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
RCC
A. Fuhrman staging (by nuclear size)
B. Surgical resection
C. VEGF inhibitor for RCC with VHL gene mutation only
D. INF-alpha for anti-viral, immunomodulatory and antiproliferative activates
E. T4 means extended into perinephric tissues or major veins
E is inaccurate
TNM staging:
T1: < 7cm, within kidney
T2: > 7cm, within kidney
T3: extend into perinephric tissues or major veins
T4: beyond Gerota’s fascia (encapsulation the kidneys and adrenal)
For tumors of the urinary tract, it can be divided into 3 types - Tumor-like lesions, benign tumors and malignant tumors.
Malakoplakia and metaplasia are the 2 tumor-like lesions.
Name the benign tumors. (2) Briefly describe
- Urothelial papilloma
- Exophytic: tend to grow outward beyond the surface epithelium from which it originates - Inverted papilloma
- Endophytic: tend to grow inward into tissues in fingerlike projections from a superficial site of origin
What is the most common urinary tract CA?
Urothelial cell carcinoma (UCC)/ Transitional cell carcinoma (TCC)
Where are the most common sites of urothelial cell carcinoma?
MC: Urethra and bladder;
Others: renal pelvis, ureter
What are the typical signs and symptoms of urothelial cell carcinoma?
Painless haematuria;
recurrent UTI
What are the risk factors for urothelial cell carcinoma?
- Environmental
- Smoking MC
- alcohol abuse
- cyclophosphamide (chemotherapy for immunosuppression)
- industrial carcinogens - Infection
- schistosoma haematobium - Genetic mutations
What are the different genetic mutations related to urothelial cell carcinoma? (2) Briefly describe
- p53 dependent
- flat tumor
- invasive - p53 independent
- papillary tumor
- less aggressive but can be invasive
What is field effect in urothelial cell carcinoma ?
Entire urothelial field is exposed to the same carcinogens
- multifocal lesion and high recurrence
What is the staging system for urothelial cell carcinoma?
Which stage is of clinical significance?
- TNM Staging
- Ta non-invasive papillary carcinoma
- Tis non-invasive flat carcinoma in situ
T1: invade lamina propria
***T2: invade muscularis propria (significant impact on treatment plan: T2: radical cystectomy)
T3: perivesical fat
T4: invade adjacent structures
N>=1 or M1: Stage 4
The WHO grading system grades urothelial cell carcinoma by?
(Grading is an important prognosticator of non-invasive tumours. It is not improtant in invasive tumours, as almost all invasive tumours are high grade.)
Degree of cellular atypia
- Papilloma
- e.g. benign inverted papilloma, which is entirely benign and not associated with an increased risk for subsequent carcinoma - Papillary urothelial neoplasm of low malignant potential
- lower change to progress into malignancies - Low grade papillary urothelial carcinoma
- High grade papillary urothelial carcinoma
Which of the following about tumors of urinary tract is correct?
A. Squamous cell carcinoma accounts fo 5% of the urinary tract tumors.
B. Most common cause of SCC of the urinary tract is schistosomiasis.
C. Adenocarcinoma most commonly arises from tracheal remnants with extensive intestinal metaplasia
D. Rhabdomyosarcoma is the MC sarcoma in adults
D is incorrect: in children
B: Schistosomiasis > squamous metaplasia > SCC
