Renal Tumors - Iczkowski Flashcards
What are the four different malignant renal cell carcinomas?
What are the two benign renal cell carcinomas?
Clear Cell, Papillary, Chromophore, Collecting Duct (also clear cell tubulopapillary mash-up?)
Renal Oncocytoma, Angiomyolipoma
Which malignant renal cell carcinomas have the best prognosis?
Chromophore
Papillary
Clear cell
Collecting Duct
Which malignant renal cell carcinomas are the most prevalent?
Clear Cell (83%)
Papillary (11%)
Chromophore (4%)
Collecting Duct (1%)
What does clear cell renal carcinoma look like on histology?
pink stroma
large clear cells (look like fat cells)
Necrosis may be present (worse outcomes)
Clear cells accumulate glycogen and lipids leading to their “clear” appearance on histology
What does papillary renal cell carcinoma look like on histology?
Papilla with blood vessels and macrophages surrounded by non-polarized nuclei
What are the two types of papillary renal cell carcinoma?
Type 1: thin papillae, better outcome
Type 2: thick papillae, worse outcome
What does a chromophobe renal cell carcinoma look like on histology?
On gross histology?
Cells appear to have a halo around a wrinkled nucleus
Cells may be binucleate
Tumor is well circumscribed, may have hemorrhages
What does a collecting duct renal cell carcinoma look like on histology?
“Irregular aggregates of tumor cells”
No idea what that means
What does a medullary renal cell carcinoma look like on histology?
Prominent nuclei
cell with indistinct borders
What is the patient profile of someone with medullary renal cell carcinoma?
African or Mediterranean descent
Sickle Cell disease or trait
Cancer presents at advanced stage
How does acquired cystic disease affect renal cell carcinoma?
Increases the risk of getting renal cell carcinoma 100x
What does acquired cystic disease look like on histology?
Lots of vacuoles
oxalate crystals
What does clear cell tubulopapillary renal carcinoma look like on histology?
papillas surrounded by cuboidal cells
apically polarized nuclei
What is clear cell tubulopapillary renal carcinoma associated with?
3p mutation
End-stage kidney disease
What is the biggest determinant of survival in renal cell carcinoma?
whether the cancer is confined to the kidney or has spread to the perinephric fat/renal vein
What are the macroscopic stages for renal cell carcinoma?
T1- tumor is less than 7 cm, confined to kidney
T2- tumor is more than 7 cm, confined to kidney
T3a- tumor has spread to the perinephric fat
T3b- tumor has spread into vena cava
What are the histologic stages for renal cell carcinoma?
Grade 1- nuclei are tiny dots
Grade 2- nucleoli are small, but can be seen on high power
Grade 3- nucleoli can be seen at high power
Grade 4- “bizarre cells”
What does an oncocytoma look like grossly? On histology?
Central scar tissue
Clumps of tumor cells with edematous stroma
What does an angiomyolipoma look like grossly? On histology?
well circumscribed, bloody, and fatty
Vessels, fats, and smooth muscle cells in close proximity, all look normal; will stain positive for melanin
What is Wilms tumor?
A rare blastoma cancer seen in the pediatric patients
mesoderm derived
What are the layers of the bladder wall?
Transitional epithelium Tunica propria Muscle Adventitia Blood vessels
What are four non-neoplastic bladder growths that can be mistaken for cancer?
Cystitis cystica/glandularis
polypoid cystitis
papillary cystitis
nephrogenic adenoma
What does cystitis cystica/glandularis look like histologically?
gland-like tissue, secreting mucin
What causes polypoid or papillary cystitis?
Irritation from a stone, catheter, etc
What does polypoid cystitis look like histologically and grossly?
grossly- it has blunt projections
histologically- it has normal thickness epithelium
What does papillary cystitis look like histologically and grossly?
grossly- projections are thin, wispy
histologically- it has thickened epithelium
What is associated with nephrogenic adenoma?
Male (2:1 more common)
GU surgery (61%)
chronic infection/cystitis
What does nephrogenic adenoma look like on histology?
proliferation of tubules
inflammatory cells
What are the grades of flat bladder cancers?
(In increasing grade) Reactive Indeterminate Dysplasia Carcinoma in situ
What are the grades of papillary bladder cancers?
(In increasing grade) Papilloma Papillary neoplasm, uncertain potential Low-grade urothelial cancer High-grade urothelial cancer
What are the stages of the TNM system in papillary bladder cancers? How do they determine treatment?
pTIS- Tumor in situ, confined to the urothelium
pTa- Low grade papillary tumor
pT1- Tumor extends into lamina propia
PT2- Tumor extends into the muscularis propria
PT3- Tumor extends into perivesical fat
pT4- Tumors past perivesical fat
pT1 and below can use conservative treatment; anything above requires a cystectomy
What histological features do each papillary bladder cancer have?
papilloma- fibrovascular core, urothelium normal thickness, polarity, less than 1/2 cm
Low grade urothelial cancer- hyperplastic urothelium, loss of polarity but still parallel nuclei
High grade urothelial cancer- hyperplastic urothelium, huge nuclei, jumbled polarity
What features are reported on a transurethral resection of bladder tumor?
- tumor invasion of lamina propia
- muscularis propria presence in biopsy
- if present, tumor invasion - percent of specimen tumor
- Necrosis
How do reactive atypia, dysplasia, and carcinoma in situ relate to risk of cancer?
60% of carcinoma in situ will become cancer
15% of dysplasias will become cancer
Reactive atypia has no increased risk of cancer
What does carcinoma in situ look like histologically?
Large nuclei
dyscohesive cells (loss of umbrella cells)
chromatin granularity
