Renal Tumors

Question 1

List extrarenal changes in CRF

Answer 1

Fibrinous pericarditis & pleurisy, uremic pneumonitis, enterocolitis & ulceration, immunodeficiency, osteodystrophy due to 2ry hyperparathyroidism, normocytic normochromic anemia due to dec erythropoietin, nervous manifestations (mental changes, peripheral neuritis & coma), fluid, electrolyte & acid-base imbalance.

Question 2

Describe G&M features of oncocytoma

Answer 2

G: well circumscribes large, brown mass with central stellate scar
M: formed of eosinophilic epithelial cells with uniform rounded nuclei

Question 3

Age of incidence of RCC is……

Answer 3

60-70 yrs

Question 4

Mention non-genetic risk factors for RCC

Answer 4

Smoking & with occupational exposure to cadmium
The risk is inc 30-fold in individuals with PKD due to chronic dialysis

Question 5

Describe genetic predisposition to RCC

Answer 5

1. Clear RCC; mostly sporadic maybe familial associated with VHL disease (tumor suppressor gene) leads to hemangioblastomas of cerebellum & retina & bilateral multiple clear cell carcinomas
2. Papillary RCC aporadic or familial associated with MET proto-oncogene
3. Chromophobe RCC; having multiple losses of entire chromosomes

Question 6

RCC extends early into……& late into……

Answer 6

Renal pelvis
Renal capsule

Question 7

The most common microscopic variant of RCC is…..while least common is…..

Answer 7

Clear
Chromphobe

Question 8

GR: Presence of clear cells in RCC

Answer 8

Due to glycogen production

Question 9

Describe spread of RCC

Answer 9

Local infiltration
Blood spread due to renal vein invasion common sites are lung & bones (pelvis & femur), CNS, adrenals. Left renal vein invasion leads to variocele
Lyphatic spread to lumbar group of LNs

Question 10

Describe microscopic features of Wilm’s tumor

Answer 10

3 components
1. Blastematous areas, extremely cellular composed of round to oval cells with scanty cytoplasm
2. Mesenchymal elements have spindle cell fibroblast-like configuration may show mesenchymal differentiation
3. Epithelial component; show glandular, tubular or glomerular formation

Question 11

Describe spread of Wilm’s tumor

Answer 11

Local infiltration with destruction of kidney tissue, invasion of renal capsule, perirenal soft tissue, adrenal gland, bowel, liver or vertebra.
Blood spread; most common to LL & brain
Lymphatic spread to regional LNs (15%)

Question 12

List paraneoplastic syndromes accompanying RCC

Answer 12

Polycythemia, HTN, gynecomastia, hypercalcemia