Renal - Pathology (Renal Cancer)

Question 1

What is the origin of renal cell carcinoma? How does it appear on histology?

Answer 1

Originates from proximal tubule cells –> polygonal clear cells filled with accumulated lipids and carbohydrates.

Question 2

In what patient population is renal cell carcinoma most common?

Answer 2

Mot common in men 50-70 years old.

Question 3

What are 2 factors that increased the incidence of renal cell carcinoma?

Answer 3

Increased incidence with smoking and obesity.

Question 4

How does renal cell carcinoma manifest clinically?

Answer 4

Manifests clinically with hematuria, palpable mass, secondary polycythemia, flank pain, fever, and weight loss.

Question 5

What does renal cell carcinoma invade, and where does it metastasize?

Answer 5

Invades renal vein then IVC and spreads hematogenously; metastasizes to lung and bone.

Question 6

What is the most common primary renal malignancy?

Answer 6

Renal cell carcinoma

Question 7

With what mutation is renal cell carcinoma associated?

Answer 7

Associated with gene deletion on chromosome 3 (sporadic or inherited as von Hippel-Lindau syndrome); Think: “RCC = 3 letters = chromosome 3”

Question 8

With what kind of syndromes is renal cell carcinoma associated? Give examples of such syndromes.

Answer 8

Associated with paraneoplastic syndromes (ectopic EPO, ACTH, PTHrP).

Question 9

What kind of cancer is renal cell carcinoma considered to be based on its common presentation? What is that presentation?

Answer 9

“Silent” cancer because commonly presents as a metastatic neoplasm.

Question 10

How is renal cell carcinoma treated? Include the variation of treatments depending on severity of disease. What is the role of chemotherapy and radiation therapy?

Answer 10

Treatment: resection if localized disease. Immunotherapy or targeted therapy for advanced/metastatic disease. Resistant to chemotherapy and radiation therapy.

Question 11

What kind of tumor is renal oncocytoma? How may it appear grossly?

Answer 11

Benign epithelial cell tumor (may be seen as well-circumscribed mass with central scar).

Question 12

What can be seen on a H & E stain for renal oncocytoma?

Answer 12

H & E stain shows round to polygonal cells with granular eosinophilic cytoplasm and round nuclei; Large eosinophilic cells with abundant mitochondria without perinuclear clearing (vs. chromophobe renal cell carcinoma)

Question 13

How does renal oncocytoma present?

Answer 13

Presents with painless hematuria, flank pain, and abdominal mass.

Question 14

How is renal oncocytoma treated?

Answer 14

Treatment: nephrectomy

Question 15

What is the most common renal malignacy of early childhood (ages 2-4)?

Answer 15

Wilms tumor (nephroblastoma)

Question 16

What does Wilms tumor contain?

Answer 16

Contains embryonic glomerular structures.

Question 17

How does Wilms tumor present?

Answer 17

Presents with huge, palpable flank mass and/or hematuria.

Question 18

What mutations are associated with Wilms tumor?

Answer 18

“Loss of function” mutations of tumor suppressor genes WT1 or WT2 on chromosome 11.

Question 19

What are the syndromes related to Wilms tumor?

Answer 19

Wilms tumor may be part of Beckwith-Wiedemann syndrome or WAGR complex: Wilms tumor, Aniridia, Genitourinary malformation, and mental Retardation (intellectual disability).

Question 20

What is the most common tumor of the urinary tract system? Where can it occur?

Answer 20

Transitional cell carcinoma; Most common tumor of the urinary tract system (can occur in renal calyces, renal pelvis, ureters, and bladder).

Question 21

What suggests bladder cancer?

Answer 21

Painless hematuria (no casts) suggests bladder cancer.

Question 22

With what factors is transitional cell carcinoma associated?

Answer 22

Think: “Associated with problems in your ‘Pee SAC’”: Phenacetin, Smoking, Aniline dyes, and Cyclophosphamide.

Question 23

What is the progression to squamous cell carcinoma of the bladder?

Answer 23

Chronic irritation of urinary bladder –> squamous metaplasia –> dysplasia and squamous cell carcinoma

Question 24

What are the risk factors for squamous cell carcinoma of the bladder?

Answer 24

Risk factors include Schistosoma haematobium infection (Middle East), chronic cystitis, smoking, and chronic nephrolithiasis.

Question 25

How does squamous cell carcinoma of the bladder present?

Answer 25

Presents with painless hematuria.