Male Genital III Flashcards
What is the size of a papillary adenoma of the kidney? what does it look like grossly? what trisomies are popular?
- <5mm
- pale, yellow, discrete, well circumscribed
- 17 and 7
Oncocytomas represent how much of renal tubular neoplasms? Are they mostly asymptomatic or symptomatic? what are the major cytogenics?
- 5%
- asymptomatic-few with hematuria, flank pain, mass
- loss of Ch. 1 and 14
What does a oncocytoma look like grossly?
well circumscribed, mahogany brown, stellate star
What does oncocytoma look like microscopically? tumor cells?
- solid compact, edematous, occasionally acini or tubules
2. Tumor cells are large, with abundant eosinophilic granular cytoplasm, SMAL ROUND NUCLEI with prominent nucleoli
Doe oncocytoma have mitoses on microscopic imaging?
NO NO NO
What represents 85-90% of all renal malignancies in adults?
renal cell carcinoma MALE MORE THAN FEMALE 3:1
What is the major cause of renal cell carcinoma we need to be aware of?
cigarette smoking
obesity, hypertension, asbestos, heavy metals, petroleum, chronic failure
Are most cases of renal cell carcinoma sporadic?
Yes
4% are familial (VHL, hereditary clear cell, hereditary papillary)
Deletion of which chromosome is the major cause of clear cell? What about for papillary renal cell?
- 3p- VHL gene
2. trisomy 7, 16, 17 or loss of Y
What is the gross characteristics of renal clear cell carcinoma?
round, non-encapsulated, bright yellow gray white tissue with hemorrhage and necrosis
GOLDEN COLOR FROM RICH LIPID CONTENT
Is there rich lipid content in renal clear cell carcinoma?
Yes- gives it a golden yellow color
What do clear cell tumor cells look like?
round, polygonal with ABUNDANT CYTOPLASM, variable shaped nuclei, with PROMINENT NUCLEOLI
NUCLEI AREN”T LARGE AND DIVIDING LIKE NORMAL CANCERS
[abundant thin walled vessels throughout too]
What is the most common type of renal cell carcinoma associated with?
in dialysis-associated cystic disease
What is the gross appearance of papillary renal cell carcinoma?
multifocal/bilateral
distinct fibrous tissue capsules
cut surface is friable and necrotic
What is the microscopic appearance of papillary renal cell carcinoma? Macrophages? what other key thing might be found?
cuboidal cells arranged in papillary formations
lipid laden macrophages
Psammoma bodies may be present
What malignant neoplasm has large pale cells with PROMINENT CELL BORDERS and PERINUCLEAR HALOS? Prognosis?
- chromophobe renal cell carcinoma
2. very good prognosis
What neoplasm does the gross image of chromophobe renal cell carcinoma imitate?
oncocytoma
well circumscribed, yellow tan or brown
What is a major characteristic of chromophobe renal cell carcinoma cells?
thick distinct membrane almost like plant cells
What are chromophobe renal cell carcinoma tumor cells positive for?
Hale’s colloidal iron
What neoplasm is defined by nests of malignant cells embedded within fibrotic stroma in a medullary location? what is the prognosis?
- collecting duct carcinoma
2. extremely poor prognosis
What does the microscopic structure of collecting duct carcinoma look like?
- dilated irregular tubules, papilla lined, single layer of atypical cuboidal cells, HOBNAIL PATTERN
Where does collecting duct carcinoma infiltrate?
the surrounding renal parenchyma and produces a large desmoplastic response
What does sarcomatous changes mean for prognosis? what do they look like grossly?
- very poor prognosis
2. bulging, lobulated, soft, fleshy areas
sarcomatoid changes appear as what microscopically? what immunostain are they positive for?
- malignant spindle shaped tumor around glomeruli or other tumor nests
- pankeratin
What percentage of renal cell neoplasm patients present with metastases? where to?
25% -lungs and bones (then lymph, liver, adrenals)
What do we treat metastatic renal cell carcinomas with?
IL-2
What is the most used treatment for renal cell carcinoma?
surgical- nephrectomy
What is a benign neoplasm with a mixture of blood vessels, smooth muscle cells, and adipose tissue? what disease is it associated with? prognosis?
- angiomyolipoma—WOMEN MORE COMMON
- tuberous sclerosis
- excellent prognosis
What is the most common pediatric renal tumor? what mutation is it associated with?
- Wilm’s tumor 85%
2. mutation of WT1 at 11p3
What is the gross view of Wilm’s tumor?
solitary mass with sharply demarcated fibrous tissue capsule
What are the 3 components to Wilm’s triphasic histology?
blastemal- small closely packed blue cells
epithelial- abortive tubules and glomeruli
stromal- myxoid and spindle cells
How often is wilm’s tumor associated with anaplasia? what does this mean?
5%
resistance to chemo
