L83: Urinary Tumours Flashcards
Kidney tumours
Benign:
- Papillary adenoma
- Angiomyolipoma
- Oncocytoma
Malignant: - Renal cell carcinoma: —> Clear cell type (70-80%) —> Papillary renal cell (10-15%) —> Chromophobe renal cell (5%) —> Collecting duct (<1%) —> Urothelial carcinoma (5-10%) - Nephroblastoma (Wilms tumour)
Papillary adenoma
- Benign
- small, discrete tumour
- <5mm diameter
- asymptomatic
- incidental finding at autopsy
- MUST be distinguished from renal cell carcinoma (malignant)
Angiomyolipoma
- Benign
- Blood vessels + smooth muscle + fat
- **- No capsule, blood vessels enclosed by smooth muscle cells, lobules of adipose tissue
- uncommon
***- originate from Perivascular epithelioid cells (surrounding vessel resembling epithelial cells) - diagnosed incidentally by CT demonstrating fat attenuation
- renal mass
- haematuria
- large tumours can present with haemorrhage and can be fatal (increase size in pregenancy)
- associated with **Tuberous sclerosis
**—> Bilateral and multiple Angiomyolipoma
—> autosomal dominant inheritance
—> Angiomyolipoma in kidney, liver
—> astrocytic tumour in brain
—> rhabdomyoma in heart
Oncocytoma
- Benign
- Solitary
- **- from Intercalated cells of collecting ducts
***- Large eosinophilic cells with small round nuclei and large nucleoli
Renal cell carcinoma
- Top 10 cancer in male
- 5 types:
—> Clear cell type (70-80%)
—> Papillary renal cell (10-15%)
—> Chromophobe renal cell (5%)
—> Collecting duct (<1%)
—> Urothelial carcinoma of renal pelvis (5-10%)
Predisposition:
- smoking, cadmium, asbestos
- Hereditary
—> Von Hippel-Lindau syndrome
—> Hereditary papillary renal cancer syndrome
—> Hereditary leiomyomastosis and renal cell carcinoma syndrome
—> Birt-Hogg Dube syndrome
Symptoms:
- Haematuria, Loin pain, Mass (***Classic Triad)
- Paraneoplastic syndrome (fever, polycythemia)
- Metastasis before symptoms
Spread:
- Local
- Haematogenous via renal vein (lungs, bones)
- Lymphatic (regional lymph nodes)
Outcome:
- 5 year survival: 70%
- Around 95% if no distant metastasis
Clear cell type
- **- mostly clear cells, some with eosinophilic / granular cytoplasm
- **- delicate branching capillary network surrounding tumour cells
- 5% with sarcomatoid change (properties of both epithelial and mesenchymal tumours)
- 95% sporadic (3p deletion at VHL gene)
- associated with Von Hippel Lindau syndrome
—> autosomal dominant
—> cerebellum hemangioblastoma
—> cysts in kidney, liver, pancreas
Papillary renal cell carcinoma
- **- Cuboidal / low columnar cell in papillary formation
- **- Foam cells common in papillary core
- **- Highly vascular stroma
***- arise from Distal tubules
- sporadic (trisomy 7, 17, loss of Y)
- associated with Hereditary papillary renal cancer syndrome
—> autosomal dominant
—> multiple bilateral tumours
—> germline mutation of MET proto-oncogene
Chromophobe renal cell carcinoma
- **- Prominent cell membranes
- **- Pale eosinophilic cytoplasm
- **- Halo around nucleus
- from Intercalated cells of CD (same as benign oncocytoma)
- Monosomies of different chromosomes
- better prognosis than clear cell type and papillary renal cell
Collecting duct carcinoma
- from collecting duct cells in medulla
- Aggressive carcinoma (early metastasis, 50% die within 2 years)
- High NC ratio, dense chromatin
Urothelial carcinoma of renal pelvis
- from transitional urothelium of renal pelvis
- ranges from benign papilloma to invasive urothelial carcinoma
- small upon presentation
—> haematuria
—> blocked urinary outflow (flank pain and hydronephrosis)
***- can affect renal pelvis, ureter, urinary bladder (all lined by urothelium) - infiltration of pelvis and calyces common
Nephroblastoma (Wilms tumour)
- MOST common primary renal tumour of childhood
- 95% before age 10
- 5-10% Bilateral kidney tumours (synchronous / metachronous)
- deletions / mutations of WT1 / WT2 genes
- both on short arm of chromosome 11
- WT1 gene: associated with WAGR and Denys-Drash syndrome
- WT2 gene: Beckwith-Wiedemann syndrome
***Histology:
- Triphasic combination
—> undifferentiated round cells (Blastemal)
—> undifferentiated spindle cells (Stromal)
—> columnar epithelial cells (Epithelial)
Symptoms:
- Haematuria, Pain, Mass
Spread:
- Local, Haematogenous (lungs, liver), Lymphatics (regional lymph nodes)
Treatment:
- Surgical resection +/- Chemotherapy and Radiotherapy
Tumours of lower urinary tract
*** Painless gross haematuria
- **- Urinary bladder most common (renal pelvis, ureter much less common)
- **- Majority —> Urothelial tumour (transitional cell tumour)
- Others —> squamous cell carcinoma, adenocarcinoma
- Middle aged / elderly
- Men: female = 3:1
Risk factors:
- occupational history (aniline dyes, rubber)
- smoking
- analgesic nephropathy
- aristolochic acid
- stones
Urinary bladder tumours
Benign:
- Papilloma
Malignant:
- Papillary / Flat urothelial carcinoma
- Non-invasive / Invasive urothelial carcinoma
Urinary bladder tumours
- Benign
- Urothelial papilloma
- Inverted papilloma
—> 1% of all bladder tumour
—> single and small
***—> finger-like with central fibrovascular core
—> lined by normal urothelium - Malignant
- Papillary vs Flat carcinoma
- Non-invasive vs Invasive
Urothelial carcinoma grading: - High grade vs Low grade (Low/High grade 都可以 invasive) —> increased cellularity —> nuclear crowding —> cellular polarity disturbance —> absence of differentiation from base to surface (no more layers of cells) —> nuclear pleomorphism —> high mitotic rate
Papillary non-invasive urothelial tumours
- Papillary urothelial neoplasm of low malignant potential
- Papillary urothelial carcinoma, low grade (<10% are invasive)
- Papillary urothelial carcinoma, high grade (80% are invasive)
- Larger than papilloma
- Thicker urothelium
- Capable of spreading within urinary system by implantation (Cauliflower like)
