg 55
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Renal cell carcinoma
-clinical features |
--hematuria
--flank pain --mass --constitutional -- weight loss; fever; HTN; night sweats; malaise |
pg 55
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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
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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
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Renal angiomyolipoma
-associated condition -histologic characteristics |
--occurs in patients with tuberous sclerosis
--triphasic tumor histologically; thick walled vessels + smooth muscle + fat |
pg 56
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Renal tumors in children
-most common tumor and its characterisitcs |
--Wilms tumor; triphasic tumor consisting of blastemal + mesenchymal + epithelial components
|
pg 56
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Urinary bladder tumor
-most common tumor |
--urothelial carcinoma
|
pg 57a
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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
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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
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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
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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
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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
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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
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Non-papillary invasive (TCC)
-microscopic pathology |
--small nests or islands of malignant cells
--vast majority are high grade |
pg 58
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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
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Squamous cell carcinoma of the bladder
-epidemiology |
--rare in North America
--common where Schistomiasis is endemic (Egypt) |
pg 59
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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
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Most common bladder tumor in children
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--rhabdomyosarcoma; grow as gelatinous polypoid masses
--small blue cells histologically |
pg 59
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Prostate cancer
-most common tumor |
--adenocarcinoma
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pg 59
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Adenocarcinoma of the prostate
-presumed precursor lesion |
--prostatic intraepithelial neoplasia (PIN)
--proliferation of cytologically malignant cells within prostatic ducts |
pg 60
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Adenocarcinoma of the prostate
-histology |
--small, uniform, round glands
--single layered epithelium --cells have prominent nucleoli |
pg 60
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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
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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
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Prostate tumors
-urothelial carcinoma |
--can involve the prostate, most often in association with bladder cancer
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pg 61
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Most common sarcoma of the prostate
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rhabdomyosarcoma, usually occurs in children
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pg 61
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