Renal Neoplasia + Urinary Tract Cancer Flashcards
What is renal cell carcinoma?
What does it present as?
Malignant epithelial tumour from PCT
PALPABLE PASS, flank pain, haematuria
Paraneoplastic's = Renin = hypertension ACTH = cushions PTH RPA = hypercalcaemia EPO = polycythaemia
Patient has tuberous sclerosis what kidney tumour does this patient have ?
What exactly does this consist of?
Angiomyolipoma = hamartoma of
blood vessels, smooth-muscle, adipose
Explain why in renal cell carcinoma patient rarely presents with right-sided varicocoel?
Left spermatic vein trains into the left renal vein hence why you get right varicocoel
Right spermatic vein drains into the IVC directly – > right RCC wouldn’t affect drainage of Right.spermatic vein
Why do we see On gross examination and microscopic examination of renal cell carcinoma
Gross exam = reveal yellow mass
Microscopic exam = clear cytoplasm
Hence RCC = clear cell type
What are the two types of renal cell carcinoma
Sporadic =
single tumour @upper lobe of kidney @adult=smoker
Hereditary = von Hippel-Lindau syndrome = AD
Multiple + bilateral tumour in kidney + young
Loss of what gene causes renal cell cancer?
What is the staging of renal cell cancer?
Loss of VHL tumour suppressor gene – >
increased IGF 1 =
promote growth
+
⬆️ HIF transcription factor = ⬆️ VEGF + ⬆️ PDGF
T = tumour size + renal vein involvement = haematogenous spread to lungs+bones
N = spread to retroperitoneal LN
What is the most common primary renal malignancy?
Treatment of RCC?
Renal cell carcinoma
Reception, immunotherapy
Chemo and radiation = shit
At 2 - 4-year-old child presents with a renal malignancy?
Wilms’ tumour Nephroblastoma
What does a Wilms’ tumour consist of ?
Blastema which is primitive tissue from which kidney forms – >
produces primitive glomeruli+tubules & stromal cells
Patient presents with Wilms’ tumour aniridia congenital abnormality and mental and motor retardation
what syndrome does he have?
what gene issue is this related to ?
WAGR syndrome
W T1 tumour suppressor gene deletion
Patient presents with Wilms’ tumour progressive renal glomerular disease and pseudohermaphroditism
What gene issue does he have?
W T1 tumour suppressor gene mutation
Denys-Drash syndrome
Patient presents wilms tumour hemihypertrophy on one side of the body, organomegaly @ tongue (macroglossia, Neonatal HYPOglycaemia
What gene issue does he have
WT2 tumour suppressor mutation
Beckwith Weidemann syndrome and
What is the most common type of lower urinary tract cancer?
Where does this tumour arise from?
What is the most common location of the lower urinary tract?
Urothelial/transitional cell carcinoma
Malignant tumour arising from urothelial lining of – Renal pelvis – Ureter – Bladder = most common location!!!! – Urethra
What are the risk factors for urothelial transitional cell carcinoma?
Pee SAC
- Phenacetin
- Smoking – polycyclic aromatic hydrocarbons + naphthylamine
- Aniline/Azo dyes
- Cyclophosphamide
An adult presents with painless haematuria with no casts. What does he have?
Urothelial/Transitional cell carcinoma
Who was in the two types Of urothelial/transitional cell carcinoma
Papillary pathway = tumour develops as papillary growth
Papilla = fibrovascular call with blood vessel running through it. Low-grade – >highgrade – >invade
Flat pathway = P 53 mutations – >
Start as Highgrade – >invade
Why do patients with urothelial transitional cell carcinoma presented multifocal tumours with recurrence?
Carcinogens hits bladder urothelium over long period of time – >
whole field = mutated – >
multifocal tumours + many mutations = Field defect
Middle Eastern Male comes in with painless haematuria. What does he have ?
Schistosoma haematobium – >
squamous cell carcinoma of bladder
Explain the pathogenesis of squamous cell carcinoma of the bladder
Schistosoma haematobium, Smoking,
Chronic cystitis/nephrolithiasis – >
Chronic irritation of bladder – >
squamous metaplasia – > Dysplasia – >
squamous cell carcinoma – >painless haematuria
What is adenocarcinoma of the bladder
Malignant of proliferation of glands at the bladder
Does the bladder have squamous or glandular epithelium?
No
What is the urachus remnant?
what is it lined by?
The urachus is a duct that connects the fetal bladder to the yolk Sac to allow waste drainage into the yolk sac
Extends from the dome of the bladder through the umbilical cord
Lined by glandular epithelium
What are the three reasons why a patient can develop adenocarcinoma of the bladder?
failure to Involute urachus – > remnant left = lined by glandular epithelium – >
adenocarcinoma @ dome of bladder
Cystitis glandularis – >chronic bladder inflammation
– > metaplasia – > adenocarcinoma
congenital failure to fall CAUDAL portion of anterior AB + bladder walls = bladder Exstrophy – >Expose bladder surface
– > Adenocarcinoma
