12 Pee cancer Flashcards
Renal cell carcinoma presentation
*Hematurria, Abdominal mass, Dull flank pain
- hematuria gross or microscopic
Polycythema in 5-10% 2/2 EPO production
Incidence of renal cancer
3-4% of cancer diagnoses and deaths
Renal tumors and prognosis
Almost all renal cell carcinomas involve chromosome 3!!
Clear cell-83%-second worst prognosis
Papillary 11% second best prog
Chromophobe 4% best
Collecting duct/medullary carcinoma 1%(worst)
Renal Oncocytoma (beign) 5-10% incidence- rare recurrence
Angiomyolipoma- Most frequent benign
Clear cell Carcinoma
- Central necrosis(worsened outcome)
- Tumor cells are clear are due to glycogen.
- some abnormal mitoses and prominant nucloli
Papillary renal carcinoma
- tumor cells surround fingerlike stromal core with macrophages
- Varied cell shape and prominant nucleoli
- better prognosis than clear cell cardcinoma
- Thicker papillae denote worse prognosis(type II)
Chromophobe carcinoma
- Halo around wrinkled nucleus
- usually binucleate
- near medulla
- rare mets
Collecting duct carcinoma
- irregular tumor aggregats
- inflammatory fibroblast deposits
- usually high grade with quick metastasis
Medullary carrcinoma
African or mediteranian descent
Sickle cel ltrait or disease
VERY HIGH STAGE- mean survival 3 months
- hypodense mass on CT
- indistinctt cell borders and mitoses
- necrosis
Acquired cystic disease associated renalcarcinoma
- 100X more common in dialysis patients with cysts
* Vaculated cytoplasm with oxalate crystals
Clear cell tubulopapillary
*ESRD associated
Papillary cores with cells with clear cytoplasm and luminal polarized nuclei.
Renal cell carcinoma prognosis and staging
50% 5 year survival
Renal vein or perinephric invasion drops 5 year survival to 15%
Staging
T1- 7 but still confined to kidney
T3a- extend into fat (through capsule
T3b- extending into renal vein
Renal cell carcinoma rading
Grade1: Tiny dot nuclei-no nucleoli
Grade2: slightly larger nuclei-inconspicuous nucleoli
Grade3: Can see nucleoli at low power
Grade 4: Bizarre cells
Oncocytoma
- Benign lesion that may look like cancer
- Stellate scarring within a yellow brown tumor
- edematous stroma- eosinophilic intercalated cells with large amount of cytoplasm
Cured by local excision
Angiomyoliposarcoma
- Vessels sm muscle and fat
- Most common benign renal tumor
- can cause hemorrhage
- premelanosomes -so stains positive with melanoma markers
Wilms Tumor
*peds tumor
* mesodermal derived tissues
-epithelial
-blastema
-Tubular
can be mimiced by congenital nephroblastoma (which is benign)
Bladder layers
Transitional epithelium 5-7 cell layers thick Lamina propria with vessels Musclaris layer Muscularis propria (detrussor) Adventitia with vessels
Non neoplastic bladder anomolies
Cystitis cystica/cystitisglandularis
Polypoid and papillary cysitis
Nephrogenic adenoma
Cystitis Glandularis/cystica
Glandular cells with mucin
Neutrophils
Polypoid and papillary cystitis
- Caused by FB in bladder- Stone, catheter etc.
- Submucosal edema
- Polypoid has larger lesions wider at top than base- more apt to mimic tumor.
LM: Urothelium, with stroma underneath containing blood vessels and inflammatory cells
Nephrogenic adenoma
Males 2:1
61% following GU surgery
Associated with chronic cystitis/longstanding infection
LM: Lots of tubules and many inflammatory cells in stroma
Bladder neoplasms
7th most common cancer in men 8 highest cause of death 3%death
3:1male to female bladder cancer
Bladder neoplasms types
Flat lesions (ulceration and redness) *Reactive->indeterrminate->dysplasia->Carcinoma in situ
Papillary lesions
*Papilloma ( fingerlike.5cm) -> papillary neoplasm/uncertain potential (1-2cm) ->Low grade uroepithelial cancer-> High-grade uroepithelial cancer.
TNM staging Bladder cancer
pTIS-pT1(incasive into lamina propria)- cancer has not invaded the muscularis propria(still in lamina propria)Treat with chemo
pT2A-PT4 Cystectomy is needed
pT3 is through fat
pT4 is into surrounding tissues
Urothelial papilloma
Minimally branching
Fibrovascular core
Normal uroepithelium surrounding
<50 YO.
Papillary urothelial neoplasm of low malignant potential
Thickened urothelium, still typical polarity
Urothelial carcinoma- low gradde
Thickened Urothelium with atypia and loss of polarity
No invasion
pT1a
Urothelial carcinoma high grade
Thickened urothelium Mass Atypia No organization of ccells Abnormal nucleii with large nucleoli Necrosis
Reporting after bladder tumor resection
- Invades into lamina propria?
- Did section take muscularis propria?
- Invasion of muscularis propria (pT1 vs pT2)
- Percent involved (% of specimin is tumor)
- Necrosis Y/N ?
Flat intraurothelial neoplasia
- Loss of polarity
- nuclear clustering
- large nuclei
- Nuclear pleiomorphism
- Increased chromatin granularity
- Scattered nucleoli
Normal uroepithelial traits
7 layers
nuclei vertical and perpendicular to BM
Umbrella cells on top
Reactive urthelium
Slightly enlarged nuclei
Good polarity
7 layers thick
Dysplastic urothelium
Enlarged nuclei Nuclei touching Polarity irregular (15%) will progress to cancer Still 5-7 layers
Urothelial CIS
Nuclei 6X larger than lymphocyte Mitoses present Nuclear atypia Polarity is jumbled relatively normal thickness Sometimes discohesive cells (60% develop cancer)
Upper urothelial cancers
Renal pelvis and ureter Usually stage pT2 or higher More aggressive with a thin wall ASSOCIATED WITH MISMATCH REPAIR- LYNCH cancer MSI markers
