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Rotation - Cytopathology > Ch. 15 - Kidney & Adrenal Gland > Flashcards

Ch. 15 - Kidney & Adrenal Gland Flashcards

1
Q

What are some accepted indications for FNA of kidney lesions?

A

Surgical non-candidacy (metastatic disease, comorbidities)
Equivocal radiologic impression
Suspected infection

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2
Q

What are the possible complications of renal FNA?

A

Bleeding (hematuria, AV fistula), urinoma. Needle tract seeding is very rare.

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3
Q

What ancillary studies are useful in evaluation of renal FNA?

A

Cytogenetics (FISH), immunohistochemistry.

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4
Q

What criteria are used for adequacy of renal FNA?

A

There are NO CONSENSUS CRITERIA for renal FNA.

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5
Q

Describe the morphologic appearance of renal glomeruli.

A

Highly cellular globular structures lacking atypia and with uneven nuclear distribution (ie, denser at the center). Capillary loops should be present.

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6
Q

Describe the morphologic appearance of proximal and distal tubular cells.

A

Proximal: Round bland nuclei with abundant granular cytoplasm and poorly defined borders.

Distal: Round bland nuclei with less cytoplasm and better-defined cell borders.

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7
Q

Describe the cytology of renal oncocytoma.

A

Numerous isolated cells with abundant eosinophilic granular cytoplasm and round nuclei with Fuhrman grade 2 nucleoli. Can have some pleomorphism.

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8
Q

What entities should be considered in the differential of renal oncocytoma, and how are they distinguished?

A

Hepatocytes: Contain lupofuscin and bile pigment.
Eosinophilic-variant papillary: Contains papillae, macrophages.
Chromophobe: Diffuse staining with HCI, CK7.

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9
Q

What is the role of cytology in diagnosing renal cortical adenoma?

A

It is indistinguishable from low-grade papillary RCCs; by definition it is <0.5cm and should therefore not be aspirated nor called on FNA.

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10
Q

Describe the pathophysiology of renal angiomyolipoma.

A

Arises from the perivascular epithelioid cell. Half of cases occur in Tuberous Sclerosis (men + women), half are sporadic in middle-aged women.

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11
Q

Describe the HISTOLOGY of renal angiomyolipoma, including staining.

A

Mature fat, blood vessels, and smooth muscle cells (which may be atypical). Stains for HMB45, MelanA.

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12
Q

Describe the cytology of renal angiomyolipoma.

A

Often paucicellular with little adipose tissue (fat-rich lesions are diagnosable by radiology). Atypical spindled to epithelioid smoth muscle and rare vessels.

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13
Q

Describe the presentation of metanephric adenoma.

A

A benign rare kidney tumor of older women which may manifest with polycythemia.

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14
Q

Describe the HISTOLOGY of metanephric adenoma.

A

Tight, uniform tubules lined by bland cells. May contain psammoma bodies.

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15
Q

Describe the cytology of metanephric adenoma.

A

Short tubules, tight balls, and loose sheets of bland cells with scant cytoplasm.

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16
Q

What is the role of cytology in diagnosing cystic nephroma?

A

Cystic nephromas can look solid on radiology but have extremely variable cytology and are not appropriate for FNA diagnosis.

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17
Q

What features are seen in FNA of xanthogranulomatous pyelonephritis?

A

Histiocytes and multinucleated giant cells which should lack atypia. Consider malakoplakia.

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18
Q

What benign entities may sometimes have atypical cells?

A 
Cystic nephroma
Renal abscess, XGP
Infarct
Atypical cysts
Angiomyolipoma
19
Q

How are renal cysts triaged for FNA eligibility? What patients especially benefit?

A

“Bosniak” scoring system based on radiologic features. Useful in patients on dialysis, or with PKD (both develop cysts and are also at high risk of malignancy)

20
Q

What is the annual incidence and mortality due to renal cell carcinomas? What is the epidemiology?

A

65k per year, with 13k deaths. Men are affected more than women, and most cases are associated with tobacco smoking and obesity.

21
Q

What are the most common renal cell carcinomas?

A
  1. Clear cell
  2. Papillary
  3. Chromophobe
  4. Sarcomatoid
  5. Rare stuff (collecting duct, translocation, mucinous tubular)
22
Q

Describe the cytology of clear cell RCC.

A

Lots of blood. Large cohesive groups of cells with abundant vacuolated cytoplasm and eccentric nuclei. May see fibrillary basement membrane material or vessels.

23
Q

Describe the cytology of papillary RCC.

A

True papillae distended with foamy macrophages. Cells resemble distal tubular cells and may also have intracytoplasmic hemosiderin.

24
Q

What is the immunostaining profile of papillary RCC?

A

Stains EMA, LMWKs (CK7), and is negative for 34BE12 and WT-1.

25
Q

Describe the cytology of chromophobe RCC.

A

Less cohesive cells with fluffy cytoplasm and marked nuclear variation (binucleation, grooves, pseudoinclusions). Koilocytoid.

26
Q

Describe the cytology of sarcomatoid RCC. Staining?

A

High-grade spindled to epithelioid lesion with keratin or EMA reactivity.

27
Q

What are some distinct features of collecting duct carcinoma?

A

Medullary location, poor definition, prominent desmoplasia. Stains 34BE12.

28
Q

What are some distinct features of Xp11.2 translocation associated RCC?

A

Pediatric population, TFE3 gene rearrangement, frequent calcifications.

29
Q

What are some distinct features of mucinous tubular and spindle cell carcinoma?

A

Rare incidence, excelelnt prognosis. Biphasic cell population (tubular and spindle cells in mucoid matrix).

30
Q

What percentage of renal tumors are urothelial? What are its associations?

A

5-10%. Associated with tobacco use, phenacetin, thorium contrast material.

31
Q

Describe the cytology of urothelial carcinoma.

A

Large cells with dark hyperchromatic nuclei and smooth cytoplasm. Sometimes elongated or cercariform with a long tail and intracytoplasmic vacuole.

32
Q

What stains can distinguish RCC from UCC?

A

34BE12, CK20, GATA3, CEA (UCC)

CD10, RCCma, PAX2, PAX8 (RCC)

33
Q

What is the most common cancer metastasis to kidney?

A

Lung

34
Q

Describe the cytology of Wilms tumor.

A

Triphasic tumor (at least two components must be present). Blastema (SRBCs), tubules, and stroma.

35
Q

What entities shouold be kept in the differential for Wilms tumor?

A

Metanephric adenoma, mesoblastic nephroma, clear cell sarcoma, rhabdoid tumors

36
Q

What is the role of FNA in the evaluation of adrenal masses?

A

Mostly to identify metastatic disease (do not FNA without a history of primary disease elsewhere).

37
Q

Describe the cytology and differential diagnosis of myelolipoma.

A

Fat and hematopoietic elements. Consider angiomyolipoma (throw melanocytic markers).

38
Q

Describe the cytology of adrenal cortical adenomas.

A

Numerous naked nuclei, frothy granular background, and some intact bubbly cells. Note: Indistinguishable from hyperplastic nodule.

39
Q

Describe the cytology of adrenal cortical carcinomas.

A

Isolated cells with nuclear atypia, mitoses, and necrosis…nonspecific. Need staining?

40
Q

What are the rules of 10 in pheochromocytoma?

A

10% are malignant, 10% are familial, 10% are extra-adrenal, 10% are bilateral.

41
Q

Describe the cytology of pheochromocytoma.

A

Highly cellular with clusters and isolated cells with neuroendocrine features. Pseudoinclusions, prominent nucleoli, granular cytoplasm.

42
Q

What are the most common metastases in adrenal?

A

Lung cancer, melanoma, RCC.

43
Q

What are some adrenal cortical stains?

A

SF1 (NR5A1), inhibin, Melan-A, calretinin

Rotation - Cytopathology (33 decks)

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