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Renal Exam > Neoplasms of Kidney and Bladder > Flashcards

Neoplasms of Kidney and Bladder Flashcards

1
Q

Key differences in Adult form auto.dominant PKD vs auto.recessive PKD vs aquired cystic diseaes

A

Adult form- Autosomal dominant- cortical based cysts (picture) 1/500 prevalence
Child form- Autosomal recessive- medulla based cysts 1/20,000 prevalence

Aquired cycstic disease: dialysis pts, kidneys don’t get so big

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2
Q

What changes do we see in hydronephrosis?

A

Cortex and medulla compressed to a rim

Pelvicalyceal system (pelvis and calyces) are very dilated

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3
Q

Kidney cancer is ____ most common and ____ leading cause in death from cancer for men.

(also serious in women)

A

6th

10th

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4
Q

Classic triad for renal cell carcinoma

*most prominent feature?

A

Painless hematuria, a palpable abdominal mass, and dull flank pain is classic triad
- Most frequent presenting manifestation is hematuria (gross or microscopic), occurring in more than 50% of cases

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5
Q

In Renal cell carcinoma, polycythemia in 5% to 10% of cases due to

A

erythropoietin production by the tumor (paraneoplastic syndrome)

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6
Q

Most frequent benign kidney tumor

A

Angiomylolipoma

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7
Q

represents 83% of renal cell carcinomas with the second worst outcome

The worst outcome is:

A

Clear cell

worst outcome = Collecting duct (subtype: medullary)

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8
Q

kidney tumor that is NOT cancer but occurs at 5-10% of the rate of kidney cancer

A

Renal oncocytoma; benign, rarely recurs

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9
Q

Renal cell tumor with best outcome

A

chormophobe

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10
Q

occurs in end stage kidneys whether cystic or non-cystic

A

Clear cell type (most common); second worst oucome

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11
Q

Papillary type tumors have a ____core with macrophages and blood vessels

Type 1 has ____papillae

Type 2 has ____ papillae

A

stromal core

thin = 1

thick = 2

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12
Q

Your attending surgically removes a tumor from the patient. The tumor itself is well circumscribed and sent to pathology. HE comes back and you notice binucleate cells. The pathologist says there are ‘halos aroud wrinkled nucleus’. This is a dead giveaway for:

A

Chromophobe!

Normal glomerulus

halo around wrinkled nucleus

binuclueate

circumscribed tumor

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13
Q

A collecting duct carcinoma has _______ of tumor cells and is based in the ______

A

irregular aggregates of tumor cells

based in medulla/collecting system and spreads outwards

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14
Q

Medullary Carcinoma
•Restricted to individuals who have some _____ or _______descent
•Patients have ________disease or _______trait

A

African or Mediterranean

sickle cell

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15
Q

•Presents at very high stage, resists chemotherapy, and has worst outcome of all
kidney cancers with median survival times of 3 months (range 1–7 months)

A

Medullary Carcinoma

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16
Q

Acquired cystic disease-associated renal ca.
•Patients with acquired cystic disease due to
chronic dialysis dependency have a 100x risk of
getting______
•Variety of patterns but lots of vacuoles

A

RCC Oxalate crystals.

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17
Q

Staging of renal cell carcinoma
•Average 5-year survival of___%, but varies greatly according to histologic subtype

A

50

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18
Q

Usually RCC has 5 yr survival of 50%… what lowers it to 15%

A

•If renal vein invasion or extension into perinephric fat, 5-year survival is reduced to 15%.

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19
Q

Describe STAGING of RCC

A

T1; <7 cm in kidney

T2 >7 cm still confined

T3 extends into fat outside kidney

T4: spread to other locations/ renal vein

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20
Q

GRADING system for RCC

A

Grade 1: nuclei are like tiny dots

Grade 2: nucleoli inconspicuous

Grade 3: nucleoli appreciated at low power

Grade 4: bizarre cells

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21
Q

Tumor that Arises from intercalated cells of collecting duct

A

Oncocytoma

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22
Q

Angiomyolipoma: a________ tumor
Vessels + smooth muscle + fat
•The most common benign tumour of the kidney; most common serious complication of it is _____

A

mesenchymal

hemorrhage

23
Q

Angiomyolipoma is simular to what other cancer?

A

melanoma bc has same derivative.. thus it will stain + with the same stains used to Dx melanoma

24
Q

Almost always a pediatric tumor; rarely seen in adults
Contain a variety of cell and tissue components, all derived from the mesoderm

A

Wilms Tumow

25
Q

The bladder has a large detrusor (sm muscl) covered with tunica propria. What cell type sits on top of that?

A

Trasitional epithelium (helps accomidate stretch)

26
Q

You see glandular tissue in the bladder, why is this concerning?

A

Cystitis cystica or glandularis

you shouldn’t have glands in the bladder

27
Q

Cystitis cystica/ cystitis glandularis
Polypoid and papillary cystitis
Nephrogenic adenoma

are all examples of:

A

Acquired non-neoplastic anomalies of Urinary Bladder

28
Q

•Polypoid and papillary cystitis arise from:

are both examples of:
•In setting of submucosal edema, usually :

A

catheter, stone, etc.

Undulated lesions

mixed inflammation

29
Q

=more blunt projections; has a tip that is wider than its base and is grossly more apt to mimic a tumor

A

Polypoid cystitis

*brooooad based best diagnosed at low power

30
Q

Benign proliferation of tubules (w/ inflammatory cells)

  • Males 2:1, can affect children
  • 61% of cases following GU surgery
  • Often associated with chronic cystitis/longstanding infection
A

Nephrogenic Adenoma (Nephrogenic Metaplasia)

31
Q

bening proliferation of tubules

A
32
Q

Bladder cancer

M:F ratio?

What forms does it take on?

A

M:F is 3:1

can be flat (ulcerated/red) or mass (papillary or exophytic

33
Q

Progression in grades for papillary bladder cancer

A

papilloma (benign)

Papillary neoplasm, uncertain potential

Low grade urothelial cancer

high grade urothelial cancer

34
Q

Progression in grades for flat lesion in bladder

A

Reactive

Intermediate

Dysplasia

Carcinoma in situ

35
Q

TNM Staging:

A key determination is whether _______ is invaded:
leads to conservative management (≤pT1) versus cystectomy
(≥pT2)

A

muscularis propria

36
Q

What staging would we do conservative management for

A

(≤pT1)

37
Q

What TNM staging would we do cystectomy on?

A

(≥pT2)

38
Q

Minimally branching delicate papillae with fibrovascular core
lined by urothelium of normal thickness and polarity and no significant cytologic atypia.

A

Urothelial papilloma:

*more common in young patients (under 40)

39
Q

branching discrete papillae with fibrovascular core lined by hyperplastic urothelium with minimal loss of polarity and minimal to absent cytologic atypia.

A

Papillary urothelial neoplasms of low malignant potential:

40
Q

Urothelial carcinoma with no invasion and nuclei stay parellel but jumbled

A

Low grade

41
Q

Urothelial carcinoma thats invasive, jumbled polarity and huge nuclei

A

High Grade

42
Q

Features of exophytic or papillary carcinoma to report on TURBT
(transurethral resection of bladder tumor) or bx

A
  • Whether tumor is invasive
  • Muscularis propria is / is not present
  • If present, it is/ is not invaded by tumor (pT1 vs. pT2)
  • Percent involved or whether “specimen is entirely tumor”
  • Necrosis
43
Q

What are 3 nuclear findings in flat intra-urothelilal neoplasias?

A
  • Nuclear clustering – touch each other
  • Increased nuclear size
  • Nuclear pleomorphism
44
Q

What’s going on in the following in flat intra-urothelial neoplasia?

  • polarity
  • chromatin
  • nucleoli
A
  • Loss of polarity
  • Increased chromatin granularity
  • Scattered nucleoli
45
Q

15% with ______developed biopsy-proven cancer

A

urothelial dysplasia

46
Q

Dysplasia:_____ increased risk of cancer
Reactive atypia: ____increased risk of cancer

A

mildly

no

47
Q

In urothelial carcinoma in situ the nuclei is ____xs the size of lymphocyte with jumbled polarity and atypical cells

A

6xs

48
Q

____% with carcinoma in situ devo biopsy proven cancer

In situ often present with ________ which mimicks some benign conditions

A

60%

ulcerations

49
Q

Denuding cystisis and carcinoma in situ are characterized by

A

dyscohesive cells (aka… molecular pins are coming apart)

50
Q

Upper urothelial tract urothelial carcinoma invovles:
•Most cases are ______and half are locally advanced, that is, stage pT2 or higher

A

•Renal pelvis and ureter

high grade

51
Q

Upper urothelial tract urothelial carcinoma

•More aggressive because:
What do we see on a genetic basis?

A

– muscle wall is thin
mismpatch repair genes and instability of at least 2 microsatellite markers seen in 1/5 cases

52
Q

What is the type of kidney cancer that presents at the most advanced stage?

A

clear cell

53
Q

Upper urotehalial tract cancer compared to bladder urothelial cancer is:

A

higher in grade on average and higher in stage on average

Renal Exam (22 decks)

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