Renal Neoplastic Dz Flashcards
Renal Cell carcinoma:
- originates in what part of the kidney?
- most common in which gender?
- most common in what age?
- risk factors
renal cortex
most common in males
most common 60-80yrs
Risk factors:
- smoking
- HTN
- Obesity
- Acquired Cystic dz of kidney
What are the 5 subtypes of Renal Cell Carcinoma and where do they orginate within the nephron??
- clear cell (75-85%) = PCT
- Papillary=PCT
- chromophobe= cortical collecting duct
- oncocytic = cortical collecting duct
- collecting duct (Bellinis duct) = medullary collecting duct)
Clear Cell Carcinoma:
- arise from what part of the nephron?
- severity
- describe microscopic appearance
- arise from the PCT
- tends to have vascular invasion, cancer metastasizes to liver and lungs.
Microscope:
-clear cytoplasm d/t lipid and glycogen, cells may be banded or poorly differentiated, cell form solid nests, fine vasculature
Papillary Cell Carcinoma:
- arise from what part of the nephron?
- common in what type of genetic mutation
- microscopic appearance
- PCT
- Trisomy 7 common
- better outcome than clear cell carcinoma
Microscope:
-delicate vascular cores with overlying lay of tumor cells, may undergo necrosis and calcification “Psammoma bodies”
- Chromophobe Carcinoma:
- arise from what part of the nephron?
- describe microscopic appearance - Collecting duct carcinoma:
- arises from what part of the nephron?
- common in who? - Oncocytomas:
- arise from what part of the nephron?
- cortical collecting duct
- sheets of pink eosinophilic cells with perinucular halos - medullary collecting duct
- African american adults (younger)
3.cortical collecting duct (benign tumors)
Renal Cell Carcinoma:
- presentation
- triad of sx & other sx
- clinical features
-predominantly asymptomatic, presents late in course and most commonly diagnosed incidentally.
Triad of Sx:
- flank pain
- Gross hematuria
- palpable renal mass
Other sx:
- sudden scrotal varocele (MC Right sided)
- Fever, fatigue, weight loss, may have night sweats
- paraneoplastic syndromes
Clinical features:
- anemia
- hepatic dysfunction
- anorexia
Renal Cell Carcinoma:
-Diagnostic evaluation
- Ultrasound is initial best step, CT is diagnostic
- may get MRI, good if pt cant handle dye or pregnant.
Differential Dx of Renal Masses:
-cyst may be what three kinds?
-3 major criteria for simple cyst
- Assessing for mets:
- -most common sites
- -diagnostic procedures
-simple, complex, multiple
3 major criteria for simple cyst:
-mass is round, sharply demarcated with smooth walls
- no echos on US
- strong posterior wall echo indicating good transmission through cyst
Assessing for Met:
-Common sites: lungs, intrabdominal LN, and Bone
- dx:
- Bone scan, CT of chest, PET (oncologist gets this)
What is the primary reason to investigate a renal mass?
-to exclude a malignant neoplasm
Treatment of Renal Cell Carcinoma?
-Treatment of choice is surgical removal; may involve regional lymphatics, inferior vena cava
- Radical Nephrectomy GOLD STANDARD
- if upper pole tumor take the adrenal gland, if lowe pole tumor you can leave the adrenal gland in. - Nephron-sparing surgery (Partial Nephrectomy)
- just taking out the tumor itself, for unliater tumor less than 4cm in size.
….i guess some people may use chemo/radiation as last ditch effort. :(
American Joint Commission on Cancer Stages of Renal Cell Carcinoma?
Stage I: tumor less than 7cm and limited to kidney
Stage 2: tumor greater than 7cm and limited to the kidney
Stage 3: tumor in major veins or adrenal gland within Gerotas Fascia or 1 regional LN is involved.
Stage 4: tumor beyond Gerotas fascia or greater than 1 regional LN involved.
Gerotas fascia is a layer of connective tissue encapsulating the kidneys and adrenal gland.
Wilms Tumor (Nephroblastoma)
- most common in who?
- mean age at dx, rarely seen after what age?
- pathogensis
- associated with what other congenital syndromes?
- most common renal malignancy in children**
- mean age at dx is 3.5years, not commonly seen after 15yrs
Pathogenesis:
-abnormal renal development and proliferation of embryological cells resulting w/o normal tubular and glomerular differentiation.
Associated congenital syndromeS:
- WAGR
- Denys-Drash Syndrome
- Beckwith-Wiedmann Syndrome
Risk factors of WIlm’s Tumor
Clinical Features
aniridia = iris color forms paritally or not at all
Hemihypertrophy
Undescended testicles
Hypospadias
Clinical Features:
-palpable mass (90%)*
- swelling w/o other signs or sx*
- abd pain
- hematuria
- HTN
- bilateral tumors
Wilms Tumor:
-Diagnostics
- what is the definitive dx of Wilms tumor?
- Staging
Dx:
- Ultrasound & Contrast CT
- surgical excision or bx
Definitive Dx: histological confirmation from surgical excision or bx.
Staging:
Stage 1: cancer found in one kidney and can be completely removed via surgery
Stage 2: cancer beyond kidney, but can be completely removed via surgery
Stage 3: cancer has not spread beyond abd, cannot be completely removed by surgery.
Stage 4: cancer spread to distal parts of body (lungs, liver, bone, brain)
Stage 5: cancer is found in both kidneys at dx
Wilms Tumor Macroscopic appearance
-large, well circumscribed tan/white appearance
