Malignant Tumours of the urinary tract

Question 1

What are the 4 types of renal cancer? How prevalent is each type?

Answer 1

Clear cell carcinoma 75% Papillary carcinoma 10-15% Chromophobe cell carcinoma 5% Collecting duct carcinoma (high mortality rate)

Question 2

Which gene is closely associated with CCC?

Answer 2

von Hippel Lindau

Question 3

What is the difference between the two types papillary carcinoma?

Answer 3

Type 1- association with MET-proto oncogene. Less aggressive Type 2- association with FH gene. Generally more aggressive

Question 4

How does papillary carcinoma present on microscopy?

Answer 4

The name is from microscopic finger-like projections (called papillae) in some, if not most, of the tumours.

Question 5

How do chromophobe renal cell carcinomas present on histology?

Answer 5

Classic chromophobe RCC cells have flocculent cytoplasm (pale or reticulated, not-optically clear as in clear cell RCC) that condenses around the edges, giving the appearance of thick prominent cell borders (“plant cell-like”) (image B). Cells grow in larger nests (larger than in renal oncocytoma and without the “chicken wire” vessels of clear cell RCC).

Question 6

How do papillary carcinomas present on histology?

Answer 6

Characterized by papillae with central fibrovascular core (true papillae) containing foamy histiocytes lined by single layer of cells. Tumor cells have either basophilic cytoplasm (type 1) or abundant eosinophilic (type 2) cytoplasm. Nuclei are round, small, with low-grade appearance. ~1/2 of tumors may have solid (non-papillary) growth consisting of tubules and “glomeruloid” growth.

Question 7

How do clear cell carcinomas present on histology?

Answer 7

Water-clear or optically-clear cells (due to glycogen content) arranged in nests in “chicken wire” vasculatures. Delicate capillary often ruptures during surgical manipulation, resulting in formation of “blood lakes” within tumor cell nests. Some cells may have granular eosinophilic cytoplasm (not all clear cell RCC have clear cytoplasm! – in the past was called “granular cell RCC”). May develop sarcomatoid change (like all other RCC) and most often shows high-grade spindle cell morphology; more aggressive behavior.

Question 8

What is the histology of collecting duct carcinomas?

Answer 8

Variable but usually has infiltrative glandular/tubular or papillary architectures. Presence of desmoplastic stroma. (In contrast to most RCC) High-grade cytology with abundant mitosis. “Hobnail” appearance of the cells lining (when you can find it).

Question 9

How is clear cell carcinoma staged?

Answer 9

Staged through nuclear grading (1 is good 4 is bad) TNM is also used with passage through Gerota’s fascia indicating T4

Question 10

What is the most prevalent carcinoma of children?

Answer 10

Wilm’s tumour

Question 11

What are the 3 components of a Wilm’s tumour?

Answer 11

Blastema: sheets of densely packed primitive small cells with scant cytoplasm and darkly staining nuclei (“small round blue cell tumor”) (image B) & (image C). Epithelial: small tubules or cysts lined by primitive or mature columnar or cuboidal cells. Stroma: spindle cells or may differentiate along the lines of any soft tissue such as fibroblasts, smooth muscles or skeletal muscles, cartilage (image D); loose myxoid and fibroblastic spindle cell stromas are the most common.

Question 12

What is the epithelial lining of the urinary tract?

Answer 12

Transitional epithelium

Question 13

What is the most common type of urothelial cancer?

Answer 13

Bladder

Question 14

What are the 3 layers of the urothelium?

Answer 14

Umbrella cells Intermediate cells Basal cells

Question 15

What are the two main types of bladder cancer?

Answer 15

Papillary carcinoma- typically p53 mutation independent and grows into the lumen of the bladder, Not typically as aggressive. P53 mutation dependent tumours tend to grow flat to the surface and invade the deeper tissues.

Question 16

The acronym PeeSAC can be used to remember common risk factors for bladder cancers. What do the letters stand for?

Answer 16

P-Phenacetin (banned analgesic) S- Smoking A- Analine (used in dyes and rubber factories) C- Cyclophosphamide

Question 17

What are the zones of the prostate?

Answer 17

Peripheral zone- largest and contains 70% of the prostates glandular tissue Central zone- 25% of glandular tissue and the ejaculatory ducts which join the prostatic urethra Transitional zone contains 5% of the glandular tissue and is lined by transitional epithelium

Question 18

Which zone increases in benign prostatic hyperplasia?

Answer 18

Transitional zone

Question 19

In which zone do prostatic adenocarcinomas typically develop?

Answer 19

Peripheral zone

Question 20

What are the two other rarer types of prostate carcinoma? From which cells do they originate

Answer 20

Transitional cell carcinoma and the transitional zone. Small cell carcinoma and the neuroendocrine cells.

Question 21

What is the gold standard of diagnosis for prostate cancer?

Answer 21

Transrectal needle core biopsy on USS guidance

Question 22

What is the Gleason score?

Answer 22

The Gleason Score is the grading system used to determine the aggressiveness of prostate cancer. … The higher the Gleason Score, the more likely that the cancer will grow and spread quickly. Scores of 6 or less describe cancer cells that look similar to normal cells and suggest that the cancer is likely to grow slowly. 2 samples must be taken.