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01 Renal Respiratory > 12 Pee cancer > Flashcards

12 Pee cancer Flashcards

0
Q

Renal cell carcinoma presentation

A

*Hematurria, Abdominal mass, Dull flank pain
- hematuria gross or microscopic
Polycythema in 5-10% 2/2 EPO production

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1
Q

Incidence of renal cancer

A

3-4% of cancer diagnoses and deaths

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2
Q

Renal tumors and prognosis

A

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

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3
Q

Clear cell Carcinoma

A
  • Central necrosis(worsened outcome)
  • Tumor cells are clear are due to glycogen.
  • some abnormal mitoses and prominant nucloli
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4
Q

Papillary renal carcinoma

A
  • 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)
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5
Q

Chromophobe carcinoma

A
  • Halo around wrinkled nucleus
  • usually binucleate
  • near medulla
  • rare mets
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6
Q

Collecting duct carcinoma

A
  • irregular tumor aggregats
  • inflammatory fibroblast deposits
  • usually high grade with quick metastasis
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7
Q

Medullary carrcinoma

A

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
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8
Q

Acquired cystic disease associated renalcarcinoma

A
  • 100X more common in dialysis patients with cysts

* Vaculated cytoplasm with oxalate crystals

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9
Q

Clear cell tubulopapillary

A

*ESRD associated

Papillary cores with cells with clear cytoplasm and luminal polarized nuclei.

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10
Q

Renal cell carcinoma prognosis and staging

A

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

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11
Q

Renal cell carcinoma rading

A

Grade1: Tiny dot nuclei-no nucleoli
Grade2: slightly larger nuclei-inconspicuous nucleoli
Grade3: Can see nucleoli at low power
Grade 4: Bizarre cells

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12
Q

Oncocytoma

A
  • 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

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13
Q

Angiomyoliposarcoma

A
  • Vessels sm muscle and fat
  • Most common benign renal tumor
  • can cause hemorrhage
  • premelanosomes -so stains positive with melanoma markers
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14
Q

Wilms Tumor

A

*peds tumor
* mesodermal derived tissues
-epithelial
-blastema
-Tubular
can be mimiced by congenital nephroblastoma (which is benign)

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15
Q

Bladder layers

A 
Transitional epithelium 5-7 cell layers thick
Lamina propria with vessels
Musclaris layer
Muscularis propria (detrussor)
Adventitia with vessels
16
Q

Non neoplastic bladder anomolies

A

Cystitis cystica/cystitisglandularis
Polypoid and papillary cysitis
Nephrogenic adenoma

17
Q

Cystitis Glandularis/cystica

A

Glandular cells with mucin

Neutrophils

18
Q

Polypoid and papillary cystitis

A
  • 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

19
Q

Nephrogenic adenoma

A

Males 2:1
61% following GU surgery
Associated with chronic cystitis/longstanding infection

LM: Lots of tubules and many inflammatory cells in stroma

20
Q

Bladder neoplasms

A

7th most common cancer in men 8 highest cause of death 3%death
3:1male to female bladder cancer

21
Q

Bladder neoplasms types

A 
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.

22
Q

TNM staging Bladder cancer

A

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

23
Q

Urothelial papilloma

A

Minimally branching
Fibrovascular core
Normal uroepithelium surrounding
<50 YO.

24
Q

Papillary urothelial neoplasm of low malignant potential

A

Thickened urothelium, still typical polarity

25
Q

Urothelial carcinoma- low gradde

A

Thickened Urothelium with atypia and loss of polarity
No invasion
pT1a

26
Q

Urothelial carcinoma high grade

A 
Thickened urothelium
Mass Atypia
No organization of ccells
Abnormal nucleii with large nucleoli
Necrosis
27
Q

Reporting after bladder tumor resection

A
  • 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 ?
28
Q

Flat intraurothelial neoplasia

A
  • Loss of polarity
  • nuclear clustering
  • large nuclei
  • Nuclear pleiomorphism
  • Increased chromatin granularity
  • Scattered nucleoli
29
Q

Normal uroepithelial traits

A

7 layers
nuclei vertical and perpendicular to BM
Umbrella cells on top

30
Q

Reactive urthelium

A

Slightly enlarged nuclei
Good polarity
7 layers thick

31
Q

Dysplastic urothelium

A 
Enlarged nuclei
Nuclei touching
Polarity irregular
(15%) will progress to cancer
Still  5-7 layers
32
Q

Urothelial CIS

A 
Nuclei 6X larger than lymphocyte
Mitoses present
Nuclear atypia
Polarity is jumbled
relatively normal thickness
Sometimes discohesive cells
(60% develop cancer)
33
Q

Upper urothelial cancers

A 
Renal pelvis and ureter
Usually stage pT2 or higher
More aggressive with a thin wall
ASSOCIATED WITH MISMATCH REPAIR- LYNCH cancer
MSI markers

01 Renal Respiratory (34 decks)

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