Renal Neoplasms

Question 1

What is the most common neoplasm in adults?

Answer 1

Clear Cell Carcinoma (70%)

Question 2

What is an angiomyolipoma?

Answer 2

A benign mesenchymal tumour composed of adipose, smooth muscle, and thick-walled blood vessels

Question 3

What is angiomyolipoma most often seen with?

Answer 3

Patients with tuberous sclerosis

Question 4

What is an oncocytoma?

Answer 4

A benign renal epithelial neoplasm composed of large cells with mitochondria-rich eosinophilic cytoplasm

Question 5

What is the key feature of oncocytoma?

Answer 5

Mitochondria making granular tissue

Question 6

What “color” and “pattern” is associated with oncocytoma?

Answer 6

Mahogany brown and a central stellate scar

Question 7

Can an oncocytoma be multiple?

Answer 7

Yup

Question 8

Are there a lot of mitotic figures in oncocytoma? And what will be seen in an electron microscope?

Answer 8

Not a lot mitotic w/ granular tissue, you’ll see mitochondria

Question 9

What are the main sites of metastasis for renal carcinoma?

Answer 9

Lung, Bone, Brain, and Skin

Question 10

What are the methods of spread of renal cell carcinoma?

Answer 10

Direct, Hematogenous (Metastasis), Contiguous venous spread, lymphatic, urine

Question 11

What is meant by direct spread?

Answer 11

Through the capsule into the perinephric fat, to the renal pelvis, through gerota’s fascia, or rarely to adjacent organs

Question 12

What lymph nodes will renal cell carcinoma spread to?

Answer 12

Renal hilar, Para-aortic, and rarely cervical nodes

Question 13

What is the common question stem for renal cell carcinoma?

Answer 13

A 54 year old man with dull flank pain and painless hematuria….

Question 14

Is the enlarging mass usually encapsulated?

Answer 14

Yes

Question 15

Are necrosis and hemorrhage common?

Answer 15

Yes

Question 16

What kind of tumor is easily palpated?

Answer 16

Wilm’s tumor (lol, larry), and huge ones

Question 17

What is clear cell carcinoma?

Answer 17

The most common, it is a malignant neoplasm composed of cels with clear or eosinophilic cytoplasm within a delicate vascular network

Question 18

Can clear cell carcinoma show color?

Answer 18

Yes, yellow due to lipids. Red due to hemorrhage, Black due to necrosis

Question 19

Is clear cell carcinoma polar and solitary?

Answer 19

Yes, usually, often with cysts too

Question 20

The vast majority of CCC express abnormality on?

Answer 20

Chromosome 3p, sporadic or VHL

Question 21

What is the most important prognostic feature?

Answer 21

Clinical Stage, then nuclear grade (Fuhrman)

Question 22

True or False. Handorf describes the cells in CCC as empty with small, bland, nuclei.

Answer 22

True

Question 23

Sensitivity to what is lose with loss of VHL?

Answer 23

Hypoxia

Question 24

What translocations are possible in sporadic CCC?

Answer 24

t(3;6), t(3;8), t(3;11) or deletion 3

Question 25

Loss of VHL, inactivated or mutated VHL, or hypermethylation of VHL result in what type of CCC?

Answer 25

Hereditary CCC

Question 26

What is papillary carcinoma?

Answer 26

Malignant renal parenchymal tumor with a papillary or tubulopapillary architecture

Question 27

Bilateral and multifocal tumors are (more/less) common than with other renal malignancies?

Answer 27

More

Question 28

Although there is no standard cytogenetic characteristic, what is common with the hereditary variant?

Answer 28

7q

Question 29

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.

Answer 29

50, 60, 40

Question 30

Does furhman apply to papillary carcinoma?

Answer 30

Nope

Question 31

In both sporadic and hereditary papillary carcinoma what is mutated and activated?

Answer 31

MET

Question 32

What trisomy will be in hereditary and what trisomies will be in sporadic?

Answer 32

7 in hereditary, 7, 16, 17 may be in sporadic (as well as loss of Y, or t(X;1) -> PRCC oncogenes

Question 33

What is Chromophobe carcinoma?

Answer 33

Large pale cells with prominent cell membranes, no genetic signature, low mortality

Question 34

What stain is chromophobe carcinoma positive for but we wont be tested on?

Answer 34

Hale's colloidal iron

Question 35

What percentage of people who smoke will have some type of renal pelvis carcinoma?

Answer 35

100%

Question 36

What is the most common pediatric neoplasm and what is it's incidence in the US?

Answer 36

WIlm's Tumor/Nephroblastoma and about 400-600 cases per year. Rare in adults

Question 37

Peak incidence for wilm's is seen when?

Answer 37

2nd-5th year of life (95% of kidney cancer in children)

Question 38

Post therapy of wilms has 5 yr survival is 90%, but what is it without therapy?

Answer 38

0%

Question 39

What is wilms a mixture of?

Answer 39

Cellular elements (blastemal, stromal, epithelial)

Question 40

What is wilms a mixture of?

Answer 40

Cellular elements (blastemal, stromal, epithelial)