SFP: renal/bladder tumors Flashcards
What is renal papillary adenoma?
A benign renal neoplasm less than 1.5 cm. They’re usually found in autopsy and have no clinical significance.
What are angiomyolipomas?
Benign renal neoplasm consisting of blood vessels, smooth muscle, and adipose tissue.
What disease are angiomyolipomas associated with?
Tuberous sclerosis.
What is an oncocytoma?
Benign renal tumor arising from intercalated cells of collecting ducts.
What causes oncocytoma?
Loss of chromosomes 1, 14, and Y.
Describe the gross pathology of oncocytomas.
Tan with central stellate scar.
Describe the histology of oncocytoma.
Lots of mitochondria and granular pink cytoplasm.
What is the treatment for oncocytoma?
Usually, they’re surgically removed.
What are renal cell carcinomas derived from?
Renal tubular epithelium.
What are risk factors for renal cell carcinoma?
Tobacco, obesity, HTN, cadmium (batteries and solar panels), chronic renal failure.
What is the common presentation of renal cell carcinomas?
They’re often asymptomatic and discovered radiologically.
What is the triad of symptoms in renal cell carcinoma?
Hematuria, palpable mass, flank pain (sometimes polycythemia).
Describe clear cell renal carcinoma.
Most common adult RCC and have the greatest risk of metastasis.
What are the cytogenetics of clear cell RCC?
Associated with 3p 25-26 loss.
What genetic condition is associated with clear cell renal carcinoma?
Von Hippel Lindau.
What is the inheritance of von Hippel Lindau?
Autosomal dominant.
How does mutated VHL lead to CCRCC?
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.
What is VHL associated with other than CCRCC?
Hemangioblastomas of cerebellum/retina.
Describe the gross pathology of clear cell RCC.
Yellow-orange surface, cystic/hemorrhagic, and can invade the renal vein.
Describe the histology of clear cell RCC.
Cells with clear cytoplasm due to high lipid and glycogen content, chicken wire vasculature.
What is a difference in the presentation of sporadic and hereditary CCRCC?
Sporadic presents with one larger tumor, hereditary presents with multiple smaller tumors spread over the surface.
Briefly describe papillary renal carcinoma.
Second most common RCC with intermediate prognosis.
What are the cytogenetics of sporadic papillary RCC?
Sporadic is associated with trisomy of chromosome 7 and 17, and a loss in Y.
what are the cytogenetics of hereditary papillary RCC
MET proto-oncogene
What is the gross pathology of papillary RCC?
Multifocal and bilateral, but less likely to metastasize.
Describe the histology of papillary RCC.
Papilla with fibrovascular core.
Briefly describe the prognosis of chromophobes.
Favorable prognosis with a 78-100% 5-year survival.
What are the cytogenetics of chromophobe RCC?
Hypodiploidy; multiple losses of several chromosomes including 1, 2, 6, 10, 13, 17, 21.
Where do chromophobe RCCs originate from?
Intercalated cells of collecting ducts.
Describe the gross pathology of chromophobe RCC.
Tan brown.
Describe the histology of chromophobe RCC.
Clear cytoplasm with distinct cell membranes.
What does the prognosis of RCC depend on?
Stage, grade, and histologic type (CCRCC is worst, chromophobe is best).
What is Wilm’s tumor?
Super common organ cancer in young children, and most common primary kidney tumor in children. They get really big.
What is Wilm’s tumor associated with genetically?
WAGR syndrome, Denys-Drash syndrome, Beckwith Wiedemann syndrome.
Describe the histology of Wilm’s tumor.
Triphasic tumor with blastemal, stromal, and epithelial components.
What defines unfavorable histology in Wilm’s tumor?
Diffuse anaplasia; enlarged, hyperchromatic tumor nuclei and mitotic figures.
What is the clinical course of Wilm’s tumor?
Very good with combination of nephrectomy and chemo.
Briefly describe Xp11 translocation carcinoma.
40% of pediatric tumors and don’t have the best prognosis.
Briefly describe the prognosis of collecting duct carcinoma.
Highly aggressive with 66% mortality in 2 years.
What is the triad of symptoms associated with acute cystitis?
Urinary frequency, lower abdominal pain, dysuria.
What are causes of non-hemorrhagic acute cystitis?
Coliforms aka E. coli, Klebsiella, Enterobacter.
What are causes of hemorrhagic acute cystitis?
Cyclophosphamide and adenovirus.
What are risk factors for acute cystitis?
Female, sexual intercourse, indwelling catheters.
What is the presentation of interstitial cystitis?
Persistent and painful with fissures, fibrosis, and contracted bladder.
What is the population for interstitial cystitis?
Middle aged/elderly women.
What is malakoplakia?
A defect in macrophages causing them to fill with bacterial products.
What is a histologic finding of malakoplakia?
Michaelis-Gutmann bodies aka laminated calcium deposits in macrophages.
What is polypoid cystitis?
Small polypoid mucosal lesions, mucosal edema, chronic inflammation.
Describe urothelial carcinoma.
Arises in urothelial lining (bladder, urethra, ureter, renal pelvis).
What are the types of papillary urothelial carcinoma?
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.
Describe the histological difference of low and high grade papillary urothelial carcinoma.
High grade has more mitotic figures and more vascularized/complex fibrotic cores.
What is the typical population for urothelial carcinoma?
Old men.
What is SCC associated with in the bladder?
Schistosomiasis haematobium.
What are risk factors for bladder cancers?
Occupational carcinogens, smoking, long term use of NSAIDs, Schistosomiasis haematobium.
Describe carcinoma in situ.
Flat urothelium; can be diffuse and multifocal and shed in urine.
What is BCG therapy?
An immunotherapy for early bladder cancer that involves putting Mycobacterium bovis into the bladder through a catheter, causing immune system to kill the cancer.
