SM_233b: Renal and Urothelial Pathology and Cancer Flashcards
Describe a normal kidney
Kidney
- Cortex: glomeruli, proximal tubules, distal tubules
- Medulla: loops of Henle, collecting ducts, renal pelvis and calyces
- Other components: vessels, connective tissue

This is a ___

This is a renal calyx

Describe common renal tumors
Renal tumors
- Benign: oncocytoma, papillary adenoma, angiomyolipoma
- Malignant: clear cell renal cell carcinoma (most cell), papillary renal cell carcinoma, chromophobe renal cell carcinoma, other tumors

Describe renal oncocytoma
Renal oncocytoma
- Benign
- Eosinophilic cytoplasm (mitochondria)
- May have nuclear atypia
- May involve capsule and perinephric fat but still benign

Describe angiomyolipoma
Angiomyolipoma
- Mostly benign tumor composed of vessels, smooth muscles (perivascular epithelial cells), and fat
- Characteristic appearance on radiology but variants

Papillary adenoma is ____ and ____
Papillary adenoma is < 1.5 cm in size and low nuclear grade

Describe renal carcinomas
Renal carcinomas
- Clear cell RCCs have clear cells
- Papillary RCCs have papillae
- Chromophobe RCCs have cells that fear color
- High grade tumors may develop sarcomatoid features
- RCCs with sarcomatoid features have cells that look like spindle cell sarcoma
This is ____

This is low grade clear cell renal cell carcinoma

This is ____

This is high grade renal cell carcinoma

Describe Fuhrman grading of clear cell renal cell carcinoma
Fuhrman grading of clear cell renal cell carcinoma
- G1: nucleoli not seen
- G2: nucleoli at high power
- G3: nucleoli at low power
- G4: bizarre nuclei

Describe papillary renal cell carcinoma
Papillary renal cell carcinoma
- Type 1 and Type 2
- High nuclea grade and low nuclear grade

This is ___

This is papillary renal cell carcinoma type 1

This is ___

This is papillary renal cell carcinoma type 2

This is ___

This is papillary renal cell carcinoma mixed type

This is ____

This is chromophobe renal cell carcinoma

Describe translocation renal cell carcinoma
Translocation renal cell carcinoma
- Xp11-associated
- Partners: TFE3 (less rare), TFEB (more rare)
- Very rare
- Poor prognosis: rapidly growing so high stage at discovery, does not respond to conventional clear cell RCC chemo, few trials

This is ____

This is bladder

Bladder consists of ____, ____, and ____

Bladder consists of umbrella cells at the top, basal cells at the bottom, and basement membrane attached to the lamina propria

This is ___

This is bladder muscle

Cystitis can be ____ or ____
Cystitis can be infectious or non-infectious
- Infectious: BCG, parasite, bacterial, malakoplakia (generally due to chronic E. coli combined with phagocytic defect)
- Non-infectious: interstitial, polypoid, hemorrhagic (cytotoxic agent such as cyclophosphamide)
Describe chronic cystitis and follicular cystitis
Chronic cystitis and follicular cystitis
- Gram negative bacteria (E. coli)
- Lymphocytic infiltrate (chronic cystitis)
- When long-standing: formation of follicles with germinal centers (follicular cystitis)
- Type of bacteria cannot be determined histologically

This is ____
This is Schistosoma cystitis and malakoplakia

Describe BCG cystitis
BCG cystitis
- BCG used as treatment of bladder cancer, particularly CIS
- Induces granulomatous inflammation (similar to TB)
- Immunotherapy

This is ___

This is cystitis glandularis and cystitis cystica

Describe the pathologic classification of bladder carcinoma
Pathologic classification of bladder carcinoma
- Urothelial carcinoma: flat (carcinoma in situ, invasive), papillary (non-invasive, invasive)
- Other primary bladder cancers: squamous cell carcinoma, adenocarcinoma, small cell carcinoma, carcinosarcoma, melanoma
These are ___

These are flat urothelial lesions

These are ___

These are papillary lesions

Describe WHO classification of urothelial neoplasms
WHO classification of urothelial neoplasms
- Papilloma
- Papillary urothelial neoplasia of low malignant potential
- Low grade papillary urothelial carcinoma
- High grade papillary urothelial carcinoma
This is ___

This is urothelial papilloma

This is ___

This is low grade papillary urothelial carcinoma

This is ___

This is papillary urothelial neoplasm of low malignant potential

This is ___

This is high grade papillary urothelial carcinoma

Describe urothelial carcinoma
Urothelial carcinoma
- Derived from urothelium
- May occur in any part of urinary tract including renal pelvis, ureter, bladder, and urethra
- Most common site is bladder
- Upper urinary tract urothelial carcinoma tends to be more aggressive and more likely to spread to low urinary tract

Major risk factors for urothelial carcinoma are ____ and ____ and also ____ in Egypt
Major risk factors for urothelial carcinoma are smoking and pollution and also Schistosoma infection in Egypt
Describe urothelial CIS (high grade dysplasia, severe dysplasia)
Urothelial CIS (high grade dysplasia, severe dysplasia)
- All high nuclear grade: positive urine cytology
- Aggressive disease: may develop into invasive high grade carcinoma in weeks or months without treatment
Ureter is ___ with ___
Ureter is a thin urine conducting tube with muscularis propria

This is ___
This is high grade papillary urothelial carcinoma

This is ___

This is urothelial carcinoma in situ

This is ___

This is urothelial carcinoma with pagetoid spread

Describe low grade papillary urothelial carcinoma
Low grade papillary urothelial carcinoma
- Most common type of bladder cancer
- Papillary growth
- Tumor cells with fibrovascular cores
- Only < 10% invasive
- Often recur

Describe high grade papillary urothelial carcinoma staging
Hgh grade papillary urothelial carcinoma staging
- No invasion
- Lamina propria invasion / suspicious for invasion
- Muscularis propria invasion
- Extravesical invasion

This is ___

This is sarcomatoid urothelial carcinoma

This is ___

This is micropapillary urothelial carcinoma

Adenocarcinoma of the bladder is ___
Adenocarcinoma of the bladder is composed entirely of malignant glandular epithelial cells

Urothelial carcinoma with glandular differentiation is ___
Urothelial carcinoma with glandular differentiation is presence of both urothelial carcinomas and malignant glandular components
This is ___

This is secondary involvement (metastasis)

This is ___

This is primary small cell carcinoma
