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P&T Block 5 Renal > L61 > Flashcards

L61 Flashcards

1
Q

Renal cell carcinoma:
M v W
Biggest risk factor
Genetic associations

A

M > F
Smoking!!!!
VHL syndrome

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2
Q

RCC symptom triad

A

CVA tenderness
Hematuria
Flank mass

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3
Q

What paraneoplastic effect is most common with RCC?

A

↑EPO -> polycythemia

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4
Q

Remind yourself of the tumors you can see with Von Hippel Lindau

A

Bilat clear cell RCC
Retinal angiomatosis
Cerebellar hemangioblastoma

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5
Q

Describe clear cell RCC

A 
Most common RCC
Unilat
Solid, clear margins mass 
Lipid + glycogen in cells 
Might be in area of necrosis or hemorrhage
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6
Q

Histo clear cell RCC

A

TEST Q: ID the histo for this
Clear to eosinophil granular cytoplasm
Branching vasculature

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7
Q

What is papillary RCC

A

Well circumscribed, encapsulaed
Often @ cortex
+/- necrosis/hemorrhage

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8
Q

Papillary RCC histo

A 
Fibrovasc stalks form papillary structures 
Foamy macrophages (lipid)
Psammoma bodies (calcification)
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9
Q

Genetics of papillary RCC

A 
Sporadic = trisomy of 7 + 16 + 17 + lose Y in men
Hereditary = mutation c-met gene
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10
Q

Gross + histo chromophobe RCC

A 
Well circumscribed mass
Cells w/ plant cell like membranes aka prominent cell membranes
- Halo around nucleus 
- Pale/pink cytoplasm
- Cells in sheets
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11
Q

EM of chromophobe RCC - what might you confuse this with?

A

Cytoplasm filled w/ empty microvesicles

Vs oncocytoma - ↑mitochondria

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12
Q

Genetics of chromophobe RCC

A

Chromosome losses

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13
Q

Describe sarcomatoid RCC

A

Spindle cells + giant cells

Poorly differenitated: worse prognosis

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14
Q

RCC prognosis

A

Good!

Worse if mets - most likely w/ sarcomatoid

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15
Q

How stage RCC

A

Stage 1 + 2 - based on size
Stage 3 - if extended beyond kidney locally
Stage 4 - regional LN involvement

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16
Q

Where are you worried about invasion with RCC?

A

Renal vein

Can creep up the IVC

17
Q

Treat RCC

A

Nephrectomy - complete or partial
Cryotherapy ablation
Resect or chemo for mets

18
Q

Where does urothelial carcinoma arise? Symptoms?

A

From renal pelvis
Hematuria
Hydronephrosis
Histo loos the same as bladder urothelial cancer

19
Q

What is a nephroblastoma? Presentation

A

Wilm’s tumor

Childhood renal tumor

20
Q

Nephroblastoma gross appearance

A 
Sphere, demarcated
@ upper pole of kidney
Tan/grey
\+/- Hemorrhage, necrosis, cysts
Often will extend beyond renal capsule
21
Q

Histo nephroblastoma

A

Small blue cells

Aspects of other embryo tissues: muscle, fat, bone

22
Q

What is anaplasia?

A

A nephroblastoma may or may not demonstrate anaplasia - will resist chemo
Atypical mitosis and/or large, dark nuclei 3x size of normal

23
Q

What is the precursor of a Wilm’s tumor?

A

Nephrogenic rest = small small blue cell lesion

Watch BOTH kidneys for development of Wilm’s tumor

24
Q

Genetics of nephroblastoma

A

Chromosome 11 mutate/delete

25
Q

What is the WAGR dysmorphic syndrome?

A

Wilms tumor
Aniridia - no iris in the eye
GU malformation
mental Retardation

26
Q

Treat nephroblastoma + common mets site

A

Met to lungs
Good outcome unless tumor w/ anaplasia
Surg + chemo

27
Q

Name 3 benign renal tumors

A
  1. Renal papillary adenoma - asymptomatic + benign version of papillary RCC (smaller lesion)
  2. Oncocytoma - asymptomatic, vs RCC
  3. Angiomyolipoma - BV + SM + fat, tuberous sclerosis
28
Q

Describe oncocytoma grossly

A

Central scar

Well circumscribed - but no capsule, histo shows ending right next to normal kidney

29
Q

Tuberous sclerosis lesions

A 
Hamartomas CNS
Ash leaf patches, cutaneous angio-fibromas
Angiomyolipomas in kidney
Retinal glial hamartoma
Cardiac rhabdomyoma
30
Q

Describe simple renal cysts

A

1+, clear fluid

Observation but rule out cysts associated with RCC

P&T Block 5 Renal (30 decks)

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