Male Genital III

Question 1

What is the size of a papillary adenoma of the kidney? what does it look like grossly? what trisomies are popular?

Answer 1

1. <5mm
2. pale, yellow, discrete, well circumscribed
3. 17 and 7

Question 2

Oncocytomas represent how much of renal tubular neoplasms? Are they mostly asymptomatic or symptomatic? what are the major cytogenics?

Answer 2

1. 5%
2. asymptomatic-few with hematuria, flank pain, mass
3. loss of Ch. 1 and 14

Question 3

What does a oncocytoma look like grossly?

Answer 3

well circumscribed, mahogany brown, stellate star

Question 4

What does oncocytoma look like microscopically? tumor cells?

Answer 4

1. solid compact, edematous, occasionally acini or tubules

2. Tumor cells are large, with abundant eosinophilic granular cytoplasm, SMAL ROUND NUCLEI with prominent nucleoli

Question 5

Doe oncocytoma have mitoses on microscopic imaging?

Answer 5

NO NO NO

Question 6

What represents 85-90% of all renal malignancies in adults?

Answer 6

renal cell carcinoma MALE MORE THAN FEMALE 3:1

Question 7

What is the major cause of renal cell carcinoma we need to be aware of?

Answer 7

cigarette smoking

obesity, hypertension, asbestos, heavy metals, petroleum, chronic failure

Question 8

Are most cases of renal cell carcinoma sporadic?

Answer 8

Yes

4% are familial (VHL, hereditary clear cell, hereditary papillary)

Question 9

Deletion of which chromosome is the major cause of clear cell? What about for papillary renal cell?

Answer 9

1. 3p- VHL gene

2. trisomy 7, 16, 17 or loss of Y

Question 10

What is the gross characteristics of renal clear cell carcinoma?

Answer 10

round, non-encapsulated, bright yellow gray white tissue with hemorrhage and necrosis

GOLDEN COLOR FROM RICH LIPID CONTENT

Question 11

Is there rich lipid content in renal clear cell carcinoma?

Answer 11

Yes- gives it a golden yellow color

Question 12

What do clear cell tumor cells look like?

Answer 12

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]

Question 13

What is the most common type of renal cell carcinoma associated with?

Answer 13

in dialysis-associated cystic disease

Question 14

What is the gross appearance of papillary renal cell carcinoma?

Answer 14

multifocal/bilateral
distinct fibrous tissue capsules
cut surface is friable and necrotic

Question 15

What is the microscopic appearance of papillary renal cell carcinoma? Macrophages? what other key thing might be found?

Answer 15

cuboidal cells arranged in papillary formations
lipid laden macrophages
Psammoma bodies may be present

Question 16

What malignant neoplasm has large pale cells with PROMINENT CELL BORDERS and PERINUCLEAR HALOS? Prognosis?

Answer 16

1. chromophobe renal cell carcinoma

2. very good prognosis

Question 17

What neoplasm does the gross image of chromophobe renal cell carcinoma imitate?

Answer 17

oncocytoma

well circumscribed, yellow tan or brown

Question 18

What is a major characteristic of chromophobe renal cell carcinoma cells?

Answer 18

thick distinct membrane almost like plant cells

Question 19

What are chromophobe renal cell carcinoma tumor cells positive for?

Answer 19

Hale’s colloidal iron

Question 20

What neoplasm is defined by nests of malignant cells embedded within fibrotic stroma in a medullary location? what is the prognosis?

Answer 20

1. collecting duct carcinoma

2. extremely poor prognosis

Question 21

What does the microscopic structure of collecting duct carcinoma look like?

Answer 21

1. dilated irregular tubules, papilla lined, single layer of atypical cuboidal cells, HOBNAIL PATTERN

Question 22

Where does collecting duct carcinoma infiltrate?

Answer 22

the surrounding renal parenchyma and produces a large desmoplastic response

Question 23

What does sarcomatous changes mean for prognosis? what do they look like grossly?

Answer 23

1. very poor prognosis

2. bulging, lobulated, soft, fleshy areas

Question 24

sarcomatoid changes appear as what microscopically? what immunostain are they positive for?

Answer 24

1. malignant spindle shaped tumor around glomeruli or other tumor nests
2. pankeratin

Question 25

What percentage of renal cell neoplasm patients present with metastases? where to?

Answer 25

25% -lungs and bones (then lymph, liver, adrenals)

Question 26

What do we treat metastatic renal cell carcinomas with?

Answer 26

IL-2

Question 27

What is the most used treatment for renal cell carcinoma?

Answer 27

surgical- nephrectomy

Question 28

What is a benign neoplasm with a mixture of blood vessels, smooth muscle cells, and adipose tissue? what disease is it associated with? prognosis?

Answer 28

1. angiomyolipoma—WOMEN MORE COMMON
2. tuberous sclerosis
3. excellent prognosis

Question 29

What is the most common pediatric renal tumor? what mutation is it associated with?

Answer 29

1. Wilm’s tumor 85%

2. mutation of WT1 at 11p3

Question 30

What is the gross view of Wilm’s tumor?

Answer 30

solitary mass with sharply demarcated fibrous tissue capsule

Question 31

What are the 3 components to Wilm’s triphasic histology?

Answer 31

blastemal- small closely packed blue cells
epithelial- abortive tubules and glomeruli
stromal- myxoid and spindle cells

Question 32

How often is wilm’s tumor associated with anaplasia? what does this mean?

Answer 32

5%

resistance to chemo