SFP: renal/bladder tumors

Question 1

What is renal papillary adenoma?

Answer 1

A benign renal neoplasm less than 1.5 cm. They’re usually found in autopsy and have no clinical significance.

Question 2

What are angiomyolipomas?

Answer 2

Benign renal neoplasm consisting of blood vessels, smooth muscle, and adipose tissue.

Question 3

What disease are angiomyolipomas associated with?

Answer 3

Tuberous sclerosis.

Question 4

What is an oncocytoma?

Answer 4

Benign renal tumor arising from intercalated cells of collecting ducts.

Question 5

What causes oncocytoma?

Answer 5

Loss of chromosomes 1, 14, and Y.

Question 6

Describe the gross pathology of oncocytomas.

Answer 6

Tan with central stellate scar.

Question 7

Describe the histology of oncocytoma.

Answer 7

Lots of mitochondria and granular pink cytoplasm.

Question 8

What is the treatment for oncocytoma?

Answer 8

Usually, they’re surgically removed.

Question 9

What are renal cell carcinomas derived from?

Answer 9

Renal tubular epithelium.

Question 10

What are risk factors for renal cell carcinoma?

Answer 10

Tobacco, obesity, HTN, cadmium (batteries and solar panels), chronic renal failure.

Question 11

What is the common presentation of renal cell carcinomas?

Answer 11

They’re often asymptomatic and discovered radiologically.

Question 12

What is the triad of symptoms in renal cell carcinoma?

Answer 12

Hematuria, palpable mass, flank pain (sometimes polycythemia).

Question 13

Describe clear cell renal carcinoma.

Answer 13

Most common adult RCC and have the greatest risk of metastasis.

Question 14

What are the cytogenetics of clear cell RCC?

Answer 14

Associated with 3p 25-26 loss.

Question 15

What genetic condition is associated with clear cell renal carcinoma?

Answer 15

Von Hippel Lindau.

Question 16

What is the inheritance of von Hippel Lindau?

Answer 16

Autosomal dominant.

Question 17

How does mutated VHL lead to CCRCC?

Answer 17

Hypoxia-inducible factor 1 is stabilized, leading to upregulated GLUT-1, VEGF, erythropoietin, TGF-a, and PDGF-B. These increase angiogenesis that leads to RCC.

Question 18

What is VHL associated with other than CCRCC?

Answer 18

Hemangioblastomas of cerebellum/retina.

Question 19

Describe the gross pathology of clear cell RCC.

Answer 19

Yellow-orange surface, cystic/hemorrhagic, and can invade the renal vein.

Question 20

Describe the histology of clear cell RCC.

Answer 20

Cells with clear cytoplasm due to high lipid and glycogen content, chicken wire vasculature.

Question 21

What is a difference in the presentation of sporadic and hereditary CCRCC?

Answer 21

Sporadic presents with one larger tumor, hereditary presents with multiple smaller tumors spread over the surface.

Question 22

Briefly describe papillary renal carcinoma.

Answer 22

Second most common RCC with intermediate prognosis.

Question 23

What are the cytogenetics of sporadic papillary RCC?

Answer 23

Sporadic is associated with trisomy of chromosome 7 and 17, and a loss in Y.

Question 24

what are the cytogenetics of hereditary papillary RCC

Answer 24

MET proto-oncogene

Question 25

What is the gross pathology of papillary RCC?

Answer 25

Multifocal and bilateral, but less likely to metastasize.

Question 26

Describe the histology of papillary RCC.

Answer 26

Papilla with fibrovascular core.

Question 27

Briefly describe the prognosis of chromophobes.

Answer 27

Favorable prognosis with a 78-100% 5-year survival.

Question 28

What are the cytogenetics of chromophobe RCC?

Answer 28

Hypodiploidy; multiple losses of several chromosomes including 1, 2, 6, 10, 13, 17, 21.

Question 29

Where do chromophobe RCCs originate from?

Answer 29

Intercalated cells of collecting ducts.

Question 30

Describe the gross pathology of chromophobe RCC.

Answer 30

Tan brown.

Question 31

Describe the histology of chromophobe RCC.

Answer 31

Clear cytoplasm with distinct cell membranes.

Question 32

What does the prognosis of RCC depend on?

Answer 32

Stage, grade, and histologic type (CCRCC is worst, chromophobe is best).

Question 33

What is Wilm’s tumor?

Answer 33

Super common organ cancer in young children, and most common primary kidney tumor in children. They get really big.

Question 34

What is Wilm’s tumor associated with genetically?

Answer 34

WAGR syndrome, Denys-Drash syndrome, Beckwith Wiedemann syndrome.

Question 35

Describe the histology of Wilm’s tumor.

Answer 35

Triphasic tumor with blastemal, stromal, and epithelial components.

Question 36

What defines unfavorable histology in Wilm’s tumor?

Answer 36

Diffuse anaplasia; enlarged, hyperchromatic tumor nuclei and mitotic figures.

Question 37

What is the clinical course of Wilm’s tumor?

Answer 37

Very good with combination of nephrectomy and chemo.

Question 38

Briefly describe Xp11 translocation carcinoma.

Answer 38

40% of pediatric tumors and don’t have the best prognosis.

Question 39

Briefly describe the prognosis of collecting duct carcinoma.

Answer 39

Highly aggressive with 66% mortality in 2 years.

Question 40

What is the triad of symptoms associated with acute cystitis?

Answer 40

Urinary frequency, lower abdominal pain, dysuria.

Question 41

What are causes of non-hemorrhagic acute cystitis?

Answer 41

Coliforms aka E. coli, Klebsiella, Enterobacter.

Question 42

What are causes of hemorrhagic acute cystitis?

Answer 42

Cyclophosphamide and adenovirus.

Question 43

What are risk factors for acute cystitis?

Answer 43

Female, sexual intercourse, indwelling catheters.

Question 44

What is the presentation of interstitial cystitis?

Answer 44

Persistent and painful with fissures, fibrosis, and contracted bladder.

Question 45

What is the population for interstitial cystitis?

Answer 45

Middle aged/elderly women.

Question 46

What is malakoplakia?

Answer 46

A defect in macrophages causing them to fill with bacterial products.

Question 47

What is a histologic finding of malakoplakia?

Answer 47

Michaelis-Gutmann bodies aka laminated calcium deposits in macrophages.

Question 48

What is polypoid cystitis?

Answer 48

Small polypoid mucosal lesions, mucosal edema, chronic inflammation.

Question 49

Describe urothelial carcinoma.

Answer 49

Arises in urothelial lining (bladder, urethra, ureter, renal pelvis).

Question 50

What are the types of papillary urothelial carcinoma?

Answer 50

PUN of low malignant potential, low and high grade; both low and high grade recur about 45% of the time but high grade is more likely to progress and lead to death. PUN of low malignant potential does not progress or cause death.

Question 51

Describe the histological difference of low and high grade papillary urothelial carcinoma.

Answer 51

High grade has more mitotic figures and more vascularized/complex fibrotic cores.

Question 52

What is the typical population for urothelial carcinoma?

Answer 52

Old men.

Question 53

What is SCC associated with in the bladder?

Answer 53

Schistosomiasis haematobium.

Question 54

What are risk factors for bladder cancers?

Answer 54

Occupational carcinogens, smoking, long term use of NSAIDs, Schistosomiasis haematobium.

Question 55

Describe carcinoma in situ.

Answer 55

Flat urothelium; can be diffuse and multifocal and shed in urine.

Question 56

What is BCG therapy?

Answer 56

An immunotherapy for early bladder cancer that involves putting Mycobacterium bovis into the bladder through a catheter, causing immune system to kill the cancer.