Renal system carcinomas and cyst Flashcards
1
Q
What is a cyst?
A
Sac filled with fluid
2
Q
what are the characteristics of a cyst?
A
1- ALL cysts are lined with CUBOIDAL EPITHELIUM ( Except one type and gives malignancy potential )
2- Some Cysts ENLARGE the kidneys, some have no effect and some even shrinks it
3- Knowing the site of cyst is very crucial for diagnosis purposes ( Medullary or cortical or both )
4- what are the conditions associated with Cysts :
Asymptomatic , patient on dialysis , carcinoma, neonatal death, RENAL FAILURE
imp to know the age of renal failure ( some come in 20-30 and some 40-50 )
3
Q
what are 3 cysts disease where the cyst is found in BOTH cortex and medulla?
A
Infantile AR polycystic kidney disease
Adult (AD) polycystic kidney disease
Renal dysplasia –> multicystic renal dysplasia
so cysts in both medulla and cortex
4
Q
do mixed cysts ( cortical and medullary ) affect the kidney size?
A
yes
when we have cysts in both it tends to ENLARGE THE KIDNEY ( tends to not all cases )
5
Q
what is infantile AR polycstic kidney diseaes?
A
poly cyst = multiple cysts in the kidney
Infantile =in infant
So multiple cysts in the kidney of an infant
AR? = AUTOSOMALL RECESSIVE
6
Q
what is the clinical presentation of infantile AR polycystic kidney disease ?
A
Stillbirth
Neonatal death
whenever u read stillbirth, neonatal death and multiple cysts in an infant = infantile AR polycystic kidney disease
7
Q
what is the gene mutation in infantile AR polycystic kidney disease ?
A
PKHD1
way to remember = infant = boss baby = has big head = PK (PIK ) HD ( head )
PKHD1= PK HEAD1 gene mutation
8
Q
what are the grossly features infantile AR polycystic kidney disease ?
A
Massively enlarged kidney by :
small cysts in cortex
small cysts in medulla ( BOTH )
the cysts ae perpendicular to the renal capsule
9
Q
what is the histological feature of the cyst in infantile AR polycystic kidney disease ?
A
Cyst lined by cuboidal cells
( REMEMBER ALL CYSTS ARE LINED BY CUBOIDAL CELLS EXCEPT ONE TYPE )
10
Q
what are the extra RENAL manifestations of infantile AR polycystic kidney disease ?
A
Congenital hepatic fibrosis in patients who survive the infancy
11
Q
what is adult AD polycystic kidney disease ?
A
multiple cysts of kidney in adults
AD = autosomal dominant so ADULT has AD =autosomal dominant
12
Q
What is the clinical presentation of adult AD polycystic kidney disease ?
A
renal failure at the age of 40-50 ( OTHER CYST WILL BE 20-30)
13
Q
What are the genetic mutations that lead to Adult AD polycystic kidney disease?
A
PKD1
PKD2
to remember –> an adult person PKED fi al 3amal or an adult persons is tired cuz his schedule is PACKED ( PKD )
so adult = PKD1 and 2
14
Q
what are the grossly features of adult AD polycystic kidney disease ?
A
Starts of as :
Few cysts in cortex and medulla
THEN PROGRESS to :
Massively enlarged kidney with many cysts
thats why renal failure comes at 40-50 cuz progression take time
15
Q
what are the histological features of the cysts of adult AD polycystic kidney disease ?
A
Cuboidal epithelium like always except the 1 case
INFLAMMATION :
interstitial fibrosis , Lymphocyte infiltrate , tubular atrophy
16
Q
what are the extra renal manifestation of adult AD polycystic kidney disease ?
A
Intracranial berry aneurysms
Pancreatic cyst
Hepatic cysts
Mitral valve prolapse
17
Q
what is renal dysplasia ?
A
Multi cystic renal dysplasia
Dysplasia here doesnt mean cancer cells proliferation
IT MEANS MALFORMATION ( abnormal development of the kidney
MOST COMMON PEDIATRIC CYSTIC RENAL DISEASE
18
Q
what are the grossly features of renal dysplasia ( multicystic renal dysplasia )?
A
Enlarged cystic kidney
Numerous variable sized cysts
COULD BE UNILATERAL OR BILATERAL
19
Q
what are microscopic features of multicystic renal dysplasia ?
A
Disorganized kidney parenchyma
Cysts lined by cuboidal epithelium ( like always except for 1 case )
Cartilage
IMMATURE TUBULES surrounded by BLASTEMAL CELLS
blastemal cells = small round blue cells that are immature
TO REMEMBER : BLUE TUBE CCs
Blue = blastema cells
Tube = immature tubules
C = cyst with cuboidal epithelium
C= cartilage
20
Q
what is acquire cystic disease ?
A
condition that happens to patients on hemodialysis or chronic renal failure
THEY START DEVOLPING CYSTS
21
Q
what is the location of the cysts in acquired cystic disease ?
A
CORTICAL CYSTS
no medulla cysts
22
Q
what could these cyst contain?
A
calcium oxalate crystals
23
Q
what type of epithelium lines these cysts?
A
ATYPICAL HYPERPLASTIC EPITHELIUM
could be come malignant and become tumor = becomes solid
its the only exception where the cyst doesnt have cuboidal epithelium
24
Q
what is medullary sponge disease ?
A
condition where we have cysts in the medulla
Children or adolescents
CYSTS ARE IN THE MEDULLA ONLY NOT CORTEX from the name
25
what happens to kidney size in medullary sponge disease ?
NORMAL SIZE
only case where the size is normal and not affected
26
what is the location of the cyst in medullary sponge disease ?
Medulla :
Medullary pyramids + papillae
27
what lines the cysts of sponge disease ?
Cuboidal epithelium
28
what is adult onsent medullary cystic disease ?
Family of PROGRESSIVE renal disorders
aka nephronophthisis
29
what is the location of cysts in adult onsent medullary cystic disease ( nephronophthisis )?
Medulla :
AT THE CORTICOMEDULLARY JUNCTIONS
30
what is the clinical presentation of adult onset medullary cystic disease ? nephronophthisis
Renal failure at 10-20
( renal failure at 40-50 was at adult AD polycystic )
31
what are the mutation seen in adult onset medullary cystic disease ?
NPH1
NPH2
and other several genes
32
what are the characteristics of cysts in adult onset medullary cystic disease ?
VERY SMALL CYST AT THE MEDULLARYCORTICO JUNCTION
cannot be seen with xray or anything else
the only way to diagnose is by excluding :
Patients come with renal failure at 10-20---> you have to investigations for every other possible disease ,then you exclude then diagnose
LINED BY CUBOIDAL EPITHELIUM like the always except for acquired cystic disease
33
what is the size of the kidney in adult onset medullary cystic disease ?
SHRINKED KIDNEY ( small kidneys )
34
what are the histological features of adult onset medullary cystic disease ?
cyst with cuboidal epithelium
Inflammation :
Interstitial fibrosis, lymphocytic infiltrate , tubular atrophy
35
what are the components of angiomyolipoma ?
Angio = blood vessel
Myo = smooth muscles
Lipoa = fat
36
what is the cause of angiomyolipoma ?
majority of the causes are SPORADIC
20% of the cases are associated with TUBEROUS SCLEROSIS ( TS)
37
what is tuberous sclerosis ?
syndrome
AUTOSOMAL DOMINANT ( AD)
38
what mutations case tuberous sclerosis ? TS?
TSC1
TSC2
These are tumor suppressor genes
Remember Ts = mutation in TS genes
39
How do you differentiate between sporadic case and Tuberous sclerosis case of angiomyolipoma ?
Patients with tuberous sclerosis has many other complains and problems :
MOST IMP : ---> EPILIPSY AND AUTISM ( 50% of patients with autism has Tuber sclerosis )
other problems are :
Cardiac rhabdomyoma ( skeletal muscle in heart )
Angiomyolipoma + renal cell carcinoma
Oral fibromas
Angiofibroma in skin
Hypopigmentation of skin
40
what are the grossly features of angiomyolipoma?
Well defined UN capsulated yellow whitish mass = yellow cuz fat
Sporadic case = SINGLE UNILATERAL
Tuberous sclerosis cases = MULTIPLE BILATERAL
41
what are the microscopic features of angiomyolipoma ?
Triphasic tumor ( 3 components )
1- Thick walled blood vessels
2- Smooth muscle cells
3- Adipose tissue
42
what is papillary adenoma?
oma = benign tumor of the gland
Papillary = shaped like papilla
43
describe papillary adenoma ?
usually incidental finding
ON PATIENTS ON HEMODIALYSIS
: so patients on hemodialysis could develop :
benign papillary adenoma
Acquired cystic disease
malignant carcinoma as a result of ACD
44
what is the location of the papillary adenoma?
CORTICAL found on the cortex ( js like how acquired cystic disease was on the cortex )
45
What is the size of papillary adenoma?
SHOULD BE SMALLER THAN 1.5 CM
size is very imp
BUT IT WAS BIGGER THAN 1.5 = PAPILLARY CARCINOMA ( malignant )
46
what is oncotyoma ?
benign tumor of oncocytes
Oncocytes have RED CYTOPLASM = cuz high number of mitochondria
47
what is the location of the oncocytoma?
CORTICAL tumor
like papillary adenoma
Note : most tumors are in cortex EXCEPT 2 will be discussed later
48
what are the grossly features of oncocytoma ?
mahogany BROWN cut surface on the cortex
Central fibrous scar
Remember :
Angiomyolipoma = yellowish white without capsule
Oncocytoma = mahogany brown
papillary adenoma = SIZE is important
49
what are the microscopic features of oncocytoma ?
Nests of tumor cells ( oncocytes ) WITH EOSINOPHILIC ABDUNDANT CYTOPLASM
50
what are the risk factors of renal cell carcinoma ?
Smoking
Chronic renal failure
Acquired cystic disease
Age old age ---> 60-70
Male
51
what are the types of renal cell carcinoma ?
Sporadic --> MOST CASES
Hereditary / Inherited/familial
52
what is special about hereditary/inherited / familial Renal cell carcinoma?
Multifocal
bilateral
at a younger age
( Multiple tumors at both sides )
53
What is the most imp clinical symptom that tells you this is renal/bladder cancer?
PAINLESS hematuria
54
what are the hereditary familial inherited renal cell carcinoma?
Von hippel linduae syndrome ( VHL )
Hereditary papillary carcinoma
Hereidtary leimyomatosis and RCC
Birt-hogg-dube syndrome
Tuberous sclerosis ( TSC1 )
55
what is the gene mutation in Von hippel lindaue syndrome?
VHL gene
This gene is supposed to INHIBIT the hypoxia state of cell
when its gone the cell will be in hypoxia state
To overcome the hypoxia it FORMS blood vessels = ANGIO
So most tumors seen with this include angio
56
what are the Renal clinical problems associated with VHL mutation/syndrome ?
CLEAR CELL RENAL CELL CARCINOMA ( could be sporadic as well )
57
what are the other organ problems that happens with VHL mutation ?
Hemangioblastomas of cerebellum and retina
Kidney, liver, pancreas CYSTS ( KLB )
PHEOCHAROMOCYTOMA
58
what gene mutation happen in HEREDITARY PAPILLARY CARCINOMA?
MET
59
what is the clinical problem associated with hereditary papillary carcinoma?
from the name :
Papillary renal cell carcinoma
Remember papillary adenoma it was SMALLER THAN 1.5 cm
HERE ITS CARCINOMA so LARGER THAN 1.5 cm
NO OTHER ORGANS AFFECTED
60
what gene mutation is found in Hereditary Leimyomatosis and RCC?
FH ( fumarate hydratase )
61
what are the renal problem associated with hereditary leimyomatosis and RCC ?
Papillary renal cell carcinoma
js like hereditary papillary carcinoma MET mutation
62
what are the other organ complications associated hereditary leiomyomatosis and RCC?
Cutaneous uterine leimyoma ( FIBROIDS ) uterus issue
Remember FH mutation with F = FIBROIDS in Females with F
F F F
63
what is the gene mutation of birt hogg dube syndrome ?
BHD
64
what are the renal tumors associated with BDH syndrome /mutation ?
Hybrid between :
Oncocytic + Chromophobe tumor
chrombophobe = slightly/weakly eosinophilic
65
what are the other organs complications associated with BHD syndrome/ mutation ?
Skin lesions
Spontaneous pneumothorax due to a cyst
66
what is the mutation in tubero sclerosis ?
TSC1 and TSC2
67
What are the renal complications of Tubero sclerosis ?
angiomyolipoma
Hybrid oncocytic / chromophobe tumor RCC
68
what are the other organ complications of tubero sclerosis ?
Epilpsy
autism
Cardiac rhabdomyoma
Oral fibroma
Angiofibroma
Hypopigmentation
69
what is the common type of Clear Cell RCC?
one arising from PCT cells
70
what causes clear cell RCC?
most cases are SPORADIC
could be familial
but in both cases ITS VHL gene mutation
71
what is the grossly feature clear cell RCC?
Yellowish to orange spherical tumor
at the upper pole of kidney
This tumor loves going inside the veins = DILATED THROMOBSED RENAL VEIN
72
what are the microscopic features of Clear cells RCC?
since its yellowish white = FAT
so
Nests of clear cells ( LIPID + GLYCOGEN )
Separated by vascular network :-
Rmember VHL missing = hypoxia = blood vessel forming thats why we see vascular network around the tumor
73
from which cells do papillary RCC arise from ?
DCT epithelial cells
74
what causes papillary RCC?
Familal and spoadic
IN both cases :
MET gene mutation
or FH ( in hereditary liemyomatosis )
75
what are the grossly features of Papillary RCC?
Yellow to brown mass forming papillary
76
what are the microscopic features of Papillary RCC?
Papilla ( From the name )
lined by normal DCT epithelial cells
Psammoma bodies ( all papillary carcinoma love forming this - calcified bodies )
Foamy macrophages
77
where do mixed chromophobe RCC arise from?
COLLECTING DUCTS --> intercalated cells
Best prognosis
78
what causes mixed chromophobe RCC?
Brit hogg dube snydrone ( BHD mutation )
Tuber sclerosis ( TSC1 )
Could be sporadic as well
79
what are the grossly features of mixed chromophobe RCC?
yellowish to BROWN mass
Where did we see Brown =? Oncocytoma
thats why Chromophobe and Oncoytic are mixed together
80
what are the microscopic features of mixed chromophobe RCC?
2 Ps
Sheet of Granular cells with :
1- Prominent cell membrane
2- Perinuclear halo
2 ps
+SLIGHT EOSINOPHILIC CYTOPLASM ( CHROMOPHOBE )
81
what are 2 medullary RCC?
Collecting duct carcinoma ( Bellini duct )
Renal medullary carcinoma
ALL THE PREVIOUS ONES WERE CORTICAL from angiomyolipoma to chromophobe RCC
82
from what does collecting duct carcinoma arise from ?
Medullary collecting duct
83
what are the grossly features of Collecting duct carcinoma?
Medullary mass
84
what are the microscopic features of collecting duct carcinoma? Bellini duct?
Tubules lined with MARKEDLY ATYPICAL tumor cells
85
from where does the renal medullary duct carcinoma arise from?
Renal papillae
86
what are the grossly features of renal medullary carcinoma?
same as collecting duct carcinoma
Medullary mass
87
what are the microscopic features of renal medullary carcinoma?
same as collecting duct carcinoma :
Tubules linked with markedly atypical tumor
88
since both collecting duct carcinoma and renal medullary carcinoma have the same grossly and microscopic features how do we differentiate between them?
1- Renal medullary carcinoma PATIENT WILL HAVE SICKLE CELL DISEASE
2- If you stain renal medullary carcinoma with a special stain it will LOSE EXPRESSION OF INI1
89
What is the clinical picture of RCC in general?
Dull loin pain
Painless HEMATURIA --> MOST IMP
abdominal mass
Few tumors can secrete :
PTH like hormone--> high calcium
ERYTHROPOIETIN-->POLYCYTHEMIA
RENIN--> HTN
90
how does RCC spread?
Direct spread --> renal pelvis , RENAL VEIN ( CLEAR CELL ) and adjacent tissues
Lymphatic --> para aortic, lymph nodes
Blood ---> lung n bones
91
what is Wilms tumor? Nephroblastoma?
Commonest primary renal tumor of children
2-5 years of age
92
what are the genetics associated with Wilms tumor?
WAGR
Denys Drash
Beckwith- wideman syndrome
93
what is WAGR syndrome?
W = Wilms tumor ( nephroblastoma )
A= Anirida ( born without iris )
G= Genito-urinary abnormalities
R = retardation
94
what is the mutation found in WAGR syndrome?
DELETION OF WT1
loss of it
95
What is Denys drash syndrome ?
Wilms Tumor
Glomerulosclerosis
Gonadal Dysgenesis (no testies or ovaries )
( 2 Ds and 2 Gs )
96
what is the mutation in denys drash?
Same gene as WAGR ---> WT1
BUT its not deleted ---> theres another mutated version that inhibit the normal function
97
what is beckwith-wideman syndrome?
Wide = big = everything big in the baby
Wilms tumor
Exopthalamus ---> big eyes
Macroglosia ---> big tongue
Gigantism ---> big
98
what is the mutation in beckwith wideman syndrome?
WT2 ---> lead to increase IGF1 ( insuline like growth factor )
99
what are the sporadic causes of Wilms tumor ?
Grain of fuction mutation of B catenin gene
TP53 mutation
100
what is clinical presentation of Wilms tumor?
Abdominal mass
101
there are 2 different tumors that can cause abdominal mass in kids ? Wilms tumor and Neuroblastoma ? how to differentiate?
Measure Serum catecholamines
cuz neuroblastoma release catecholamines in blood
102
what are the microscopic features of Wilms tumor?
its nephroblastoma
3 things :
1- Blastemal ---> small blue cells
2- epithelial --->Poorly formed tubules or glomeruli
3- Stromal ---> Spindle cells or myxoid tissue , skeletal muscle, fat, cartilage ,bone
these are very similar to MULTICYSTIC RENAL DYSPLASIA ( Blue tubules CCs )
103
why are all the mentioned tumor above are from renal tissue and not pelvis?
cuz pelvis is formed from a different type of epithelium
called
Urothelium
in histo its called transitional epithelium
104
what are the layers of bladder?
Mucosa
Muscularis propria
Adventitia
Serosa at the dome
NO SUBMUCOSA
105
What are the components of mucosa of the bladder?
Urothelium
Lamina propria
Discontinuous muscularis mucosa
106
what are the epitheliums ?
urothelium : umbrella cells, intermediate and basal cells
Non kera, glycogenated squamous epithelium --> in trigone and bladder neck in women , Distal portion of penile urethra
107
why do we need the know the layers?
if tumor reaches the MUSCULARIS PROPRIA = you need to remove the whole bladder
If tumor only reaches muscularis mucosa = we can js remove the tumor leaving the bladder
108
what is cystitis ?
inflammation of the bladder
We have chronic and acute
109
what causes cystitis ?
Infection
Radiation and chemotherapies
110
what are 2 important cystitis ?
Interstitial cystitis ( Chronic pelvic pain syndrome )
Malakoplakia
111
what is the clinical presentation of Interstitial cystitis ?
FEMALES
Suprapubic pain that :
Increases with bladder filling
Relieved by bladder emptying
similar to irritable bowel syndrome
112
what are the grossly features of interstitial cystitis ?
Hemorrhage
followed by localized ulceration --> Hunners ulcer
113
what are the microscopic features of Interstitial cystitis ?
MAST CELLS INFILTRATE
in lamina propria
U ONLY SEE MAST CELLS
114
what is malakoplakia?
Plakia = white Malako = gross
its gross white plaques so called malakoplakia
115
what causes malakoplakia ?
Chronic bacterial cystitis by E coli or Proteus species
116
what are the grossly features of malakoplakia?
Soft yellow
mucosal plaques ( MALAKO )
117
what are Microscopic features of malakoplakia?
2 things :
Von hansemann histiocytes ---> Histocytes with eosinophilic cytoplasm ---> MACROPHAGES THAT ENGLUFED A BACTERIA AND COULDNT DIGEST IT
Michaelis gutmann bodies ---> INSIDE THE HISTIOCYTES --> the bacteria inside the cell will get deposited on calcium ( so its bacteria with calcium deposits on them inside the histiocytes )
118
what are some bladder proliferative metaplastic lesions ?
The urothelial cells are crazy with any minor irritation = go crazy
Brunn nests
Cystic cystica
Cystitis glandularis
Could undergo squamous metaplasia
or
Nephrogenic metaplasia ( shed tubular cells implants and look like at site of injured urothelium )
119
what is brunn nests ?
normal urothelial proliferation BUT
instead of going outside it proliferate downward toward the lamina propria forming a nest HENCE brunn netsts
120
what is cystitis cysticia ?
the brunn nests starts developing CENTRAL CYSTIC DILATION
121
what is Cystitis glandularis ?
the Brunn nests start undergoing GLANDULAR METAPLASIA
from urothelium = mucus secreting glands
122
what are the risk factors of bladder neoplasms ?
smoking = most imp risk factor
Industrial exposure to arylamine
Schistosoma hematobium infection ---> SQUAMOUS CELL CARCINOMA
drugs : analgesics , cyclophosphamide
radiation
123
what is special in treatment of squamous cell carcinoma and adenocarcinoma ?
we have to remove the whole bladder ( cystectomy )
regardless if reaches the propria or not
124
how does a bladder cancer start off?
2 ways :
Papillary then it becomes cancer
Flat lesion then becomes cancer
125
Describe the progressions from Papilloma to invasive carcinoma?
1- Papilloma --> benign tumors of epithelium forming papilla
2- Papillary urothelial neoplasm of LOW malignant potential ( not malignant yet )
3- Non invasive LOW papillary urothelial CARCINOMA
4- Non invasive HIGH grade papillary urothelial CARCINOMA
5- INVASIVE CARCINOMA ( END )
126
describe papilloma?
benign tumor of epithelium forming papillae
has central fibrovascular core
Covered by NORMAL CELLS ( 6-7 layers )
If excised rarely reoccur
127
describe papillary urothelial neoplasms with low malignant potential > PUNLMP?
same as papilloma BUT MORE CELLS LINING THE PAPILLAE
If excised may reoccur with the same morphology OR
as higher grade tumor associated with invasion
128
describe non invasive low grade papillary urothelial carcinoma?
now khalas we are low grade carcinoma ( BUT ITS NOT NON INVASIVE = the bladder is the only location where you have cancer that doesnt invade the basement membrane )
Papillary tumor tissue lined with many layers of urothelial cells
the cells are LOW GRADE ATYPIA ( mild cellular and nuclear pleomorphism, mild disturbed polarity )
129
describe non invasive high grade papillary urothelial carcinoma?
same as the low grade papillary urothelial carcinoma but :
The cells are now HIGH grade ATYPIA ( marked grade cellular and nuclear pleomorphism, mild disturbed polarity )
130
describe carcinoma ?
khalas fully blown cancer that invades muscles and the bladder is removed
131
describe the progression of flat urothelial lesions into invasive carcinoma?
3 stages only --> ITS MUCH FASTER THAN PAPILLOMA PATHWAY CUZ WE DONT FORM PAILLPOMA WE GO DIRECTLY AT THE SURFACE
1- Urothelial dysplasia = low grade intra-urothelial neoplasia ( LG IUN )
2- Urothelial CARCINOMA IN SITU = high grade intra urothelial neoplasia ( HG IUN )
3- invasive carcinoma
132
describe low grade intra urethelial neoplasia > LG IUN?
Urothelial dysplasia = malignant cells in the urothelium but not severe enough to occupy all layers
Grossly = since its FLAT on the surface u wont see anything it would js be either NONE or Erythema
Microscopically = Loss of cell polarity + nuclear crowding + cytologic atypa = BUT NOT SEVERE ENOUGH TO DIAGNOSIE IN SITU carcinoma
133
Describe urothelial carcinoma in situ?
now its severe enough, HIGH GRADE intra urothelial neoplasia
Grossly = same since its flat u will see nothing , or erythema
Microscopic =
Loss of polarity + Nuclear crowding + cytogenic atypia but severe
Atypia may not be full thickness
IF LET UNTREATED 75% OF CASES PROGRESS INTO INVASIVE CARCINOMA ( invade muscle )
134
what are the genetic mutations found in papillary tumors?
FGFR3
RAS
135
what are the gentic mutations found in carcinoma in situ ( flat )?
p3
RB
136
what mutations do we see in invasive carcinomas?
p53
137
what is the clinical presentation of invasive carcinoma?
PAINLESS HEMATURIA
138
what is the grossly features of invasive carcinoma?
Funging tumor from the wall of the bladder filling the lumen
REGARDLESS OF THE ORIGIN EITHER PAPILLA OR FLAT
139
What is the microscopic features of invasive carcinoma ?
Invasion of urothelial nests or single cell
MUSCLURALIS PROPRIA invasion ( u would see cancer cells near the muscles bundles )
140
describe bladder adenocarcinoma?
bladder cancer that doesnt orignate from urothelial cells
Tumor formed of malignant GLANDS sometimes with mucin secretions
141
describe bladder squamous cell carcinoma ?
same thing, cancer that is not from urothelial cells
Tumor formed of malignant squamous cell with KERTAINIZATION
most imp risk factor is schistamosis ( bilharziasis )
142
what is Rhabdomyosarcoma ?
Most common tumor of children ( UNDER 15 )
malignant tumor of connective tissue ( SARCOMA )
RHABDO = skeletal muscle
143
where does rhabdomyosarcoma arise from?
detrusor muscle
144
what is the grossly feature of rhabdomyosarcoma ?
Polypoid grapelike clusters
145
what are the microscopic features of rhabdomyosarcoma ?
Sheets of SRBC = small cells with hyperchromatic nuclei
in between the small cells u will see :
LARGE CELLS WITH EOSINOPHILIC CYTOPLASM AND CROSS STRIATIONS ( strap cells )
146
what are 2 urethral lesions ?
Caruncles
Fibro-epithelial polyp
147
where doe carnucles happen?
Females
148
Grossly features of Carnucles ?
Painful small BLEEDY polyp
found on external urethral meatus
149
what are the microscopic features of carnucles?
Polyp lined with :
Urothelium OR squamous epithelium
overlying inflammed tissue
150
where does fibro-epithelial polyp happen?
Males, adult, children
151
what are the grossly features of fibro-epithelial polyp ?
Polyp in prostatic urethra
152
what are the microscopic features of fibro-epithelial polyp?
poly lined by urothelium overlying STROMA with inflammation
