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Renal > Kidney and Bladder Pathology > Flashcards

Kidney and Bladder Pathology Flashcards

1
Q

Child vs. Adult Polycystic Kidney Disease

A
  1. Adult form - **Autosomal dominant **- cortical based cysts (picture) 1/500 prevalence
  2. Child form - **Autosomal recessive **- medulla based cysts 1/20,000 prevalence
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2
Q

How can you tell the difference between polycystic kidney disease and acquired cystic kidney disease based on morphology?

A
  • 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
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3
Q

How will hydronephrosis appear morphologically?

A
  • Cortex and medulla compressed to a rim
  • Pelvicalyceal system (pelvis and calyces) are very dilated
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4
Q
  • What is the classic triad for renal cell carcinoma?
  • What are other manifestations for renal cell carcinoma?
A
  • 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)
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5
Q

Main types of renal tumors

  • % of renal cancers & Outcome
A
  • 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
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6
Q

What is the histological difference between Papillary Type I vs. Papillary Type II renal cell cancer?

A
  1. Papillary Type I
    • thin papillae
  2. Papillary Type II
    • thick papillae
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7
Q

What can be seen histologically in chromophobe carcinoma?

A
  • Normal glomerulus
  • Halo around a wrinkled nucleus
  • Binucleate cell
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8
Q
  • What are the characteristics of medullary carcinoma?
  • What is the outcome?
A
  • 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)
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9
Q
  • How is acquired cystic disease associated with renal cancer?
  • What is common histological finding?
A
  • 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
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10
Q

_____ ____ ___________ cancer occurs in end stage kidneys whether cystic or non-cystic

A

Clear Cell (Tubulo)papillary cancer occurs in end stage kidneys whether cystic or non-cystic

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11
Q

Renal Cell Carcinoma Nucleolar Grading:

  1. Grade 1:
  2. Grade 2:
  3. Grade 3:
  4. Grade 4:
A
  1. Grade 1: nuclei are like tiny dots
  2. Grade 2: nucleoli inconsipicuous
  3. Grade 3: nucleoli appreciated at low power
  4. Grade 4: bizarre cells
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12
Q

__________ arises from intercalated cells of collecting duct

A

Oncocytoma arises from intercalated cells of collecting duct

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13
Q
  • What is the most common benign tumour of the kidney?
  • What is its most serious complication?
A

Angiomyolipoma

  • most common serious complication of it is hemorrhage
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14
Q

In which renal tumor will premelanosomes be present?

A

angiomyolipoma

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15
Q

Which renal tumor is almost always pediatric?

A

Wilms tumor

  • Contain a variety of cell and tissue components, all derived from the mesoderm
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16
Q

List the Acquired non-neoplastic anomalies of Urinary Bladder:

A
  • Cystitis cystica/ cystitis glandularis
  • Polypoid and papillary cystitis
  • Nephrogenic adenoma
17
Q
  • What are the characteristics of polypoid and papillary cystitis?
  • How can you distinguish between the them?
A
  • 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
18
Q

What are the characteristics of Nephrogenic Adenoma (Nephrogenic Metaplasia)?

A
  • Males 2:1, can affect children
  • 61% of cases following GU surgery
  • Often associated with chronic cystitis/ longstanding infection
19
Q

Nephrogenic Adenoma is a benign proliferation of …

A

tubules

20
Q

What are the different grades of bladder cancer (flat and papillary) from lower to higher grade?

A
  • 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
21
Q

Bladder TMN Staging:

  • Urothelium:
  • Lamina propria:
  • Muscularis propria:
  • Perivesical fat:
  • Other organs:
A
  • Urothelium:
    • pTIS, pTa
  • Lamina propria:
    • pT1
  • Muscularis propria:
    • pT2a, pT2b
  • Perivesical fat:
    • pT3
  • Other organs:
    • pT4
22
Q

What is the key determinant in bladder TMN staging?

A

whether muscularis propria is invaded

23
Q
  • What are the histologic characteristics of urothelial papilloma?
  • In which patients is it more common in?
A
  • 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
24
Q

What are the histologic characteristics of papillary urothelial neoplasms with low malignant potential?

A
  • branching discrete papillae with fibrovascular core lined by:
    • hyperplastic urothelium with minimal loss of polarity and minimal to absent cytologic atypia
25
Q

Why would a transurethral resection of bladder tumor (TURBT) or bx be performed?

A
  • 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
26
Q

FLAT Intra- Urothelial Neoplasia:

Histology

A
  • Loss of polarity
  • Nuclear clustering – touch each other
  • Increased nuclear size
  • Nuclear pleomorphism
  • Increased chromatin granularity
  • Scattered nucleoli
27
Q

How do dysplasia and reactive atypia differ with regards to cancer risk?

A
  • Dysplasia: mildly increased risk of cancer
  • Reactive atypia: no increased risk of cancer
28
Q
  • __% with urothelial dysplasia developed biopsy-proven cancer
  • __% with carcinoma in situ developed biopsy-proven cancer
A
  • 15% with urothelial dysplasia developed biopsy-proven cancer
  • 60% with carcinoma in situ developed biopsy-proven cancer
29
Q

Upper urothelial tract urothelial carcinoma

  • What does it affect?
  • How are genetics potentially involved?
A
  • 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

Renal (17 decks)

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