Fang 2

Question 1

Types of Benign kidney tumors

Answer 1

• Papillary adenoma
  
  • ALWAYS within the cortex
  • small (<.5cm)
  • Pale, yellow, well circumscribed
• Angiomyolipoma
  
  • Association with tuberous sclerosis
    
    • mental retardation, multisystem hamartomas
  • Consists of
    
    • Thick-walled vessels, fat and smooth muscle cells

Question 2

RENAL CELL CARCINOMA risk factors

Answer 2

• TOBACCO
• Chronic renal failure and ACQUIRED CYSTIC RENAL DISEASE
• obesity
• HTN
• unopposed estrogen therapy
• asbestos

Question 3

RENAL CELL CARCINOMA SYmptoms

Answer 3

• Hematuria (50-60%) (painless)
• Abdominal mass (25-40%)
• Flank pain (35-40%
• HTN (20-40%)
• Weight loss (30-35%)
• Fever (5-15%)

STRONGLY TEND TO INVADE THE RENAL VEIN EARLY (Metastasize early)

Question 4

HISTOTYPES of renal cell carcinoma (RCC)

Answer 4

• CLEAR CELL RCC (80%)
  
  • loss of tumor suppressor gene VHL
  • GROSS: YELLOW-ORANGE mass (contains FAT = clear in microscopy)
• PAPILLARY (chromophil) RCC (15%)
  
  • activation of pro-oncogene gene MET
  • MICRO: papillary structures which enclose clusters of FOAMY MACROPHAGES
• Chromophobe RCC (5%)
  
  • loss of multipe chromosomes resulting hypodiploidy
  • prognosis is the best among 3 types

Question 5

Clear cell RCC vs Papillary RCC in microscope

Answer 5

• Clear cell
  
  • abundant clear cytoplasm
  • abundant capillaries
• Papillary RCC
  
  • eosinophilic (pink) cytoplasm
  • Sparse capillaries

Question 6

Von Hippel-Lindau syndrome (VHL syndrome)

Answer 6

• Cavernous hemangiomas in cerebellum, brian stem and eye
• REMARKABLY INCREASE INCIDENCE OF RCC
• ass with germline mutation of the VHL tumor suppressor gene

Question 7

urothelial carcinoma of renal pelvis (transitional cell carcinoma)

Answer 7

• occurs in renal pelvis
• EXACTLY the same appearance as lower urinary tract carcinomas
• MUCH MORE LIKELY to obstruct the kidney than renal cell carcinoma
• ass. with ureter and bladder carcinomas