Exam 2- Tumors

Question 1

What is the most common benignrenal cancer

Answer 1

renal papillary adnoma

Question 2

What are the benign cancers of the kidneys

Answer 2

renal papillary adenoma, angiomyolipoma, oncocytoma, renal fibroma or hamartoma
juxtaglomerular cell tumor
mesenchymal tumores

Question 3

What is the size of a benign ademoa

Answer 3

<1 cm

Question 4

what are ademoas that are >1cm in diameter

Answer 4

low grade RCC

Question 5

What is the gross appearance or papillary ademoas

Answer 5

cortical, discrete, yellow gray, small and there may be multiple of them
may have psammoma bodies
acidophilic cytoplasm

Question 6

what genetic mutation is assoc with renal papillary ademoa

Answer 6

trisomy 7 and 17

Question 7

What disease has 25-50% patients present with angiomyolipomas

Answer 7

tuberous sclerosis

Question 8

What is tuberous sclerosis and what is mutation involved

Answer 8

TSC1 or 2 (tumor suppressor genes
autosomal dominant
tumores or lesions of brain(mental retardation), skin, kidney, hear, lungs and eyes
lisch nodules

Question 9

Angiomyolipomas greatest risk factor is what

Answer 9

susceptible to spontaneous hemorrhage, massive retroperitoneal hemorrhage and shock

Question 10

Where do oncocytomas arise from

Answer 10

type A intercalated cells of renal cortical collecting ducts

Question 11

what is the morphology on oncocytomas

Answer 11

epithelial tumor with large eosinophilic cells, large round nuclei
numerous mitochondria
large tan or brown mahogany color. 
get grow to 12 cm
stellate scar

Question 12

What is the familial association with oncocytomas

Answer 12

familial 10 q deletion with multicentricity and b/l

Question 13

What are oncocytomas confused with

Answer 13

RCC , non clear cell

Question 14

What age gorup are oncocytomas Dx in

Answer 14

adults.

Question 15

What is the population of tuberous sclerosis and renal angiomyolipoma

Answer 15

middle aged females

Question 16

What is the most common adult renal malignant tumor

Answer 16

RCC

Question 17

what population is RCC seen mostly in

Answer 17

60-80 yrs old male to femal 2:1 equal distribution racially

Question 18

what does RCC arise from

Answer 18

renal tubular epithelium, adenocarcinoma

Question 19

what are the risk factors assoc with RCC

Answer 19

SMOKING

HTN obesity, estrogens, asbestos, chronic renal disease, tuberous sclerosis, acquired cystic disease

Question 20

What is the hereditary form of RCC

Answer 20

autosomal dominant
younger patients
VHL syndrome develop b/; hereditary clear cell carcinoma or hereditary papillary carcinoma

Question 21

What is the most common type of RCC

Answer 21

clear cell
clear granular cytoplasm
non papillary
95% sporadic

Question 22

what is the mutation seen with clear cell carcinoma familial

Answer 22

loss of sequences on short arm of chromosome 3. deletions or translocations
this is the VHL tumor supressor gene

Question 23

What is Birt Hogg Dube syndrome and what type inheritance

Answer 23

folliculin gene mutation, autosomal dominant

skin pulmonary and renal tumors

Question 24

What type of mutation is seen in papillary carcinoma

Answer 24

trisomy 7, 16,17 lost Y (MET oncogene)

Question 25

A renal tumor has clear cytoplasm with papillary architecture in the medulla. and is Dx in a young patient. not clear cell or papillary. what is it?

Answer 25

Xp11 translocation carcinoma | collecting (bellini) duct carcinoma

Question 26

What is the morphology of chromophobe renal carcinoma

Answer 26

pale eosinophilic cytoplasm, nuclear halos, arise from type B intercalated cells of renal Cx collecting ducts solid growth pattern

Question 27

What does chromophobe renal carcinoma resemble

Answer 27

oncocytoma

Question 28

where are papillary tumors clinically found

Answer 28

distal convoluted tubles b/l can invade renal vein, vena cava

Question 29

What is the classic triat of RCC

Answer 29

hematuria (microscopic usually) CVA pain palpable flank mass

Question 30

When RCC are Dx whats the main concern

Answer 30

already have metastasized

Question 31

What are the begining symptoms of RCC

Answer 31

weight loss, malaise, weakness, fever

Question 32

where does RCC metastasize to

Answer 32

lung, bone, regional nodes, liver, adrenal brain and unusual sites

Question 33

Rank the types of RCC histologic types and associated prognostic value

Answer 33

papllary and chromophobe have better Px clear cell is moderate collecting duct, sarcamatoid and medullary have worse Px

Question 34

What is the main mode of spread of RCC

Answer 34

hematogenous

Question 35

what is another name for clear cell renal carcinoma

Answer 35

hypernephroma

Question 36

What does a sarcamatoid RCC look like

Answer 36

spindle cells simulating mesenchymal neoplasm

Question 37

what does collecting duct RCC look like

Answer 37

branching tubules lined by cuboidal cells

Question 38

What does renal medullary RCC look like

Answer 38

in patient with sickle cell | poorly differentiated and heavily infiltrated with neutrophils

Question 39

What type of cancer arises from urothelium of renal pelvis

Answer 39

urothelial(transitional cell) carcinoma of renal pelvis

Question 40

50% of people with urothelial carcinomas have what other type tumor

Answer 40

bladder

Question 41

what nephropathies are urothelial carcinomas assoc with

Answer 41

analgesic and tubulo-interstitial

Question 42

what are signs of urothelial carcinoma

Answer 42

hematuria, small, may block outglow and cause hydronephrosis and flank pain

Question 43

What is the 5 yr survival rate for urothelial carcinoma of renal pelvis

Answer 43

50-100% for low grade noninvasive lesions | 10% for high grade infiltrating tumors