Kidney Pathology

Question 1

what are the lifestyle causes of renal cell carcinoma?

Answer 1

smoking, obesity, hypertension, occupation, oestrogens, cadmium, irradiation, NSAIDs = SPORADIC

Question 2

what are the genetic causes of renal cell carcinoma?

Answer 2

mutations in VHL (chromosome 3p25) – mutations in pVHL protein = MULTIFOCAL

Question 3

what type of cancer is renal cell carcinoma?

Answer 3

• Adenocarcinoma of epithelial cells in proximal convoluted tubule

Question 4

what is the most common type of renal cell carcinoma?

Answer 4

clear type

Question 5

what is the microscopy of clear cell renal carcinoma?

Answer 5

polygonal epithelial cells with clear cytoplasm filled with carbohydrates + lipids (papillary)

Question 6

what is the invasion of renal cell carcinoma?

Answer 6

o Locally this is very common
o Bone metastasis can occur anywhere in the body
o Lymphatic spread it via the para-aortic nodes.

Question 7

what is the macroscopic features of renal cell carcinoma?

Answer 7

• Large, well circumscribed mass centred on cortex

* Yellow colour with solid, cystic, necrotic, haemorrhage areas

Question 8

what are the clinical features of renal cell carcinoma?

Answer 8

Symptomless until late stage
haematuria, loin pain, abdominal mass, Anorexia, malaise, weight lost, Varicocele, Raised ESR, Polycythaemia, Hypertension, Anaemia, Pyrexia of unknown origin

Question 9

how is renal cell carcinoma diagnosed?

Answer 9

Bloods: FBC, ESR, U&E, ALP, LFTs
Urine: RBCs, cytology
Imaging

Question 10

what imaging is used for renal cell carcinoma?

Answer 10

US, CT/MRI, IVU (filling defect +/ calcification), excretion urography CXR (cannon ball mets)

Question 11

What is the management of renal cell carcinoma?

Answer 11

• T1 = Radical Nephrectomy
• RCC is radio & chemo resistant
• Unresectable or Metastatic = Biological (sunitnib, nevacizumab, sorafenib
• 1st line for multoiple poor risk factors – temsirolimus