Kidney, Bladder Cancer

Question 1

what do the following symptoms suggest about the cause of a patient’s hematuria?
a. flank pain alone
b. flank pain + ureteral colic
c. dysuria, frequency, urgency

Answer 1

a. flank pain alone: acute urinary obstruction, vascular event
b. flank pain + ureteral colic: kidney stones
c. dysuria, frequency, urgency: UTI

Question 2

recent onset of hematuria in a patient older than 35 is a red flag for…

Answer 2

malignancy

Question 3

benign mesenchymal tumor derived from pericytes

Answer 3

angiomyolipoma - composed of thick blood vessels (angio-), spindle smooth muscle cells (-myo-), adipose (-lipo)

majority are asymptomatic but can cause hemorrhage or mass effect (flank pain)

size is determinant for intervention

Question 4

what drug can be used to treat tuberous sclerosis, which is associated with renal angiomyolipoma?

Answer 4

tuberous sclerosis: mutation in TSC1-TSC2 complex, downstream target of which is mTOR

everolimus (mTOR inhibitor) is first ever treatment for tuberous sclerosis

Question 5

what is the most common renal benign tumor?

Answer 5

oncocytoma: arises from intercalated cells of collecting ducts, benign but can grow large

unilateral/single if sporadic, multiple/bilateral if associated with tuberous sclerosis or Birt-Hogg-Dube syndrome

Question 6

how do biopsies of oncocytoma appear?

Answer 6

oncocytoma: benign renal tumor of intercalated cells of collecting duct

can grow very large - eosinophilic cells with small nuclei and large nucleoli, many mitochondria

brown color and central stellate scar

Question 7

Pt is a 78yo M presenting with painless hematuria, flank pain, and a palpable abdominal mass. Biopsy shows large eosinophilic cells, and the tumor has a brown color with a central stellate scar. What kind of tumor does the patient have?

Answer 7

oncocytoma: benign renal tumor of intercalated cells of collecting duct

can grow very large - eosinophilic cells with small nuclei and large nucleoli, many mitochondria

most common renal benign tumor

Question 8

from what portion of the kidneys do renal cell carcinomas vs transitional cell carcinomas arise?

Answer 8

renal cell - arise in renal cortex, 90% of renal neoplasms

transitional cell - arise from renal pelvis

Question 9

what occupational exposures are associated with renal cell carcinoma?

Answer 9

asbestos, petroleum products, heavy metals

[sporadic in most patients]

Question 10

what chromosome deletion is associated with clear cell carcinoma?

Answer 10

clear cell carcinoma: most common renal cell carcinoma, cells appear clear because of glycogen and lipids

deletion of p arm of chromosome 3 - VHL gene (tumor suppressor) —> VEGF is therapeutic target

Question 11

from which cells does sporadic clear cell carcinoma arise and how does it appear on gross examination?

Answer 11

clear cell carcinoma: most common renal cell carcinoma, cells appear clear because of glycogen and lipids

arises from proximal tubular epithelium, most common affecting upper pole (single/unilateral when sporadic)

grossly appears bright yellow due to lipid accumulation

Question 12

what mutation is linked to familial renal papillary carcinoma?

Answer 12

papillary carcinoma: type of renal cell carcinoma, arises from DCT, cuboidal/columnar cells in papillary formations with psammoma bodies, more commonly multifocal/bilateral

familial form linked to MET gene mutation

Question 13

what are the general clinical manifestations of bladder cancer? (3)

Answer 13

1. painless gross hematuria - MUST rule out cancer in patients 40+
2. irritative bladder symptoms - dysuria, urgency, frequency
3. pelvic pain/ lower-extremity edema/ flank pain (advanced disease)