L61 Flashcards
Renal cell carcinoma:
M v W
Biggest risk factor
Genetic associations
M > F
Smoking!!!!
VHL syndrome
RCC symptom triad
CVA tenderness
Hematuria
Flank mass
What paraneoplastic effect is most common with RCC?
↑EPO -> polycythemia
Remind yourself of the tumors you can see with Von Hippel Lindau
Bilat clear cell RCC
Retinal angiomatosis
Cerebellar hemangioblastoma
Describe clear cell RCC
Most common RCC Unilat Solid, clear margins mass Lipid + glycogen in cells Might be in area of necrosis or hemorrhage
Histo clear cell RCC
TEST Q: ID the histo for this
Clear to eosinophil granular cytoplasm
Branching vasculature
What is papillary RCC
Well circumscribed, encapsulaed
Often @ cortex
+/- necrosis/hemorrhage
Papillary RCC histo
Fibrovasc stalks form papillary structures Foamy macrophages (lipid) Psammoma bodies (calcification)
Genetics of papillary RCC
Sporadic = trisomy of 7 + 16 + 17 + lose Y in men Hereditary = mutation c-met gene
Gross + histo chromophobe RCC
Well circumscribed mass Cells w/ plant cell like membranes aka prominent cell membranes - Halo around nucleus - Pale/pink cytoplasm - Cells in sheets
EM of chromophobe RCC - what might you confuse this with?
Cytoplasm filled w/ empty microvesicles
Vs oncocytoma - ↑mitochondria
Genetics of chromophobe RCC
Chromosome losses
Describe sarcomatoid RCC
Spindle cells + giant cells
Poorly differenitated: worse prognosis
RCC prognosis
Good!
Worse if mets - most likely w/ sarcomatoid
How stage RCC
Stage 1 + 2 - based on size
Stage 3 - if extended beyond kidney locally
Stage 4 - regional LN involvement
Where are you worried about invasion with RCC?
Renal vein
Can creep up the IVC
Treat RCC
Nephrectomy - complete or partial
Cryotherapy ablation
Resect or chemo for mets
Where does urothelial carcinoma arise? Symptoms?
From renal pelvis
Hematuria
Hydronephrosis
Histo loos the same as bladder urothelial cancer
What is a nephroblastoma? Presentation
Wilm’s tumor
Childhood renal tumor
Nephroblastoma gross appearance
Sphere, demarcated @ upper pole of kidney Tan/grey \+/- Hemorrhage, necrosis, cysts Often will extend beyond renal capsule
Histo nephroblastoma
Small blue cells
Aspects of other embryo tissues: muscle, fat, bone
What is anaplasia?
A nephroblastoma may or may not demonstrate anaplasia - will resist chemo
Atypical mitosis and/or large, dark nuclei 3x size of normal
What is the precursor of a Wilm’s tumor?
Nephrogenic rest = small small blue cell lesion
Watch BOTH kidneys for development of Wilm’s tumor
Genetics of nephroblastoma
Chromosome 11 mutate/delete
What is the WAGR dysmorphic syndrome?
Wilms tumor
Aniridia - no iris in the eye
GU malformation
mental Retardation
Treat nephroblastoma + common mets site
Met to lungs
Good outcome unless tumor w/ anaplasia
Surg + chemo
Name 3 benign renal tumors
- Renal papillary adenoma - asymptomatic + benign version of papillary RCC (smaller lesion)
- Oncocytoma - asymptomatic, vs RCC
- Angiomyolipoma - BV + SM + fat, tuberous sclerosis
Describe oncocytoma grossly
Central scar
Well circumscribed - but no capsule, histo shows ending right next to normal kidney
Tuberous sclerosis lesions
Hamartomas CNS Ash leaf patches, cutaneous angio-fibromas Angiomyolipomas in kidney Retinal glial hamartoma Cardiac rhabdomyoma
Describe simple renal cysts
1+, clear fluid
Observation but rule out cysts associated with RCC
