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GIR Test 4 > B5-081 Renal and Urinary Tumors > Flashcards

B5-081 Renal and Urinary Tumors Flashcards

1
Q

biggest risk factor for renal cell carcinoma

A

smoking

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2
Q

familial variants of renal cell carcinoma

A
  • von Hippel Lindau
  • Hereditary papillary carcinoma

often bilateral

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3
Q

most common renal cell carcinoma

A

clear cell

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4
Q
A

clear cell carcinoma

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5
Q

98% of clear cell RCC is caused by an abnormality on chromosome

A

3

loss of VHL tumor suppressor

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6
Q

most common subtype of RCC found in dialysis patients

A

papillary carcinoma

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7
Q
  • papillary growth with interstitial foam cells
  • multifocal
A

papillary carcinoma

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8
Q

associated with trisomy 7 and 17, loss of Y

A

papillary carcinoma

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9
Q

MET locus (proto onocogene)

A

papillary carcinoma

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10
Q
A

papillary carcinoma

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11
Q
  • tumor cells have prominent cell membranes and pale cytoplasm “vegetable cells”
  • halo around nucleus
A

chromophobe RCC

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12
Q

does chromophobe RCC have a good prognosis?

A

yes

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13
Q
A

chromophobe RCC

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14
Q

RCC triad

A
  • flank pain
  • palpable mass
  • hematuria
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15
Q

why is RCC called a great mimicker?

A
  • variety of systemic symptoms
  • paraneoplastic syndromes

polycythemia, HTN, hypercalcemia

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16
Q

most common sites of metastasis of RCC

2

A

lungs
bones

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17
Q

RCC tends to invade which vessel?

A

renal vein

can reach vena cava, right heart eventually

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18
Q

treatment RCC

A
  • nephrectomy or partial nephrectomy
  • chemotherapy if metastatic
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19
Q
  • present with hematuria, urinary obstruction
  • 50% of patients have previous or concurrent bladder tumor
A

urothelial carcinoma of renal pelvis

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20
Q

risk factors for urothelial carcinoma of renal pelvis

A
  • analgesic nephropathy
  • lynch syndrome
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21
Q

most common pediatric renal tumor

A

Wilm’s tumor

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22
Q

WAGR syndrome

A
  • Wilm’s
  • Aniridia
  • Genital anomalies
  • mental Retardation
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23
Q

protein affected by germline 11p13 mutation

A

WT1 -Wilm’s
PAX6 -aniridia

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24
Q
  • critical for normal renal and gonadal development
  • encodes DNA binding transcription factor in embryogenesis
A

WT1 protein

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25
Q
  • causes gonadal dysgenesis and early onset nephropathy
  • diffuse mesangial sclerosis
  • 90% risk of wilms
A

Denys-Drash syndrome

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26
Q

Denys-Drash syndrome is caused by germline mutations in

A

WT1

missense mutation

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27
Q
  • organomegaly
  • macroglossia
  • omphalocele
  • adrenal cytomegaly
A

Beckwith-Wiedermann Syndrome

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28
Q

11p15.5 (WT2) imprinting mutation

A

Beckwith-Wiederman

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29
Q
  • caused by loss of imprinting of normally maternally silenced IGF2 allele
  • or duplication of active paternal allele
A

Beckwith-Wiederman

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30
Q
  • small blue bastemal cells
  • fibrous or myxoid stromal cells
  • epithelial cells
A

Wilms

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31
Q

[…] mutations indicated a worse prognosis for Wilms

A

p53

cause anaplasia

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32
Q
A

wilms

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33
Q

precursor for Wilms

A

nephrogenic rests

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34
Q
  • seen in renal parenchyma adjacent to tumor in 25-40% of cases
  • seen in 100% of bilateral cases
A

nephrogenic rests

precursor to Wilms, increases risk of WIlms in other kidney

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35
Q
  • large abdominal mass
  • hematuria
  • abdominal pain
  • intestinal obstruction
  • hypertension
  • may have pulmonary mets
A

Wilms

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36
Q

key determinant of prognosis of Wilms

A

anaplastic histology

37
Q

survivors of Wilms have an increased risk of

A

secondary tumors

38
Q

can occur in renal calyces, renal pelvis, ureters and bladder

A

urothelial cell carcinoma

39
Q

painless hematuria without casts may indicate

A

urothelial carcinoma

40
Q

syndromes causing Wilms

3

A
  • WAGR
  • Deny-Drash
  • Beckwith-Wiederman
41
Q
  • most common renal malignancy of early childhood (2-4 yrs)
  • contains embryonic glomerular structures
42
Q
  • most often presents with large palpable, unilateral flank mass
  • and/or hematuria
  • possible HTN
43
Q

caused by WT1 deletion

2

A

WAGR, Denys-Drash

44
Q

caused by WT2 mutation

A

beckwith-weidermann

45
Q
  • polygonal clear cells filled with accumulated lipids and carbohydrates
  • often golden yellow due to high lipid content
46
Q

originates in PCT –> invades renal vein –> IVC –> hematogenous spread –> metastasis to lung and bone

47
Q
  • flank pain, palpable mass, hematuria
  • anemia, polycythemia, fever, weight loss
48
Q

90% of bladder cancer is

A

urothelial carcinoma

49
Q

biggest risk factor for bladder cancer

50
Q

precursor lesions to UCC

A
  • non-invasive papillary urothelial carcinoma
  • non-invasive flat urothelial carcinoma (always high grade)
51
Q

prognosis for low grade noninvasive papillary carcinoma

52
Q
  • prognosis of high grade invasive papillary carcinoma
  • invasion of muscularis propria
A

25%, not good

53
Q
A

papillary noninvasive low grade UCC

54
Q
  • orderly architecture and cytology
  • evenly spaced
  • maintain polarity
  • cohesive
  • minimal nuclear atypia
  • papillary architecture
A

low grade papillary UCC

55
Q
A

high grade papillary UCC

56
Q
  • dyscohesive
  • large, hyperchromic nuclei
  • pleomorphism and atypia
  • frequent mitoses
  • disordered, loss of polarity
  • higher risk of invasion and progression
A

high grade papillary UCC

57
Q
A

UCC in situ

always high grade

58
Q
  • flat lesion
  • dyscohesive
  • hyperchromatic enlarged cells
  • little cytoplasm
  • multifocal
A

UCC in situ

59
Q

on cytoscopy, there is no mass, just erythema

A

UCC in situ

60
Q

most common site of metastasis for bladder cancer

A

lymph node

61
Q

deletion of tumor suppressors on chr 9 leads to

bladder cancer

A

low grade papillary tumors

acquire p53 mutation –> able to invade

62
Q

initial p53 mutation leads to

bladder cancer

A

high grade tumors/UCC in situ

acquire loss of chr 9 –> invasion

63
Q

T2 staging of bladder cancer indicates

A

muscularis propria invasion

64
Q
  • rare in US but more common in countries with endemic schistosomias
  • caused by chronic bladder irritation/infection
A

squamous cell carcinoma of bladder

65
Q
A

schistosoma hematobium

possible buzzword: patient from Eygpt ??

66
Q
A

squamous cell carcinoma of bladder

keratin pearls

67
Q

what is the limit of urine cytology?

A

can’t detect low grade tumors

68
Q

treatment of small localized low grade papillary tumors

UCC

A
  • transurethral resection
  • follow with cysto/urine cytology forever due to tendency to regenerate
69
Q

treatment of high grade UCC

A

tuberculous bacillus (BCG)

70
Q

treatment for T2 UCC

A

radical cystectomy
chemo if metastatic

71
Q

why is urine cytology the best initial test for suspected cancer?

A

highly specific for high grade tumors

72
Q

good for monitoring patients who have bladder cancer or patients you suspect have cancer

A

urine cytology

73
Q

RCC with excellent prognosis

A

chromophobe RCC

74
Q

many invasive high grade UCs show deletions in

75
Q

papillary low grade UCs are associated with deletions in

76
Q

deletion of WT1 on chr 11

77
Q

reddening or granularity of the bladder mucosa but no evident mass

A

UC in situ

78
Q

papillary urothelial carcinoma and invasive high grade UC show a […] on cytoscopy

79
Q

treatment for low grade papillary UC

A

transurethral resection and periodic follow up

80
Q

cystectomy, chemotherapy, and radiation are used to treat

A

high grade tumors

81
Q

topical BCG therapy is used to treat

2

A
  • in situ carcinoma
  • multifocal high grade papillary carcinoma
82
Q

cuboidal cells arranged in papillary formations with foam cells

A

papillary renal cell carcinoma

83
Q

clear cytoplasm without papillary architecture

A

clear cell RCC

84
Q

pale eosinophillic cells with perinuclear halo and prominent cytoplasmic membranes arranged in solid sheets

A

chromophobe carcinoma

85
Q

urothelial cells in solid sheets with or without papillary projections

86
Q
  • blastemal
  • stromal
  • epithelial
87
Q

origin site of RCC

88
Q
  • anemia
  • hematuria
  • elevated creatinine
89
Q

golden yellow tumor due to high lipid content

GIR Test 4 (18 decks)

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