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Bloc D - Renal > Jan15 M3-Pathology of Bladder and Kidney > Flashcards

Jan15 M3-Pathology of Bladder and Kidney Flashcards

1
Q

most common type of bladder tumor

A

urothelial/transitional cell neoplasms

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2
Q

risk factors for bladder CA

A

smoking, radiation, analgesics, arylamines (petroleum, paint)

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3
Q

symptoms of bladder CA

A

painless hematuria, frequency, urgency, dysuria

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4
Q

2 ureteral orifice possible involvements in bladder CA

A

pyelonephritis

hydronephrosis

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5
Q

urothelial lesion invasive vs non invasive

A

invasive = beneath the BM

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6
Q

initial investigations for bladder CA suspicion

A

cystoscopy and cytology

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7
Q

temporary and permanent treatments of CA

A

temporary is resect visible tumors on cystoscopy.

definitive therapy based on histology

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8
Q

why do cytology + limitation of it

A

check for malignant cells. but won’t know where they’re from

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9
Q

cystectomy def

A

remove bladder

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10
Q

treatment options for urothelial lesions

A
  • removal of tumor + intravesical therapy
  • partial cystectomy
  • total cystectomy
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11
Q

intravesical therapies (2)

A
  • chemo

- BCG (weakened bacillus fof TB: induces intense T cell rx)

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12
Q

normal histo of the bladder

A
  • adipose tissue
  • muscular propria (SM): detrusol muscle
  • LP (fibroblasts and CT)
  • urothelium
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13
Q

2 types of non invasive urothelial lesions

A

flat and papillary

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14
Q

2 lesions that lead to invasive CA (one flat and one papillary)

A 
flat = CIS
papillary = papillary carcinoma, high grade (HGTCC = high grade transitional cell carcinoma)
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15
Q

papillary lesion charact

A

tree with branches being vessels feeding the neoplasm

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16
Q

charact of a benign urothelium

A

polarized cells, organized, translucid nuclei (not hyperchromatic), all same size and shape, no mitosis

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17
Q

4 non-invasive flat urothelial lesions

A
  • hyperplasia
  • reactive atypia
  • dysplasia
  • CIS
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18
Q

4 non-invasive papillary urothelial lesions

A
  • papilloma
  • punlmp (lmp = low malignant potential)
  • pap CA low grade (LGTCC)
  • pap CA high grade (HGTCC)
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19
Q

LGTCC histo

A

MILD: loss of polarity, hyperchromatic nuclei (some), rare mitosis

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20
Q

HGTCC charact histo + specific one

A

total loss of polarity, pleimorphism

*prominent nucleoli

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21
Q

CIS vs HGTCC on cystoscopy

A

CIS: hemorrhagic patch
HGTCC: papillary lesion

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22
Q

CIS on histo

A

cells still above BM but mitoses, hyperchromasia, prominent nucleoli, loss of polarity

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23
Q

CIS and HGTCC are non invasive. name when become invasive

A

invasive urothelial CA

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24
Q

pT1, pT2 and pT3 staging of urothelial CA

A

1: reached LP
2: reached muscle
3: reached adipose tissue

25
Q

what urothelial lesions get resection only (+ follow up cysto/cyto)

A

papilloma, punlmp, LGTCC

26
Q

what urothelial lesions get resection (TURB) + intravesical med (+ follow up cysto/cyto)

A

CIS, HGTCC, pT1

27
Q

what urothelial lesions get surgery (cystectomy)

A

pT2, pT3

28
Q

recurrence and progression of papillary lesions

A

papilloma and pnlump: low
LGTCC: 50% recurrence low progression
HGTCC: 50% recurrence 40% progression (to invasive)

29
Q

2 benign renal epithelial tumors

A

oncocytoma

papillary adenoma

30
Q

3 malignant renal epithelial tumors

A

conventional RCC
papillary RCC
chromophobe RCC

31
Q

kidney CA risk factors

A

95% sporadic: smoking, obesity, htn

5% familial: VHL syndrome (von hipper lindau syndrome)

32
Q

other name for conventional RCC

A

clear cell RCC

33
Q

VHL syndrome charact

A

hemangioblastomas of cerebellum and retina, liver+pancreas+renal cysts, clear cell RCC

34
Q

typical syndrome where get conventional or clear cell RCC

A

VHL syndrome

35
Q

presentation of kidney CA

A

asymptomatic 90%

10% hematuria, CVA pain, palpable mass (all three together)

36
Q

classic triad of kidney CA presentation (10% of the time)

A

hematuria, CVA pain, palpable mass

37
Q

other presentations for kidney CA

A

paraneoplastic, general symptoms (fever, weight loss)

38
Q

one word to describe clear cell RCC macro

A

heterogenous (bc solid mixed with cystic, hemorrhagic, necrotic, lipidic and yellow, brown and hemorrhagic)

39
Q

two things on clear cell RCC micro

A

clusters of malignant cells with distinct membranes + network of capillaries between them

40
Q

Fuhrman grading and which is bad

A

1 to 4 grading for nuclear atypia.

3-4 is bad. 3 is prominent nucleoli

41
Q

papillary RCC derived from what cells

A

PCT, DCT, CD cells

42
Q

charact of papillary RCC + who gets it most commonly

A
  • sporadic or hereditary
  • has the most cases of bilaterality/multifocality
  • most common in long-term hemodialysis pts
43
Q

papillary RCC macro

A

no yellow. encapsulated. mainly hemorrhagic

44
Q

papillary RCC micro

A

papillary structures lined by malignant tubular cells

45
Q

papillary RCC type 1 vs type 2

A

1: 1 layer of cubidal cells
2: many layers of columnar cells. 2 is bad

46
Q

RCC with best prognosis

A

chromophobe RCC

47
Q

chromophobe RCC micro features

A

binucleated, halos around nuclei, eosinophilic cytoplasm, irreg membranes

48
Q

main features of RCCs covered + which is worse which is best

A

clear cell (worst): presence of clear cells

papillary: architecture
chromophobe: best

49
Q

oncocytoma macro

A

orange. rim of kidney parenchyma. no hemorrhage, no necrosis

50
Q

oncocytoma micro

A

eosinophilic. nests of cells + hypocellular hyalinized edematous stroma

51
Q

angiomyolipoma charact + type of kidney CA

A

dysmorphic blood vessels, myoid cells, adipose tissue.

Benign

52
Q

angiomyolipoma associated with what

A

tuberous sclerosis

53
Q

angiomyolipoma: when to resect

A

when risk of retroperitoneal bleeding

54
Q

RCC: where does it spread and in what way does it try to reach out of the kidney

A

spreads centrally to the hilum. tries to go to renal vein

55
Q

advanced RCC reaches where

A

renal vein

56
Q

clear cell associated with what

A

VHL

57
Q

tuberous sclerosis associated with what

A

AML (benign)

58
Q

best RCC

A

chromophobe

59
Q

2 types of papillary RCC and prognosis

A

2 is the bad one.
1 is layer cuboidal
2 is many layers colimnar + acidophilic cytoplasm + nucleoli

Bloc D - Renal (32 decks)

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