Renal Neoplasia Flashcards
What are oncocytomas?
benign tumors from the intercalated cells of the collecting ducts
How common are oncocytomas?
represent less than 10+ of renal tumors
no clinical symptoms
What chromosomal causes are associated with oncocytomas?
loss of chrom 1, 14, and Y
T or F. Oncocytomas are more common in men
T.
Description of oncocytomas
well-circumscribed tumor with a central scar
What are the most common primary neoplasms in adults?
Clear cell carcinoma (70%)
Papillary carcinoma (10%)
Chromophobe carcinoma (5%)
Oncocytoma (5%)
Others (urothelial, squamous, 10%)
One thing that can help differentiate kidney tumors is location. Where do urothelial and squamous tumors tend to be?
Test question
near the renal pelvis while the others are at the poles of the kidney
Usually the first sign of a kidney tumor is what?
painful hematuria (in elm’s it might actually be palpation of the mass)
most kidney tumors have to get large before they cause symptoms
Renal carcinomas tend to spread via what routes?
either through Gerota’s fascia or into the renal vein and up through the IVC
What are the types of renal cell carcinoma?
- clear cell (most common)
- papillary
- chromophobe
What are renal cell carcinomas derived from?
renal tubular epithelium
located in cortex (polar)
What patient population is common for renal cell carcinoma?
men in 60-70s
What are the risk factors for renal cell carcinoma?
- *smokers (same for bladder cancer),
- hypertensive or obese patients,
- occupational exposure to cadmium,
- acquired polycystic disease in chronic dialysis patients
Are clear cell carcinomas sporadic or familial?
Most are sporadic, however familial forms do exist as those with loss of VHL (autosomal dominant, chromosome 3)
What does loss of VHL cause?
Without VHL, HIFs are stabilized. HIFs are transcription factors that contribute to carcinogenesis by stimulating the expression of vascular endothelial growth factor (VEGF), an important angiogenic factor
What is the most important prognostic feature of renal cell carcinoma?
Clinical stage…after that nuclear grade (Fuhrman)
Why are renal cell carcinomas yellow grossly?
cells are filled with lipids
How do papillary renal cell carcinomas present?
frequently multifocal and bilateral and appear as early-stage tumors
How can papillary renal cell carcinomas be distinguished from papillary adenomas?
size greater than 5 mm suggests papillary renal cell carcinoma
Are papillary RCCs sporadic or hereditary?
can be either
What are some potential causes of hereditary papillary RCC?
Chromosome 7 alterations that increase dosage of the MET proto-oncogene seems to spur abnormal growth in the proximal tubular epithelial cell precursors of papillary carcinomas
What has to be present to be a true papillary lesion?
a papillary fibrovascular core
What do chromophobe carcinomas arise from?
Arise from intercalated cells of collecting ducts
No specific genetic signature, lots of different losses
Prognosis for chromophobe carcinomas?
Good prognosis - Same behavior as clear cell when stratified by grade/stage
Typical Fuhrman grading may NOT have prognostic significance
