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Renal 2 > Path - Renal Neoplasms > Flashcards

Path - Renal Neoplasms Flashcards

1
Q

What are the percentages associated with the 5 different categories of renal neoplasms

A

1) Clear Cell Carcinoma (70%)
2) papillary carcinoma (10%)
3) chromophobe carcinoma (5%)
4) oncocytoma (5%)
5) other - urothelial and squamous (10%)

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2
Q

Can a clear cell carcinoma of a small enough size be an adenoma (benign)?

A

No, all clear cell carcinomas are malignant

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3
Q

What is the exmple of an adenoma associated with the kidney ?

what percentage of population can you find them in?

are the completely benign?

A

small renal cortical papillary neoplasms (adenomas)

22% of population at autospy, these can be found

not entirely, reports of mets, “uncertain malignant potential”

none of this will probably be on the test anyway, but fuck it

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4
Q

Oncocytoma

1) benign or malignant
2) cell of origin
3) histo features

A

1) benign
2) renal tubular epithelial cells, the intercalated cells of the CD
3) large cells, many mitochondria, eosinophilic cytoplasm

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5
Q

what is the genetic signature of oncocytoma?

A

none

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6
Q

What is the gross appearance of oncocytoma

A

Mahogany Brown!!

can have a central stellate scar (30%) - good for the future radiologists?

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7
Q

oncocytoma - comment on the aggressive malignant potential of them

A

very very Rarely can be aggressive

they can get very large w/out being malignant - will not invade, will not metastasize

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8
Q

Histo features of oncocytoma

A

nuclei appear regular, maybe large ish, can see nucleoli (all nml)

cytoplasm - ton of mitochondria and eosinophilic color

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9
Q

for renal carcinomas in general

1) what is the appearance gross/ origin
2) what are 2 general pathologic process associated with them

A

1) large mass originating from tubular epithelial cells - look/ may be encapsulated
2) necrosis and hemorrhage

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10
Q

Why is necrosis common with renal carcinomas

A

renal vasculature comes from cortex, runs into the medulla - in general medulla is already hypoxic ish - so yeah, necrosis

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11
Q

why are renal carcinomas hemorrhagic

A

they are highly neovascularized to begin with, and they love to invade veins, and this adds to capacity to be hemorrhagic

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12
Q

What is the met pattern of renal carcinomas in general?

A

Hematogenous - go to lung, bone (brain, skin less common)

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13
Q

what are 3 features of the spread of generalized renal carcinomas

1) in general, where
2) another location
3) where do they rarely go

A

1) through capsule into perinephric fat
2) renal pelvis
3) rarely go to adjacent organs

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14
Q

Renal carcinomas love to invade veins - what is the process of this (where does it go, etc)

A

renal vein –> IVC –> R atrium

does not attach to the vessel wall, when you remove the kidney/tumor, can pull this tumor snake back out of the vessel

think about hemodynamic concerns associated with occluding your IVC like this

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15
Q

Renal carcinomas are hemorrhagic - when does this become a life threatening deal

A

when the thing mets to the brain, hemorrhage there, and then kick your bucket

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16
Q

what is the classic clinical triad for diagnosis of renal carcinomas

(High yield)

A

1) microscopic hematuria
2) dull flank pain, older male (very nonspecific)
3) abdominal mass (often times hard to find, ppl are fat)

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17
Q

1) are most renal carcinomas caught early or late?
2) and why

A

1) early
2) “excessive” CT scans / imaging

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18
Q

definition of clear cell carcinoma

A

malignant neoplasm composed of cells with clear or eosinophilic cytoplasm within a delicate vascular network

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19
Q

significance of delicate vascular network associated with clear cell carcinoma

A

VEGF

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20
Q

Buzz words for clear cell carcinoma

1) single or multiple
2) location
3) color
4) appearance

A

1) solitary
2) polar
3) yellow (not always though)
4) cystic

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21
Q

Genetics associated with clear cell carcinoma

A

chrom 3p abnormality

vast majority of these have something wrong with chrom 3p - whether it is sporadic or the inherited VHL type

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22
Q

What is the most important prognostic feature?

What is the next most important, and how do we measure this

A

clinical stage is most impt

nuclear grade is next most impt, Fuhrman

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23
Q

what are the general gross features of clear cell carcinoma

A

large, cystic, encapsulated, polar, variegated, hemorrhagic

24
Q

we know what clear cell carcinoma looks like on histo

A

clear cells, noted vascularity, nuclei largely inconsequential

25
Q

Fuhrman low nuclear grade

A

nuclei small, no mitotic figures, no nucleoli

26
Q

Fuhrman high nuclear grade

A

nuclei variable size, irregular nucleol, also no mitotic figures

27
Q

Fuhrman nuclear grading scale only applies to clear cell carcinoma

A
28
Q

Genetic abnormalities associated with the sporadic type clear cell carcinoma

A

anything fucking with chrom 3

t(3;6), t(3;8), t(3;11)

deletion on chrom 3

29
Q

genetic abnormalitites associated with hereditary form of clear cell carcinoma

A

VHL - which is on chrom 3

loss of VHL

inactivated or mutated VHL

hypermethylation of VHL

note: VHL mutation present in the McCoy family of the Hatfields and McCoys - played a role in why that feud got so out of hand (I mean, it really escalated quickly)

30
Q

malignant, parenchymal tumor with papillary or tubulopapillary architecture

A

papillary carcinoma

31
Q

papillary carcinomas more common solitary or multifocal?

unilateral or bilateral

A

multifocal and bilateral

32
Q

what cytogenetic characteristics are associated with papillary carcinomas

A

none

33
Q

Bob comes in to your office, has dull flank pain and an abdominal mass. you find out he is a chronic hemodialysis patient - what are you thinking?

A

acquired renal cystic disease from the hemodialysis leading to a 50% increase in risk for renal carcinoma (which for this vignette, we are assuming he now has; wrong side of coin flip for Bob)

60% clear cell

40% papillary carcinoma

(we talked about it with papillary, know that it is a significant percentage)

34
Q

Bob died; here is his kidney

A

papillary carcinoma - can resemble clear cell carcinoma in many ways, grossly, maybe more cystic looking?

35
Q

Here is th histo of Bob’s kidney

A

histo of papillary carcinoma

papillary structure, long, finger-like projections of tumor on a fibrovascular stalk

36
Q

what is the genetics of papillary carcinoma

A

mutated activated Met - PRCC protoncogene

MET encodes a tyrosine kinase receptor of the hepatocyte growth factor

37
Q

you take a histo section of some sort of renal tumor, stain it with Hale’s collodial iron stain and it lights up blue - what are you thinking?

A

Chromophobe carcinoma

38
Q

What are the histo features of Chromophobe carcinoma

A

large pale cells, prominent cell membranes

will look worse than clear cell - looks more aggressive, big ugly nuclei (follow up question about this next)

39
Q

what is the prognosis of chromophobe carcinoma

A

good

depsite the ugly aggressive looking nuclei, chromophobe is associated with a lower mortality

40
Q

what is the cell of origin for a renal pelvis carcinoma

A

urothelial/transitional epithelial cells

tumors of the collecting system

41
Q

what is an epidemiologic correlation for renal pelvis carcinomas

A

smokers

traditionally they get urothelial tumors of the bladder, over time they can spread to higher up in the collecting system

42
Q

location of renal pelvis carcinoma

A

centrally, in the renal pelvis

(convenientally)

43
Q

Bob’s wife Karen is giving their son, Billy, a bath when she notices an abdominal mass

Billy is somewhere between 2 and 5 years old

In your office, you note that billy has a fever and hematuria

what are you thinking

A

Wilm’s tumor / nephroblastoma

44
Q

what percentage of kidney cancers in children does Wilm’s tumor comprise?

A

95%

45
Q

what is the prognosis of Wilm’s tumor

A

good

post therapy 5 yr survival is 90%

46
Q

microscopically, what is Wilm’s tumor composed of

A

mixture of cellular elements

blastema, stromal, and epithelial

47
Q

Billy’s kidney - how does it appear grossly

A

Wilm’s tumor

big, encapsulated renal mass

looks a lot like any other kidney tumor, will need to use history and presentation to differentiate

48
Q

what are the 3 syndromic associations for Wilm’s tumor (just the names)

A

1) WAGR
2) Denys-Drash
3) Beckwith-Wiedemann

49
Q

aniridia (no irises), genital abnormalities and mental retardation

associated with a childhood kidney tumor

what syndrome is this?

A

WAGR

50
Q

gonadal dysgenesis and renal abnormalities

associated with a childhood kidney tumor

what syndrome

A

Denys-Drash

51
Q

enlargement of individual organs (organomegaly, often splenomegaly or hepatomegaly) and enlargement of one half of the body (hemimegaly, hemihypertrophy, hemihyperplasia)

associated with childhood kidney tumor

what syndrome is this

(probably high yield, Handorf liked this)

A

Beckwith-Wiedemann

all the hemi- stuff just means enlargement of the structures of one half of the body

52
Q

How are you going to help Billy get better?

A

tx for Wilm’s tumor is nephrectomy and chemo

b/c it is a very aggressive neoplasm

53
Q

Kidney is a highly vascularized structure that filters your whole blood volume a gazillion times a minute

so it is a very common site of metastasis, right?

A
54
Q

what does a metastatic tumor of the kidney look like?

A
55
Q

How do you remember the 4 disease manifestations of the WAGR syndrome

A

W - Wilm’s Tumor

A - aniridia

G- genital abnormalities

R -(mental) retardation

Renal 2 (11 decks)

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