Renal Neoplasms Flashcards
What are the gross Characteristics of adenoma
Pale yellow gray well circumcised nodules
Describe the histologic characteristics of adenoma
Peppa lemada structures with numerous complex fronds; cells are cubodial to polygonal With small central nuclei with little cytoplasm
We’re in the kidneys papillary adenoma Commonly found
Renal cortex
Adenoma is derived from what part of the kidney
renal tubular epithelium
Angiomyolipoma is derived from what renal structure
perivascular epithelioid cells
Angiogmyelipomas are commonly found in which population and why
women; These cells express estrogen receptors
Additionally angiomyolipomas are associated with what disease
tuberous sclerosis
Describe the pathogenesis of tuberous sclerosis
Inhibition of activity of mTOR, kinase that stimulates cells growth TSC1 (Ch. 9, hamartin); TSC2 (Ch. 16, tuberin);
What’s the contents found in angiomyolipoma lesions
Thick walled blood cells, adipose tissue, and smooth muscle cells
Oncocytoma arises from What cells in the kidneys
intercolated cells of the collecting ducks
Describe the gross characteristics of oncocytoma
mahogany brown encapsulated lesions with central scarring
Describe the histologic characteristics of o oncocytoma
many mitochondria; granular eosinophilic cytoplasm with uniform around nuclei
What are risk factors for renal cell carcinoma
Tobacco use, hypertension, obesity, unopposed estrogen therapy, asbestos, petroleum, and heavy metal exposure
What comorbidities are associated with increased risk for renal cell carcinoma
In stage renal disease, DM, cystic kidney disease, and tuberous sclerosis
The most common septype of renal cell carcinoma is clear cell. List the different variants within this subtype
Von Hippel-Lindau syndrome; tuberous sclerosis; hereditary papillary carcinoma
What type of inheritance Pattern is associated with all familial forms of renal cell carcinoma
Autozone will dominate
Describe the pathogenesis of von Hippel-lindau
Overactivation of HIF on VHL gene Located on chromosome 3; promotes angiogenesis, cell growth and some metabolism
List the common clinical manifestations associated with von Hippel-Lindau ccRCC
Hemangioblastoma’s of the cerebellum and retina; Pheochromocytoma (adrenal gland tumor)
Describe the pathogenesis of hereditary papillary carcinoma
MET Proto oncogene; This gene is involved in many mediated cell processes from growth to differentiation
List the Parineetioplastic syndromes associated with renal cell carcinoma
PEAR:
PTH: Hypercalcemia
EPO: polycythemia
ACTH: Cushing syndrome
Renin: hypertension
What is a unique manifestation of perineal plastic syndrome in males
left-sided varicocele; Tumor that blocks the left renal vein which drains into the left testicular vein
Clear cell rcc’s originate in what part of the kidney
Proximal tubule
Describe the histologic features of clear cell RCC
clear cytoplasm; chicken wire pattern of branching basculature; Clear cytoplasm is due to abundance of lipids and glycogen
Carcinomas have a tendency To invade what structure
the renal lane; usually unilateral and rarely bilateral
Describe the gross characteristics of CCRCCS
cystic Yellow to gray white lesions with extensive hemorrhaging
Describe the different grades of CCR CC
1: Small come around, uniform nuclei That looked like lymphocytes
2: slightly irregular nuclei; seen at 40x power
3: Very irregular nuclei; seen at 10x power
4: Mitosis with bizarre multilobulated pleomorphic cells w/ sacromatoids
papillary renal carcinoma is commonly seen in which patients
Patients with dialysis associated cystic disease
Describe the gross characteristics of Papillary rcc
Multifocal hemoretic cystic lesions
describe the different pathogenesis of capillary rcc
Associated with Trisomies of seven, 16, 17, loss of Y chromosome; Note: MET Proto onto gene located on chromosome 7
Capillary rcc Originates from what part of the kidneys
distal convoluted tubules
Describe the histologic characteristics of papillary rcc
Foamy macrophages and psammona bondies
Describe the histologic characteristics of chromophobe RCC
Pill ears and excitoplasm with a vegetable cell wall appearance And often have a halo found around the nucleus
Describe the gross characteristics of chromophobic rcc
Well circumcised globular solid tan brown lesions
chromophobe rcc originates from what cells in the kidneys
Intercolated cells
Describe the pathogenesis of chromophobe Rcc
Multiple chromosome losses
Describe the pathogenesis of XP11 translocation rcc
Translocations of the TFE 3 gene located at Position xp11.2; Over expression of TFE 3 transcription factor
XP11 translocation rcc is commonly found in what population of patients
young patients
Bellini RCC Originates from what structure in the kidneys
Collecting Ducks In the medulla
Logic features ofbellini rcc
nest malignant cells within fibrotic stroma Along with complex duct like tubular cells
How are rcc tumors stage with TNM
‘T: Primary tumor
N: regional lymph nodes
M: Distant metastasis
Describe the different stages of T and MRCC
T1 less than seven centimeters; T2 greater than seven centimeters; T three extends into major veins and perinephrat tissues; T4 extends beyond gerota’s fascia
What is the most common primary renal tumor found in pediatric patients
nephoroblastoma; aka Wilms tumor
Nephroblastoma is associated with what syndromes
WAGR syndrome; DD syndrome; BW syndrome
Describe the pathogenesis of WAGR syndrome
Deletion of 11p13; WT1 gene;
List the clinical manifestations of wagr syndrome
aniridia, Genital anomalies, intellectual disabilities
what is the pathogenesis of DD syndrome
mutated WT1 gene
List the clinical manifestations of DD syndrome
Gonadal dysgenesis; Early onset of Diffuse mesangial sclerosis and renal failure
What is the pathogenesis of BW syndrome
Deletion of 11p15
List the clinical manifestations of WBS
organomegaly, Macroglossia, hemi Hypertrophy, omphalocele, enlarged urinals
What’s the clinical manifestations found In pediatric patients with Nephroblastoma
Large abdominal mass, hematuria, hypertension, intestinal obstruction due to read and release; Occasionally With hepatic pulmonary metastasis
describe the gross pathology of nephroblastoma
Soft homogeneous mass that is well circumcised with a fibrous pseudocapsule
Describe the histologic characteristics of neuroblastoma
Stromal component: Fibrocytic or myxoid w/ Skeleton muscle, adipose tissue, Cartilage, bone differentiation; Additionally epithelial structures and blastema Immature mesenchyme) is also present
Nephroblastoma with anaplasia is associated with what mutations
TP53
Describe the characteristics of blastemia`
sheets of uniform small blue cells that are densely packed
Describe the characteristics of The epithelial structures found a nephroblastoma
poorly differentiated tubular structures
describe the characteristics of the Stroma component of nephrolasoma
fibrovascular with fibroblasts and smooth muscle
Transitional cell carcinomas are found in what renal structures
The pelvis and callouses To the distal urethra which is covered by transitional epithelium
what gene deletion is associated with superficial papillary and non evasive institute lesions of TCC
9P deletion
invasive tc’s are associated with what gene pathogenesis
17P deletions and P503 MUTATIONS
What are the risk factors for tcc
cigarette spoken, exposure to polycyclic aromatic hydrocarbons, aromatic amines, long term analgetic use, radiation, family history
Aggressive TCC invasion into the renal parent kinda leads to what problems
Obstruction and dilation of the pelvis and callouses which produces hydro nephrosis
describe the histologic characteristics of tcc
pleomorphic nuclei in the epithelium; fibrovascular core surrounded by stratified transitional epithelium
List the clinical manifestatins of TS.
assoc. w/ angiofibromas
