Neoplasms of Kidney and Bladder Flashcards
Key differences in Adult form auto.dominant PKD vs auto.recessive PKD vs aquired cystic diseaes
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
What changes do we see in hydronephrosis?
Cortex and medulla compressed to a rim
Pelvicalyceal system (pelvis and calyces) are very dilated
Kidney cancer is ____ most common and ____ leading cause in death from cancer for men.
(also serious in women)
6th
10th
Classic triad for renal cell carcinoma
*most prominent feature?
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
In Renal cell carcinoma, polycythemia in 5% to 10% of cases due to
erythropoietin production by the tumor (paraneoplastic syndrome)
Most frequent benign kidney tumor
Angiomylolipoma
represents 83% of renal cell carcinomas with the second worst outcome
The worst outcome is:
Clear cell
worst outcome = Collecting duct (subtype: medullary)
kidney tumor that is NOT cancer but occurs at 5-10% of the rate of kidney cancer
Renal oncocytoma; benign, rarely recurs
Renal cell tumor with best outcome
chormophobe
occurs in end stage kidneys whether cystic or non-cystic
Clear cell type (most common); second worst oucome
Papillary type tumors have a ____core with macrophages and blood vessels
Type 1 has ____papillae
Type 2 has ____ papillae
stromal core
thin = 1
thick = 2
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:
Chromophobe!
Normal glomerulus
halo around wrinkled nucleus
binuclueate
circumscribed tumor
A collecting duct carcinoma has _______ of tumor cells and is based in the ______
irregular aggregates of tumor cells
based in medulla/collecting system and spreads outwards
Medullary Carcinoma
•Restricted to individuals who have some _____ or _______descent
•Patients have ________disease or _______trait
African or Mediterranean
sickle cell
•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)
Medullary Carcinoma
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
RCC Oxalate crystals.
Staging of renal cell carcinoma
•Average 5-year survival of___%, but varies greatly according to histologic subtype
50
Usually RCC has 5 yr survival of 50%… what lowers it to 15%
•If renal vein invasion or extension into perinephric fat, 5-year survival is reduced to 15%.
Describe STAGING of RCC
T1; <7 cm in kidney
T2 >7 cm still confined
T3 extends into fat outside kidney
T4: spread to other locations/ renal vein
GRADING system for RCC
Grade 1: nuclei are like tiny dots
Grade 2: nucleoli inconspicuous
Grade 3: nucleoli appreciated at low power
Grade 4: bizarre cells
Tumor that Arises from intercalated cells of collecting duct
Oncocytoma
Angiomyolipoma: a________ tumor
Vessels + smooth muscle + fat
•The most common benign tumour of the kidney; most common serious complication of it is _____
mesenchymal
hemorrhage
Angiomyolipoma is simular to what other cancer?
melanoma bc has same derivative.. thus it will stain + with the same stains used to Dx melanoma
Almost always a pediatric tumor; rarely seen in adults
Contain a variety of cell and tissue components, all derived from the mesoderm
Wilms Tumow
The bladder has a large detrusor (sm muscl) covered with tunica propria. What cell type sits on top of that?
Trasitional epithelium (helps accomidate stretch)
You see glandular tissue in the bladder, why is this concerning?
Cystitis cystica or glandularis
you shouldn’t have glands in the bladder
Cystitis cystica/ cystitis glandularis
Polypoid and papillary cystitis
Nephrogenic adenoma
are all examples of:
Acquired non-neoplastic anomalies of Urinary Bladder
•Polypoid and papillary cystitis arise from:
are both examples of:
•In setting of submucosal edema, usually :
catheter, stone, etc.
Undulated lesions
mixed inflammation
=more blunt projections; has a tip that is wider than its base and is grossly more apt to mimic a tumor
Polypoid cystitis
*brooooad based best diagnosed at low power
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
Nephrogenic Adenoma (Nephrogenic Metaplasia)
bening proliferation of tubules
Bladder cancer
M:F ratio?
What forms does it take on?
M:F is 3:1
can be flat (ulcerated/red) or mass (papillary or exophytic
Progression in grades for papillary bladder cancer
papilloma (benign)
Papillary neoplasm, uncertain potential
Low grade urothelial cancer
high grade urothelial cancer
Progression in grades for flat lesion in bladder
Reactive
Intermediate
Dysplasia
Carcinoma in situ
TNM Staging:
A key determination is whether _______ is invaded:
leads to conservative management (≤pT1) versus cystectomy
(≥pT2)
muscularis propria
What staging would we do conservative management for
(≤pT1)
What TNM staging would we do cystectomy on?
(≥pT2)
Minimally branching delicate papillae with fibrovascular core
lined by urothelium of normal thickness and polarity and no significant cytologic atypia.
Urothelial papilloma:
*more common in young patients (under 40)
branching discrete papillae with fibrovascular core lined by hyperplastic urothelium with minimal loss of polarity and minimal to absent cytologic atypia.
Papillary urothelial neoplasms of low malignant potential:
Urothelial carcinoma with no invasion and nuclei stay parellel but jumbled
Low grade
Urothelial carcinoma thats invasive, jumbled polarity and huge nuclei
High Grade
Features of exophytic or papillary carcinoma to report on TURBT
(transurethral resection of bladder tumor) or bx
- 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
What are 3 nuclear findings in flat intra-urothelilal neoplasias?
- Nuclear clustering – touch each other
- Increased nuclear size
- Nuclear pleomorphism
What’s going on in the following in flat intra-urothelial neoplasia?
- polarity
- chromatin
- nucleoli
- Loss of polarity
- Increased chromatin granularity
- Scattered nucleoli
15% with ______developed biopsy-proven cancer
urothelial dysplasia
Dysplasia:_____ increased risk of cancer
Reactive atypia: ____increased risk of cancer
mildly
no
In urothelial carcinoma in situ the nuclei is ____xs the size of lymphocyte with jumbled polarity and atypical cells
6xs
____% with carcinoma in situ devo biopsy proven cancer
In situ often present with ________ which mimicks some benign conditions
60%
ulcerations
Denuding cystisis and carcinoma in situ are characterized by
dyscohesive cells (aka… molecular pins are coming apart)
Upper urothelial tract urothelial carcinoma invovles:
•Most cases are ______and half are locally advanced, that is, stage pT2 or higher
•Renal pelvis and ureter
high grade
Upper urothelial tract urothelial carcinoma
•More aggressive because:
What do we see on a genetic basis?
– muscle wall is thin
mismpatch repair genes and instability of at least 2 microsatellite markers seen in 1/5 cases
What is the type of kidney cancer that presents at the most advanced stage?
clear cell
Upper urotehalial tract cancer compared to bladder urothelial cancer is:
higher in grade on average and higher in stage on average
