Renal Neoplasia + Urinary Tract Cancer

Question 0

What is renal cell carcinoma?

What does it present as?

Answer 0

Malignant epithelial tumour from PCT

PALPABLE PASS, flank pain, haematuria

Paraneoplastic's =
Renin = hypertension
ACTH = cushions
PTH RPA = hypercalcaemia
EPO = polycythaemia

Question 1

Patient has tuberous sclerosis what kidney tumour does this patient have ?
What exactly does this consist of?

Answer 1

Angiomyolipoma = hamartoma of

blood vessels, smooth-muscle, adipose

Question 2

Explain why in renal cell carcinoma patient rarely presents with right-sided varicocoel?

Answer 2

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

Question 3

Why do we see On gross examination and microscopic examination of renal cell carcinoma

Answer 3

Gross exam = reveal yellow mass
Microscopic exam = clear cytoplasm
Hence RCC = clear cell type

Question 4

What are the two types of renal cell carcinoma

Answer 4

Sporadic =
single tumour @upper lobe of kidney @adult=smoker

Hereditary = von Hippel-Lindau syndrome = AD
Multiple + bilateral tumour in kidney + young

Question 5

Loss of what gene causes renal cell cancer?

What is the staging of renal cell cancer?

Answer 5

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

Question 6

What is the most common primary renal malignancy?

Treatment of RCC?

Answer 6

Renal cell carcinoma

Reception, immunotherapy

Chemo and radiation = shit

Question 7

At 2 - 4-year-old child presents with a renal malignancy?

Answer 7

Wilms’ tumour Nephroblastoma

Question 8

What does a Wilms’ tumour consist of ?

Answer 8

Blastema which is primitive tissue from which kidney forms – >
produces primitive glomeruli+tubules & stromal cells

Question 9

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 ?

Answer 9

WAGR syndrome

W T1 tumour suppressor gene deletion

Question 10

Patient presents with Wilms’ tumour progressive renal glomerular disease and pseudohermaphroditism

What gene issue does he have?

Answer 10

W T1 tumour suppressor gene mutation

Denys-Drash syndrome

Question 11

Patient presents 
wilms tumour 
hemihypertrophy on one side of the body,
organomegaly @ tongue (macroglossia,
Neonatal HYPOglycaemia

What gene issue does he have

Answer 11

WT2 tumour suppressor mutation

Beckwith Weidemann syndrome and

Question 12

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?

Answer 12

Urothelial/transitional cell carcinoma

Malignant tumour arising from urothelial lining of
– Renal pelvis
– Ureter
– Bladder = most common location!!!!
– Urethra

Question 13

What are the risk factors for urothelial transitional cell carcinoma?

Answer 13

Pee SAC

• Phenacetin
• Smoking – polycyclic aromatic hydrocarbons + naphthylamine
• Aniline/Azo dyes
• Cyclophosphamide

Question 14

An adult presents with painless haematuria with no casts. What does he have?

Answer 14

Urothelial/Transitional cell carcinoma

Question 15

Who was in the two types Of urothelial/transitional cell carcinoma

Answer 15

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

Question 16

Why do patients with urothelial transitional cell carcinoma presented multifocal tumours with recurrence?

Answer 16

Carcinogens hits bladder urothelium over long period of time – >
whole field = mutated – >
multifocal tumours + many mutations = Field defect

Question 17

Middle Eastern Male comes in with painless haematuria. What does he have ?

Answer 17

Schistosoma haematobium – >

squamous cell carcinoma of bladder

Question 18

Explain the pathogenesis of squamous cell carcinoma of the bladder

Answer 18

Schistosoma haematobium, Smoking,
Chronic cystitis/nephrolithiasis – >

Chronic irritation of bladder – >
squamous metaplasia – > Dysplasia – >
squamous cell carcinoma – >painless haematuria

Question 19

What is adenocarcinoma of the bladder

Answer 19

Malignant of proliferation of glands at the bladder

Question 20

Does the bladder have squamous or glandular epithelium?

Answer 20

No

Question 21

What is the urachus remnant?

what is it lined by?

Answer 21

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

Question 22

What are the three reasons why a patient can develop adenocarcinoma of the bladder?

Answer 22

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