Renal Neoplasms - Handorf

Question 1

What are common renal neoplasms in adults?

Answer 1

clear cell carcinoma (70)
pipillary carcinoma (10)
chromophobe carcinoma (5)
oncocytoma (5)
angiomyolipoma (1)

Question 2

What is an angiomyolipoma?

Answer 2

a benign mesenchymal tumor composed of avriable proportions of adipose tissue, spindle and epitheliod smooth muscle cells, and abnormal thick-walled blood vessels. Its often seen in patients with tuberous sclerosis.

Question 3

What is an oncocytoma?

Answer 3

a gneign renal epithelial neoplasm composed of large cells with mitochondria-rich eosinophilic cytoplasma (why they look granular and basophilic)
Grossly mahogany brown with central stellate scare *30%

Question 4

on histo exam. what do you seem in an oncocytoma?

Answer 4

stippling (sandy appearance), see nucleoli, no mitotic figures (but not exclusive to oncocytomas)

Question 5

When renal carcinomas are spread hematogenously, what organs should we be concerned about?

Answer 5

lung, bone brain skin,

Question 6

when renal carcinomas are spread lymphatically, what should we be concerned about?

Answer 6

renal hilar nodes
para-aortic nodes
cervical node s(rare)

Question 7

what is the presentation for renal carcinoma?

Answer 7

hematuria in 50ish yo man presenting with dull flank pain (worsens on pressure).

Question 8

what is the specific renal tumor that palpating is crucial in dx?

Answer 8

wilms tumor

Question 9

what is clear cell carcinoma

Answer 9

malignant neoplasm composed of cells with clear or eosinophilic cytoplasm within a delicate vascular network. usually solitary , polar, and yllow (often fatty), with cysts, necrosis and hemorrhage

Question 10

what is the chromosome abnormality for clear cell carcinoma that is genetic?

Answer 10

chromosome 3p deletion in sporadic and familial (von hippel lindau)

Question 11

what are the three questions you want to ask to differentiate between cancers?

Answer 11

polar or peripheral
what color
cystic or not

Question 12

describe the nuclei in clear cell carcinoma

Answer 12

you can’t, their description is being extremely bland.

Question 13

what is the difference between low and high nuclear grade in clear cell carcinoma?

Answer 13

high nuclear grade has a lot of nuclear ability

Question 14

what are common genetic mutations that lead to clear cell carcinoma?

Answer 14

translocations 3:6, 3:8 or 3:11
deletions on chromosome 3 basically
or hypermethylation of VHL

Question 15

What is the relationship between clear cell carcinomas and veins?

Answer 15

they love to invade veins, not into the structure of them but growing through. Can invade all the way into the right heart which is why you can get frequent lung metastases

Question 16

What is a papillar carcinoma?

Answer 16

a malignant renal parenchymal tumor with a papillary or tubulopapillary architecture, bilateral and multifocal tumors are more common. no standard cytogenetic characteristics except 7q variant.

Question 17

When you have dialysis, by how much does your risk of renal cancer increase?

Answer 17

50 fold (60% clear cell, 40% papillar)

Question 18

on histology, what do papillary carcinomas look like?

Answer 18

they have finger-like projections

Question 19

what are the genetics assocaited with papillary carinoma?

Answer 19

trisomy 7, 16, 17
loss of y
activated MET

Question 20

what is chromophobe carcinoma?

Answer 20

characterized by large pale cells with prominent cell membranes, no specific genetic signature, lower mortality, polar, some have clear cells

Question 21

when is the most important risk factor for renal cancer?

Answer 21

smoking (15-20% of smokers have cancer. 100% are pre-cancerous

Question 22

What is wilms tumor?

Answer 22

pediatric tumor of kidney, rarely in adults. 90% survival rate. composed of a mixture of cellular elements