Renal Neoplasms Flashcards
What is the most common neoplasm in adults?
Clear Cell Carcinoma (70%)
What is an angiomyolipoma?
A benign mesenchymal tumour composed of adipose, smooth muscle, and thick-walled blood vessels
What is angiomyolipoma most often seen with?
Patients with tuberous sclerosis
What is an oncocytoma?
A benign renal epithelial neoplasm composed of large cells with mitochondria-rich eosinophilic cytoplasm
What is the key feature of oncocytoma?
Mitochondria making granular tissue
What “color” and “pattern” is associated with oncocytoma?
Mahogany brown and a central stellate scar
Can an oncocytoma be multiple?
Yup
Are there a lot of mitotic figures in oncocytoma? And what will be seen in an electron microscope?
Not a lot mitotic w/ granular tissue, you’ll see mitochondria
What are the main sites of metastasis for renal carcinoma?
Lung, Bone, Brain, and Skin
What are the methods of spread of renal cell carcinoma?
Direct, Hematogenous (Metastasis), Contiguous venous spread, lymphatic, urine
What is meant by direct spread?
Through the capsule into the perinephric fat, to the renal pelvis, through gerota’s fascia, or rarely to adjacent organs
What lymph nodes will renal cell carcinoma spread to?
Renal hilar, Para-aortic, and rarely cervical nodes
What is the common question stem for renal cell carcinoma?
A 54 year old man with dull flank pain and painless hematuria….
Is the enlarging mass usually encapsulated?
Yes
Are necrosis and hemorrhage common?
Yes
What kind of tumor is easily palpated?
Wilm’s tumor (lol, larry), and huge ones
What is clear cell carcinoma?
The most common, it is a malignant neoplasm composed of cels with clear or eosinophilic cytoplasm within a delicate vascular network
Can clear cell carcinoma show color?
Yes, yellow due to lipids. Red due to hemorrhage, Black due to necrosis
Is clear cell carcinoma polar and solitary?
Yes, usually, often with cysts too
The vast majority of CCC express abnormality on?
Chromosome 3p, sporadic or VHL
What is the most important prognostic feature?
Clinical Stage, then nuclear grade (Fuhrman)
True or False. Handorf describes the cells in CCC as empty with small, bland, nuclei.
True
Sensitivity to what is lose with loss of VHL?
Hypoxia
What translocations are possible in sporadic CCC?
t(3;6), t(3;8), t(3;11) or deletion 3
Loss of VHL, inactivated or mutated VHL, or hypermethylation of VHL result in what type of CCC?
Hereditary CCC
What is papillary carcinoma?
Malignant renal parenchymal tumor with a papillary or tubulopapillary architecture
Bilateral and multifocal tumors are (more/less) common than with other renal malignancies?
More
Although there is no standard cytogenetic characteristic, what is common with the hereditary variant?
7q
Acquired dialysis related renal cystic disease results in a (30/40/50/60) fold increase in renal cancer. Of that (60/50/40/30) is CCC and (60/50/40/30) is papillary.
50, 60, 40
Does furhman apply to papillary carcinoma?
Nope
In both sporadic and hereditary papillary carcinoma what is mutated and activated?
MET
What trisomy will be in hereditary and what trisomies will be in sporadic?
7 in hereditary, 7, 16, 17 may be in sporadic (as well as loss of Y, or t(X;1) -> PRCC oncogenes
What is Chromophobe carcinoma?
Large pale cells with prominent cell membranes, no genetic signature, low mortality
What stain is chromophobe carcinoma positive for but we wont be tested on?
Hale’s colloidal iron
What percentage of people who smoke will have some type of renal pelvis carcinoma?
100%
What is the most common pediatric neoplasm and what is it’s incidence in the US?
WIlm’s Tumor/Nephroblastoma and about 400-600 cases per year. Rare in adults
Peak incidence for wilm’s is seen when?
2nd-5th year of life (95% of kidney cancer in children)
Post therapy of wilms has 5 yr survival is 90%, but what is it without therapy?
0%
What is wilms a mixture of?
Cellular elements (blastemal, stromal, epithelial)
What is wilms a mixture of?
Cellular elements (blastemal, stromal, epithelial)
