Renal & Bladder Tumors Flashcards
What are the benign Renal Tumors?
- Renal adenoma
- Renal oncocytoma
- Angiomyolipoma
What are the Malignant Renal Tumors?
- Renal cell carcinoma90%
- Urothelial carcinoma
- Children: Wilms’ tumor
What are the common features of Angiomyolipoma?
- Benign tumor ( rarely malignant)
- Involvement (lymph nodes, spleen, Renal vein)..not malg.
- 50% …tuberous sclerosis ( 25ys)/asymtomatic / small
- Sporadic…45ys / flank pain, mass, hematuria, retroperitoneal hemorrhage
- Triphasic ( muscle, fat, vessels)
must exclude: tubularsclerosis becauase you can get cycstic lesions in other parts of the body like the brain
WHat are the common Features of Renal cell carcinoma (RCCa)
• Malignant tumor of renal tubular epithelial cells
Associated with: - Autosomal dominant RCCa -Von-Hippel-Lindau (VHL) disease -Hereditary papillary RCCa
• Incidence peaks in six decade of life • M:F 2:1 • Clinical: hematuria/flank pain/ palpable mass <10% of patients
*Hematuria is most common sign
**Paraneoplastic syndrome:
What are the Paraneoplastic syndromes Assocaited with Renal Cell Carcinoma:
* Polycythemia (erythropoietin)
* Hypertension (renin)
* Hypercalcemia (PTH)
* Cushing’s syndrome (ACTH)
* leukemoid reaction
*Amyloidosis
What are the Grade and Stage of Renal Cell Carcinoma?
• Grade, nuclear Grade (Fuhrman) (1-4)
• Stage clinical ( I – IV ):
* Stage I: Confined to kidney ( 5ys:60- 80%)
* Stage II: perirenal fat ( 5ys:40- 70%)
* Stage III: lymph node & IVC ( 5ys:10- 40%)
* Stage IV: Adjacent organs/metas.( 5ys:5%)
What are the common features of Wilms tumor?
- Commonest solid tumor in children<6 ys
- Cytogenetic{2 tumor supp. Genes short arm 11}
- Single, well circumscribed, encapsulated soft, fleshy, grey-white / tan
- Triphasic pattern (blastema, stroma,epithelial)
- Anaplasia { nuclear size ( 3X) & abn. mitosis
Cystitis usually secondary to what types of infection ?
- Bacteria - E. Coli, Proteus, Klebsiella, Enterobacter
- Fungus – Candida - Parasites – Schistosoma hematobium
Or: Iatrogenic: chemotherapy , radiation (hemorrhagic cystitis)
What are the predisposing factors of cystitis?
- More common in female – short urethra
- Diabetes mellitus
- Instrumentation ( catheter, cystoscopy)
- Bladder calculi
- Bladder outlet obstruction (male –prostate hyperplasia)
What are the clinical features associated with cystitis?
- Urinary frequency (up to 20 times/day)
- Dysuria – pain or burning micturition
- Pain over bladder / suprapubic
- Fever and chills
- Microhematuria
What is the common features of Chronic Interstitial Cystitis?
- Unknown etiology
- Middle age female
• Clinically:
* Suprapubic pain
* Frequency / Urgency
*Nocturia / Hematuria
- Cystoscopic examination: edema, hemorrhage,ulceration
- Pathological Exam: chronic inflammation, mast cells
What are the types of Urothelial Neoplasms
*Epithelial tumors:
Benign - Urothelial papilloma
Malignant:
- Urothelial carcinoma (90%) - Squamous cell carcinoma ( 7% ) - Adenocarcinoma (1-2%)
*Mesenchymal tumors: benign or malignant
(sarcoma)
*Secondary tumors ( metastatic tumors )
What are the common features of Urothelial Carcinoma ?
- Male : female = 3: 1
- Associated with mutations (p53, Rb,p16 genes)
What are the risk factors assocaited with Bladder cancer?
* Smoking- greatest risk factor (2X)
* Drugs: Analgesic abuse (phenacetin) and Cyclophosphamide
*Chemicals in workplace: (Naphthylamine, rubber products)
* Infections: Schistosomiasis
What are the clinical presentation of someone with Urothelial Carcinoma?
*Painless hematuria (70 – 90%)
* Dysuria (20%)
* Urgency & frequency
* Flank pain
* Metastatic disease (up to 20% )
