L25 Tumors of kidney and urinary tracts Flashcards
Tumors of the kidneys can be divided into 3 types - Tumor-like lesions, benign tumors and malignant tumors.
Name the 2 tumor-like lesions.
- Xanthogranulomatous pyelonephritis (XGP)
2. Angiomyolipoma
Tumors of the kidneys can be divided into 3 types - Tumor-like lesions, benign tumors and malignant tumors.
Name the 3 benign tumors.
- Renal papillary adenoma
- Oncocytoma
- Medullary fibroma
Tumors of the kidneys can be divided into 3 types - Tumor-like lesions, benign tumors and malignant tumors.
Name the 3 malignant tumors.
- Renal cell carcinoma (RCC)
- Urothelial carcinoma
- Wilms tumor
Xanthogranulomatous pyelonephritis is the infection of renal parenchyma and tubes. Xanthogranulomatous refers to the histology of?
Macroscopically: kidneys are enlarged with yellow nodules
Granulomatous inflammation with 1. aggregates of foamy macrophages
- Atrophy and loss of functional parenchyma
Angiomyolipoma is
A. a harmatoma
B. Triad of Mental retardation, seizures and skin lesions
C. Associated with mutation in TSC1, TSC2 encoding tumor suppressors hamartin and tuberin
D. MC sporadic in cause or due to tuberous sclerosis (genetic)
E. Consists of blood and fat only
E is wrong: with muscle too;
vessels + smooth muscle + fat malformation in microscopy
Which of the following about benign tumors of the kidneys are correct?
A. Renal papillary adenoma usually asymptomatic
B. There are single of multiple nodules in renal papillary adenoma of <1cm at the cortex
C. Renal papillary adenoma shows papillary of tubular pattern microscopically
D. Oncocytoma is due to oncocytes (epithelial cell) with excessive mitochondria
E. Oncocytoma can be distinguished from RCC easily by biopsy.
E is incorrect
- difficult to distinguish, determined only by evidence of metastasis/ aggressive infiltration to adjacent structures
Oncocytoma are benign kidney tumors that are _________ in color macroscopically, with pseudo-capsule compressing normal parenchyma.
Microscopically, there are eosinophilic cells of abundant __________.
dark brown;
mitochondria
Medullary fibroma
A. is benign
B. is non-functioning, incidental finding
C. is whitish macroscopically
D. is > 1cm
E. shows hyalinized fibrous nodule microscopically
D
<1cm
What is the typical triad in renal cell carcinoma?
- Haematuria
- loin pain
- palpale renal mass
What is paraneoplastic syndrome of RCC?
- Polycythaemia (increased erythropoietin)
- Hypercalcemia (increased PTHrP)
- Hypertension (increased renin)
MC metastasis from RCC?
Lung (MC)
Bone
Risk factors of RCC?
- Smoking
- Obesity
- HT
- Chronic kidney disease
But mostly sporadic
5% of RCC is hereditary: von Hippel-Lindu disease (VHL) that is a mutation in VHL ___________gene, causing increased hypoxia inducible factor 1alpha, thus increased VEGF and other tumorigenic factors like IGF-1 > Dysregulated cell growth and angiogenesis.
tumor suppressor
von Hippel Lindu disease can cause other diseases (Hippel) - haemangioblastoma - islet cell carcinoma (pancreatic NET) - pheochromocytoma - Paraganglioma - Epididymal tumor - Liver cysts
How do we classify RCC? (4) (by what method (1) )
Microscopic
1. clear cell carcinoma (MC) - lipid, glycogen
- papillary cell carcinoma
- chromophobe carcinoma (does not stain readily, appears pale)
- collecting duct carcinom
Macroscopically, RCC is homogenous/heterogenous with areas of haemorrhage, _________(color) tissue and cystic areas.
Heterogenous;
yellowish