CVPR First Aid: renal malignancies Flashcards
What is hydronephrosis
Distention/dilation of renal pelvis and calyces
Dilation occurs proximal to the site of pathology
Causes of hydronephrosis
Usually caused by urinary tract obstruction (eg, renal stones, severe BPH, congenital obstructions, cervical cancer, injury to uterer)
Other causes include;
retroperitoneal fibrosis
Vesicoureteral reflux
Signs of hydronephrosis
Creatinine becomes elevated if obstruction is bilateral or if patient has an obstructed solitary kidney
Leads to compression and possible atrophy of renal cortex and medulla
What is the most common renal malignancy?
Renal cell carcinoma
Renal cell carcinoma most commonly occurs in?
Men 50-70
↑incidence with smoking and obesity
Renal cell carcinoma is associated with?
Paraneoplastic syndromes (“PEAR”-aneoplastic) eg, PTHrP, Ectopic EPO, ACTH, Renin
Gene deletion on chromosome 3 (sporadic or inherited as Von Hippel-Lindau Syndrome)
RCC = 3 letters = Chromosome 3
Renal cell carcinoma originates in?
Originates from PCT → invades renal vein (may develop variocele if left sided) →IVC → hematogenous spread → metastasis to lung and bone
Presentation of Renal cell carcinoma
Hematuria
Palpable masses
2° polycythemia
Flank pain
Fever
Weight loss
Treatment of Renal cell carcinoma
Surgery/ablation for localized disease
Immunotherapy (eg, aldesleukin) or targeted therapy for metastatic disease
Rarely curative
Resistant to chemotherapy and radiation therapy
Describe the cells in Renal cell carcinoma
Polygonal clear cells
Filled with accumulated lipids and carbohydrate
Often golden-yellow die to high lipid content
Pg 583
What is renal oncocytoma
Benign epithelial cell tumor arising from collecting ducts pg 583 pic (well-circumscribed mass with a central scar
Large eosinophilic cells with abundant mitochondria without perinuclear clearing (vs chromophobe renal cell carcinoma)
Presentation of renal oncocytoma
Painless hematuria
Flank pain
Abdominal mass
Treatment of renal oncocytoma
Often resected to exclude malignancy
Pictures of renal oncocytoma
583
What is the most common renal malignancy of early childhood (2-4)
Wilms tumor
Wilms tumor AKA
Nephroblastoma
Describe the histological features of nephroblastoma
Contains embryonic glomerular structures
Causes of nephroblastoma
Loss of function mutations of tumor suppressor genes WT1 or WT2 on chromosome 11
Nephroblastoma AKA
Wilms tumor
Nephroblastoma associations
May be a part of several syndromes
WAGR complex
Denys-Drash syndrome
Beckwith-Wiedemann syndrome
What is WAGR?
Wilms tumor
Aniridia
Genitourinary malformations
Mental Retardation/intellectual disability (WT1 deletion)
What is Denys-Drash syndrome?
Wilms tumor, Diffuse mesangial sclerosis (Early-onset nephrotic syndrome) Dysgenesis of gonads (male pseudohermaphroditism), WT1 mutation
What is Beckwith Wiedemann syndrome
Wilms tumor
Macroglossia
Organomegaly
Hemihyperplasia (WT2 mutation)
What is the most common tumor of the urinary tract system?
Transitional cell carcinoma
Transitional cell carcinoma AKA
Also known as urothelial carcinoma
Transitional cell carcinoma can occur in these locations
Urinary tract system
Renal calyces
Renal pelvis
Ureters
Bladder
Transitional cell carcinoma is associated with?
Problems in your Pee SAC
Phenacetin
Smoking
Aniline dyes
Cyclophosphamide
Transitional cell carcinoma picture
584
Squamous cell carcinoma of the bladder
Chronic irritation of urinary bladder → squamous metaplasia → dysplasia and squamous cell carcinoma
Risk factors of Squamous cell carcinoma of the bladder
Schistosoma haematobium infection (Middle East), chronic cystitis, smoking, chronic nephrolithiasis
Presentation of squamous cell carcinoma of the bladder
Presents with painless hematuria
Types of urinary incontinence
Stress incontinence
Urgency incontinence
Mixed incontinence
Overflow incontinence
