L15- Renal and Bladder Tumors Flashcards
list the common benign renal tumors
- renal adenoma
- renal oncocytoma
- angiomyolipoma
list the common malignant renal tumors
- renal cell carcinoma (90%, RCCa)
- urothelial carcinoma (TCCa)
-Wilm’s Tumor / Nephroblastoma (in children)
Angiomyolipoma is a (benign/malignant) tumor and is considered triphasic because it (2). 50% present with (3) which is usually (4). Some present sporadically and occur with (5).
(most common benign tumor) 1- benign (rarely malignant) 2- involves muscle, fat, vessels 3- tuberous sclerosis (25 yrs) 4- asymptomatic, small in size 5- (45 yrs) flank pain, mass, hematuria, retroperitoneal hemorrhage (good prognosis, treat by excision)
The most common kidney cancer is (1) and it is a (benign/malignant) tumor of the (3). The majority of tumors are described as (single/multiple), (uni/bi)-lateral, (predictable/sporadic).
1- RCCa (renal cell carcinoma- 90%)
2- malignant
3- tubular epithelial cells
4- single, unilateral, and sporadic (majority, some are syndrome related)
(1)% of RCCa is hereditary with the following 3 types: (2)
1- 5% 2- i) Autosomal Dominant RCCa ii) Von-Hippel-Lindau disease (VHL) iii) hereditary papillary RCCa (multiple and bilateral found in younger people)
glial cell RCCa are most common
RCCa mostly in occurs in (1) age group among (males/females) most.
1- 50s
2- males > females (2:1)
RCCa usually presents with (1) as the most common sign with (2) as a very seldom accompanied sign. One of the most distinguishing features is that RCCa causes (3).
1- hematuria
2- flank pain, (palpable mass <10% of Pts)
3- paraneoplastic syndrome
describe the related issues of RCCa and paraneoplastic syndrome
- polycythemia (EPO)
- HTN (renin)
- hypercalcemia (PTH)
- Cushing’s syndrome (ACTH)
- leukemoid rxn (leukoxytosis)
- amyloidosis
RCCa is diagnosed via….
- renal US
- CT
- IV pyelography
- biopsy
RCCa is graded based on (1).
Describe the 4 stages of RCCa: (2)
1- nucleus appearance: Fuhrman 1-4
2-
Stage I) confined to kidney (5yrs, 60-80%)
II) perirenal fat (5yrs, 40-70%)
III) lymph node + IVC (5yrs, 10-40%)
IV) adjacent organs / metastasis (5yrs, 5%)
RCCa is treated by….
nephrectomy (radical or partial)
(1) is the most common solid tumor in children, usually affecting them before (2) y/o. It is the result of a (3) mutation.
1- Wilm’s Tumor
2- <6 y/o (90%)
3- 2 mutated suppressor genes (WT1/WT2 loss of function mutations; *somatic mutation, not inherited)
Wilm’s tumor appears (1) on gross inspection. It is considered to have a triphasic pattern because (2). (3) is the main description of cell status upon microscopic investigation.
1- single, well circumscribed, encapsulated, soft, fleshy, grey-white/tan
2- it involves blastema, stroma, epithelial (tubular structure and glomeruli)
3- anaplasia (nuclear size is 3x bigger, abnormal mitosis)
list and briefly describe the 3 congenital abnormalities involved with the bladder (malformations)
- Extrophy: bladder protrudes out of abdomen wall
- Diverticula: extra pouch stemming from bladder wall (through the muscle, inc chance for infection, renal stones)
- Urachus: remnant of allantois which drained fetal bladder via umbilical cord (urine from navel and cyst in canal is common)
list the 3 inflammatory (infectious) lesions of the bladder
- acute cystitis
- chronic interstitial cystitis
- malacoplakia
Cystitis (acute) is more common in (males/females) because of (2).
1- females
2- short urethra
list the common pre-disposing factors that help lead to cystitis (acute)
(females > males, short urethra)
- DM
- instrumentation (catheter, cystoscopy)
- bladder calculi (stones)
- bladder outlet obstruction (BPH)
Cystitis (acute) is usually secondary to (1), but it can also occur as a result of (2).
1- Infection:
- bacteria: E.Coli, Proteus, Klebsiella, Enterobacter
- fungus: Candida
- parasite: Schistoma hematobium
2- Iatrogenic: chemotherapy, radiation => hemorrhagic cystitis
list the symptoms / clinical presentation of cystitis (acute)
- urinary frequency (up to 20 times daily)
- dysuria (pain or burning micturition)
- microhematuria
- pain over bladder / suprapubic pain
- fever, chills
(Dx via UA)
Chronic interstitial cystitis is caused by (1) and is most common in (2) people (age/gender).
1- unknown
2- middle aged women
list the signs and symptoms of chronic interstitial cystitis
- suprapubic pain (pain with bladder filling)
- urinary frequency / urgency
- nocturia, hematuria
Chronic interstitial cystitis has (1) appearance on cystoscopy and (2) via pathological examination
1- edema, hemorrhage, ulceration
2- chronic inflammation, mast cells
list the 3 types of urothelial neoplasms (indicate if usually benign or malignant)
- Epithelial
- Mesenchymal (sarcomas, bengin or malignant, not kidney)
- secondary tumors (metastatic tumors via kidney, not common)
list the breakdown of epithelial tumors
Benign: urothelial papilloma
Malignant: urothelial carcinoma (TCCa, 90%), SCC (via infection, 7%), adenocarcinoma (via Urachus, 1-2%)
describe the 4 types of gross features of urothelial tumors (aka the 4 classifications)
i) Papilloma (papillary carcinoma)
ii) Invasive papillary carcinoma
iii) flat noninvasive carcinoma (carcinoma in situ, serious dysplasia)
iv) flat invasive carcinoma
Urothelial carcinomas, aka (1), are most common in (2) age group and more common in (males/females). It is also associated with the following mutations: (4).
1- TCCa (transitional cell carcinoma)
2- 50-80 y/o
3- males > females, 3:1
4- p53, Rb, p16 genes
list the risk factors for bladder cancer
- Smoking: biggest factor, inc 2x
- Drugs: analgesic abuse (phenacetin), cyclophosphamide
- Chemicals (in workplace): naphthylamine, rubber
- Infections: schistosomiasis (parasite)
list the clinical features of urothelial carcinoma
- painless hematuria (70-90%)
- dysuria (20%)
- urinary urgency / frequency
- flank pain
- metastatic disease (up to 20%)
(1) is the most common bladder tumor. It grows (endo/exo)-phytic and is a (high/low) grade tumor with (superficial/deep) invasion, (no/single/multiple) recurrences, and is describes as (uni/multi)-focal in terms of the urinary tract.
1- Papillary carcinoma (75%)
exophytic, both low/high grade, superficial invasion, multiple recurrences, multifocal (multiple locations on urinary tract)
flat noninvasive urothelial carcinoma is also called…
carcinoma in situ (CIS)
Most invasive urothelial carcinomas are (flat/papillary) and are (high/low) grade tumors with frequent metastasis to (3), therefore giving it a (good/poor) prognosis.
1- flat (papillary is ~10% of invasives)
2- high grade (poor differentiation)
3- regional nodes, liver, lung, bone
4- poor prognosis
describe the treatment for urothelial carcinomas based on stage
i) CIS: TUR (transurethral ressection) if localized, chemotherapy if multifocal
ii) noninvasive papillary: TUR
iii) invasive CA: TUR if superficial, surgical/cystectomy if deep, radiotherapy
iv) metastatic CA: chemotherapy
list the prognostic factors affecting Stage and Grade of urothelial carcinomas
Stage: depth of invasion of bladder wall, nodal metastases, distant metastases
Grade (via architecture and cytology): low and high grade
The 5 yr survival rate for urothelial carcinomas is (1).
- (2) for 10 yr rate in low grade tumors
- (3) for 10 yr rate in high grade tumors
- (4) for 5 yr rate in deeply invasive tumors
1- 57%
2- 98%
3- 40%
4- 20%
SCC urothelial neoplasm is a (primary/secondary) tumor, mostly caused by (2) and has a (good/bad) prognosis
1- primary (5% of total)
2- Schistosoma Hematobium (parasite)
3- bad, the worst prognosis
