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%)
