Kidney and Bladder Pathology Flashcards
Child vs. Adult Polycystic Kidney Disease
- Adult form - **Autosomal dominant **- cortical based cysts (picture) 1/500 prevalence
- Child form - **Autosomal recessive **- medulla based cysts 1/20,000 prevalence
How can you tell the difference between polycystic kidney disease and acquired cystic kidney disease based on morphology?
- PKD: these kidneys weigh 1000-2000 g (normal, 100 g)
- AKD: dialysis patients get an acquired cystic disease but the kidney is normal-sized, not so huge
How will hydronephrosis appear morphologically?
- Cortex and medulla compressed to a rim
- Pelvicalyceal system (pelvis and calyces) are very dilated
- What is the classic triad for renal cell carcinoma?
- What are other manifestations for renal cell carcinoma?
- Classic triad: Painless hematuria, a palpable abdominal mass, and dull flank pain
- Most frequent presenting manifestation is hematuria (gross or microscopic), occurring in more than 50% of cases
- Polycythemia in 5% to 10% of cases due to erythropoietin production by the tumor (paraneoplastic syndrome)
Main types of renal tumors
- % of renal cancers & Outcome
-
Clear cell
- 83%; Second worst
-
Papillary
- 11%; Second best
-
Chromophobe
- 4%; Best
-
Collecting duct (subtype: Medullary carcinoma)
- 1% (medullary, <1%); Worst
- Renal oncocytoma
- NOT cancer but occurs at 5-10% the rate of kidney cancer; Benign, rarely recurs
-
Angiomyolipoma
- Most frequent benign tumor; Benign
What is the histological difference between Papillary Type I vs. Papillary Type II renal cell cancer?
-
Papillary Type I
- thin papillae
-
Papillary Type II
- thick papillae
What can be seen histologically in chromophobe carcinoma?
- Normal glomerulus
- Halo around a wrinkled nucleus
- Binucleate cell
- What are the characteristics of medullary carcinoma?
- What is the outcome?
-
Restricted to individuals who have some African or Mediterranean descent
- Patients have sickle cell disease or sickle cell trait
- Presents at very high stage, resists chemotherapy, and has worst outcome of all kidney cancers with median survival times of 3 months (range 1–7 months)
- How is acquired cystic disease associated with renal cancer?
- What is common histological finding?
- Patients with acquired cystic disease due to chronic dialysis dependency have a 100x risk of getting RCC
- Variety of patterns but lots of vacuoles
- Also will see oxalate crystals
_____ ____ ___________ cancer occurs in end stage kidneys whether cystic or non-cystic
Clear Cell (Tubulo)papillary cancer occurs in end stage kidneys whether cystic or non-cystic
Renal Cell Carcinoma Nucleolar Grading:
- Grade 1:
- Grade 2:
- Grade 3:
- Grade 4:
- Grade 1: nuclei are like tiny dots
- Grade 2: nucleoli inconsipicuous
- Grade 3: nucleoli appreciated at low power
- Grade 4: bizarre cells
__________ arises from intercalated cells of collecting duct
Oncocytoma arises from intercalated cells of collecting duct
- What is the most common benign tumour of the kidney?
- What is its most serious complication?
Angiomyolipoma
- most common serious complication of it is hemorrhage
In which renal tumor will premelanosomes be present?
angiomyolipoma
Which renal tumor is almost always pediatric?
Wilms tumor
- Contain a variety of cell and tissue components, all derived from the mesoderm
List the Acquired non-neoplastic anomalies of Urinary Bladder:
- Cystitis cystica/ cystitis glandularis
- Polypoid and papillary cystitis
- Nephrogenic adenoma
- What are the characteristics of polypoid and papillary cystitis?
- How can you distinguish between the them?
- Polypoid and papillary cystitis arise from catheter, stone, etc.
- In setting of submucosal edema, usually mixed inflammation
-
Polypoid cystitis = more blunt projections
- has a tip that is wider than its base
- this _distinguishes it from Papillary cystitis _
- Polypoid type is grossly more apt to mimic a tumor
What are the characteristics of Nephrogenic Adenoma (Nephrogenic Metaplasia)?
- Males 2:1, can affect children
- 61% of cases following GU surgery
- Often associated with chronic cystitis/ longstanding infection
Nephrogenic Adenoma is a benign proliferation of …
tubules
What are the different grades of bladder cancer (flat and papillary) from lower to higher grade?
-
FLAT lesions: (low to high)
- Reactive
- Indeterminate
- Dysplasia
- Carcinoma in situ
-
PAPILLARY lesions: (low to high)
- Papilloma
- Papillary neoplasm, uncertain potential
- Low-grade urothelial cancer
- High grade urothelial cancer
Bladder TMN Staging:
- Urothelium:
- Lamina propria:
- Muscularis propria:
- Perivesical fat:
- Other organs:
- Urothelium:
- pTIS, pTa
- Lamina propria:
- pT1
- Muscularis propria:
- pT2a, pT2b
- Perivesical fat:
- pT3
- Other organs:
- pT4
What is the key determinant in bladder TMN staging?
whether muscularis propria is invaded
- What are the histologic characteristics of urothelial papilloma?
- In which patients is it more common in?
- Histology:
- Minimally branching delicate papillae with fibrovascular core lined by
- Urothelium of normal thickness and polarity and no significant cytologic atypia.
- Urothelial papilloma is more commonly encountered in young patients
What are the histologic characteristics of papillary urothelial neoplasms with low malignant potential?
- branching discrete papillae with fibrovascular core lined by:
- hyperplastic urothelium with minimal loss of polarity and minimal to absent cytologic atypia
Why would a transurethral resection of bladder tumor (TURBT) or bx be performed?
- Whether tumor is invasive (into lamina propria) or not
- Muscularis propria is / is not present
- If present, it is/ is not invaded by tumor (pT1 vs. pT2)
- Percent involved or whether “specimen is entirely tumor”
- Necrosis
FLAT Intra- Urothelial Neoplasia:
Histology
- Loss of polarity
- Nuclear clustering – touch each other
- Increased nuclear size
- Nuclear pleomorphism
- Increased chromatin granularity
- Scattered nucleoli
How do dysplasia and reactive atypia differ with regards to cancer risk?
- Dysplasia: mildly increased risk of cancer
- Reactive atypia: no increased risk of cancer
- __% with urothelial dysplasia developed biopsy-proven cancer
- __% with carcinoma in situ developed biopsy-proven cancer
- 15% with urothelial dysplasia developed biopsy-proven cancer
- 60% with carcinoma in situ developed biopsy-proven cancer
Upper urothelial tract urothelial carcinoma
- What does it affect?
- How are genetics potentially involved?
-
Renal pelvis and ureter
- Most cases are high grade and half are locally advanced, that is, stage pT2 or higher
- More aggressive – muscle wall is thin
-
Mismatch repair genes (as with Lynch Syndrome – hereditary nonpolyposis colon cancer)
- Instability of at least two microsatellite markers (MSI-high) was detected in 21% of cases
