Jan15 M3-Pathology of Bladder and Kidney Flashcards
most common type of bladder tumor
urothelial/transitional cell neoplasms
risk factors for bladder CA
smoking, radiation, analgesics, arylamines (petroleum, paint)
symptoms of bladder CA
painless hematuria, frequency, urgency, dysuria
2 ureteral orifice possible involvements in bladder CA
pyelonephritis
hydronephrosis
urothelial lesion invasive vs non invasive
invasive = beneath the BM
initial investigations for bladder CA suspicion
cystoscopy and cytology
temporary and permanent treatments of CA
temporary is resect visible tumors on cystoscopy.
definitive therapy based on histology
why do cytology + limitation of it
check for malignant cells. but won’t know where they’re from
cystectomy def
remove bladder
treatment options for urothelial lesions
- removal of tumor + intravesical therapy
- partial cystectomy
- total cystectomy
intravesical therapies (2)
- chemo
- BCG (weakened bacillus fof TB: induces intense T cell rx)
normal histo of the bladder
- adipose tissue
- muscular propria (SM): detrusol muscle
- LP (fibroblasts and CT)
- urothelium
2 types of non invasive urothelial lesions
flat and papillary
2 lesions that lead to invasive CA (one flat and one papillary)
flat = CIS papillary = papillary carcinoma, high grade (HGTCC = high grade transitional cell carcinoma)
papillary lesion charact
tree with branches being vessels feeding the neoplasm
charact of a benign urothelium
polarized cells, organized, translucid nuclei (not hyperchromatic), all same size and shape, no mitosis
4 non-invasive flat urothelial lesions
- hyperplasia
- reactive atypia
- dysplasia
- CIS
4 non-invasive papillary urothelial lesions
- papilloma
- punlmp (lmp = low malignant potential)
- pap CA low grade (LGTCC)
- pap CA high grade (HGTCC)
LGTCC histo
MILD: loss of polarity, hyperchromatic nuclei (some), rare mitosis
HGTCC charact histo + specific one
total loss of polarity, pleimorphism
*prominent nucleoli
CIS vs HGTCC on cystoscopy
CIS: hemorrhagic patch
HGTCC: papillary lesion
CIS on histo
cells still above BM but mitoses, hyperchromasia, prominent nucleoli, loss of polarity
CIS and HGTCC are non invasive. name when become invasive
invasive urothelial CA
pT1, pT2 and pT3 staging of urothelial CA
1: reached LP
2: reached muscle
3: reached adipose tissue
what urothelial lesions get resection only (+ follow up cysto/cyto)
papilloma, punlmp, LGTCC
what urothelial lesions get resection (TURB) + intravesical med (+ follow up cysto/cyto)
CIS, HGTCC, pT1
what urothelial lesions get surgery (cystectomy)
pT2, pT3
recurrence and progression of papillary lesions
papilloma and pnlump: low
LGTCC: 50% recurrence low progression
HGTCC: 50% recurrence 40% progression (to invasive)
2 benign renal epithelial tumors
oncocytoma
papillary adenoma
3 malignant renal epithelial tumors
conventional RCC
papillary RCC
chromophobe RCC
kidney CA risk factors
95% sporadic: smoking, obesity, htn
5% familial: VHL syndrome (von hipper lindau syndrome)
other name for conventional RCC
clear cell RCC
VHL syndrome charact
hemangioblastomas of cerebellum and retina, liver+pancreas+renal cysts, clear cell RCC
typical syndrome where get conventional or clear cell RCC
VHL syndrome
presentation of kidney CA
asymptomatic 90%
10% hematuria, CVA pain, palpable mass (all three together)
classic triad of kidney CA presentation (10% of the time)
hematuria, CVA pain, palpable mass
other presentations for kidney CA
paraneoplastic, general symptoms (fever, weight loss)
one word to describe clear cell RCC macro
heterogenous (bc solid mixed with cystic, hemorrhagic, necrotic, lipidic and yellow, brown and hemorrhagic)
two things on clear cell RCC micro
clusters of malignant cells with distinct membranes + network of capillaries between them
Fuhrman grading and which is bad
1 to 4 grading for nuclear atypia.
3-4 is bad. 3 is prominent nucleoli
papillary RCC derived from what cells
PCT, DCT, CD cells
charact of papillary RCC + who gets it most commonly
- sporadic or hereditary
- has the most cases of bilaterality/multifocality
- most common in long-term hemodialysis pts
papillary RCC macro
no yellow. encapsulated. mainly hemorrhagic
papillary RCC micro
papillary structures lined by malignant tubular cells
papillary RCC type 1 vs type 2
1: 1 layer of cubidal cells
2: many layers of columnar cells. 2 is bad
RCC with best prognosis
chromophobe RCC
chromophobe RCC micro features
binucleated, halos around nuclei, eosinophilic cytoplasm, irreg membranes
main features of RCCs covered + which is worse which is best
clear cell (worst): presence of clear cells
papillary: architecture
chromophobe: best
oncocytoma macro
orange. rim of kidney parenchyma. no hemorrhage, no necrosis
oncocytoma micro
eosinophilic. nests of cells + hypocellular hyalinized edematous stroma
angiomyolipoma charact + type of kidney CA
dysmorphic blood vessels, myoid cells, adipose tissue.
Benign
angiomyolipoma associated with what
tuberous sclerosis
angiomyolipoma: when to resect
when risk of retroperitoneal bleeding
RCC: where does it spread and in what way does it try to reach out of the kidney
spreads centrally to the hilum. tries to go to renal vein
advanced RCC reaches where
renal vein
clear cell associated with what
VHL
tuberous sclerosis associated with what
AML (benign)
best RCC
chromophobe
2 types of papillary RCC and prognosis
2 is the bad one.
1 is layer cuboidal
2 is many layers colimnar + acidophilic cytoplasm + nucleoli
