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Renal Week 3 > Renal Neoplasia > Flashcards

Renal Neoplasia Flashcards

1
Q

T or F: this kidney has no associated pathology.

A

True, the presence of a simple cyst is no big deal

This is what the inside of a normal kidney looks like - notice clearly demarcated medullary and cortical boundaries

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2
Q

*Oncocytoma*

A
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3
Q

What are the 3 types of renal cell carcinoma?

A
  • Clear
  • Papillary
  • Chromophobe
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4
Q

*Wilms Tumor*

A
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5
Q

*Transitional/Urothelial Carcinoma*

A
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6
Q

Name this tumor.
• Cell Types
• Associated Mutations
• Key Features
• Epidemiology

A

Oncocytoma - make up LESS THAN 10% of renal tumors

Comes from the INTERCHELATED CELLS of the collecting duct, males are typically affected

Mutations in chromosome 1, 14, and Y are common

KEY FEATURES:
• Tumor is well circumscribed with a CENTRAL SCAR

Tumor may appear on CT as shown here

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7
Q

What are the KEY features on this H and E taken from a kidney tumor? Tumor Type?

A

•uniform round cells with abundant, intensely eosinophilic and granular cytoplasm = MITOCHONDRIA

***NOTABLY no PLEOMORPHISM***
•uniform small, round and central nuclei, Evenly dispersed chromatin

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8
Q

What is the Number 1 most common renal cancer?
• how does it commonly come to attention?
• What are the other renal cancers from most to least common?

A

Renal Clear Cell Carcinoma = 70% of renal Cancers

Often present in all types of cancer with HEMATURIA

Others Below are far less common.

–Papillary carcinoma (10%)

–Chromophobe carcinoma (5%)

–Oncocytoma (5%)

–Others (urothelial, squamous, 10%)

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9
Q

What is unique about the location of urothelial and renal pelvic carcinomas?

A

These are located in the MEDULLARY/Pelvic area whereas other Renal Cancers present at the POLES

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10
Q

What is shown here?

• key features?

A

Oncocytoma

Key Features:

  • Oncocytic = pink and grainy with sheets of pink and grainy PINK cells
  • UNIFORM, not much pleomorphism
  • smooth cell borders
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11
Q

How does a Renal Cell tumor present grossly?

A

• Hemorrhage and Necrosis are common - hemorrhage most likely related to highly vascularized tissue arising from VHF mutations leading to HIF-1alpha and ultimately VEGF release

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12
Q

Where does Renal Cell Cancer (Clear Cell Carcinoma, Papillary Carcinoma, and Chromophore) most often spread?

A

Most common Sides:
1. Stays behind the Retroperitoneum under Renal (GEROTAs) Fascia

  1. Seeds into Renal Vein => Inferior Vena Cava => Left Atria –> spread throughout the vascular system
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13
Q

For ALL Renal Cell Carcinomas.
• Cells that they’re derived from?
• Risk Factors?
• Typical Patient that presents?
• Name the 3 types.

A

Cells:
• Renal TUBULAR cells in the CORTEX, contrast this with the collecting duct cells in benign tumors (oncocytoma)

Risk Factors:
• SMOKING
• Cadmium
• HTN, Diabetes, DIALYSIS

Typical Pt:
• Male 60-70 y.o. - probably will have Hematuria

3 Types:

• Clear, Papillary, and Chromophobe

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14
Q

How does the most common type of Renal Cell Carcinoma Arise? • what mutation is associated with this disorder?

A

Most common type = CLEAR CELL Renal Carcinoma

Mutation:
• SPORADIC most commonly

FAMILIAL Form:
• Less common but importantly associated with Von Hippel Lindau (VHF) mutation. VHL typically suppresses HIF-1alpha which is a transcription factor for VEGF.

• VEGF production promoates vascularization allowing the tumor to proliferate quickly

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15
Q

What is the Best Prognostic Indicator of Clear Cell Renal Carcinoma?

• 2nd best?

A

Best Prognostic Indicator:
• STAGE - i.e. where has the cancer invaded

2nd Best:
• Fuhrman Grading - looks at Nuclear size etc.

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16
Q

What type of cancer is seen here?
• KEY Features?
• what would you expect to see on microscopic examination?

A

Renal Clear Cell Carcinoma

• Key Features
• solitary, well defined, polar
• YELLOW, cysts , necrosis, HEMORRHAGE

MICROSCOPIC FEATURES:
• Clear LIPID FILLED cells with CHICKEN WIRE vessel formation found between the cells

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17
Q

What is the general principle behind Fuhrman grading?
• Prognositic Significance?
• can you differentiate a stage 1 from a stage 4?

A
  • Fuhrman grading is an assement of the cellular appearance of the cancer, not of its invasion into other tissues
  • Really only has prognostic significance in Clear Cell Carcinoma - but has very close correlation
  • Stage 1 (top left) cells have small, non-aggressive looking nuclei
  • Stage 4 (bottom right) have hyperchormic nuclei and are pleomorphic
18
Q

what is the whit arrow pointing to?

A

• Renal Carcinoma traveling into the renal vein

19
Q

What distinguishes papillary renal cell carcinoma from other tumors?
• size cuff-offs?
• Gene alterations common in this cancer?

A

Papillary Carcinoma = BILATERAL and MULTIFOCAL
• Size greater than 5mm differentiates this tumor from papillary adenoma

Papilary Carcinoma is associated with mutations in the MET pro-oncogene

20
Q

What tumor type is shown here?

* key features?

A

Papillary Adenocarcinoma

• MULTIFOCAL, Granular appearance is key

hemorrhage and necrosis may also be seen here but is less common than renal cell carcinoma

21
Q

What is shown here?

• What are the KEY features?

A
  • Well-circumscribed, often with distinct fibrous capsule
  • PAPILLARY - little finger like projections in the cellular arrangment
  • Have papillary FIBROVASCULAR CORES (seen in center)
  • Foamy macrophages (clear cells) in papillary cores and intracellular hemosiderin are sensitive/specific features
22
Q

Chromophobe Renal Carcinoma
• Derived from what cell type
• Prognosis?
• Appears similar to what other tumor? DDx?

A
  • Intercalated Cells of the Collecting Ducts
  • Good Prognosis
  • DDx between chromophobe renal carcinoma and oncocytoma made on basis of Hale’s Iron Colloidal Stain
23
Q

What are some key features of this chromophobe renal cell carcinoma?

A

Lacks a central scar BUT is well circumscribed with a brown hue

24
Q

What is shown in this image?
• what are some KEY features?

A

Renal Cell CHROMOPHOBE carcinoma

  • Clearing (HALO) around the nuclei = another key feature to look for in addition to Hale’s colloidal for differentiating this from oncomocytoma
  • Distinct cell membranes
25
Q

This specimen taken from the kidney was positive for Hale’s colloidal stain. What kind of cancer is it?

A

Chomophobe Carcinoma = Hale’s Colloidal positive as seen here

Oncocytoma is Hale’s Colloidal Negative

26
Q

What is shown here?

A

Normal Uroepithelium - notice transitional epithelium up top

27
Q

What is shown here?

A

Papillary protrusion from the Uroepithelium with a fibrovascular core - indicative of cancer

28
Q

What is abnormal about this uroepithelium?
• what could you still diagnosis even if the cells under the top layer could not be visualized?

A
  • There is some sloughing off of the transitional epithelium
  • Even without these underlying cells it would be Urothelial carcinoma in situ
29
Q

What are some key features of this tumor?
• what type of cells?

A

• Transitional cells urothelial carcinoma

KEY features:
• Notice Granular Appearance
• Pay attention to location these are located in the pelvis NOT the medulla

30
Q

Would this renal Urothelial Carcinoma be considered a high or low grade tumor?

A

HIGH GRADE - you can see this from the high N/C ratio and multiple mitosis

**Shown below is a low grade urothelial tumor

31
Q

Wilms Tumor (MUST KNOW)
• Epidemiology
• Prognosis
• DISTINCTIVE GENE MUTATIONS

A
  • An embryonal (*just means we see immature elements) pediatric tumor of the kidney
  • The peak incidence of Wilms tumor is between the second and fifth year of life (95% of kidney cancer in children).
  • Post therapy 5 yr survival 90%

•Defects in WT1 gene chromosome 11

32
Q

What type of gene defects might you suspect if you see anaplasia of Wilms Tumor?

A

p53, this is a BAD prognostic indicator as usual

33
Q

What syndrome that causes Hemihypertrophy is associated with Wilms Tumor?

A

Beckwith-Wiedemann

34
Q

What is shown here?
• Key features?

A

Wilms Tumor - appears grossly as lobulated tan and white mass

35
Q

What is Wilms Tumor also known as?

A

Nephroblastoma

36
Q

What are the key histologic features seen here?

• diagnosis?

A

3 key elements:

  • Top/left/middle – EPITHELIAL component - glandular appearance
  • Filling in the most space - BLASTEMAL – small round blue/purple cells
  • Clearish part - STROMAL component – can be any mesenchymal compoenent – muscle etc.
37
Q

What is seen here?
.

A

• Focal Anaplasia within a wilms tumor

38
Q

What is shown here?

A

Metastatisis to kidneys multiple nodules found bilaterally indicates that this is not a primary tumor

39
Q

What is seen here?

A

• Metastatic Cancer Crushing the glomerulus

40
Q

What is shown here?
• key features?
• gene associations?

A

Fat, Vessel, Muscle => angiomyolipoma => Tubular Sclerosis TSC1, TSC2 code for hammerin and tuberin

41
Q
A

Renal Week 3 (16 decks)

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