Tumors of Kidney & Urinary Tract Flashcards
List the benign tumors of the kidney.
papillary adenoma
metanephric adenoma
angiomyolipoma
oncocytic adenoma
why do they call it an angiomyolipoma?
Its a kidney tumor that affects muscle, fat, and vasculature.
Almost is always benign.
When a surgeon removes a renal cell carcinoma, sometimes they will remove the kidney only and other times they will remove the kidney and all the surrounding fat as well. How is this decision made and why?
If the tumor is only in the kidney parenchyma you can just take that out but if it starts to invade extra renal parenchyma then you have to start looking at the surrounding fat and other structures as well.
what does a clear cell type renal carcinoma look like histologically and why?
The cytoplasm is very clear looking (looks empty like fat). This is due to the presence of large amounts of glycogen.
How does the Fuhrman nuclear grading system work (for histologic grading)?
What type of renal cell carcinoma does this system classify?
1- nuclei round and cells are uniform. nucleoli not visible.
2- nuclei are larger nucleoli are present present
3- nuclei are larger still. nucleoli are bigger as well (about the size of a RBC)
4- anaplastic looking. See bizarre, multilobated cells with prominent nucleoli
4 w/sarcomatoid features-
This is not actually a sarcoma but when the cell just looks totally out of whack we say it is a 4 w/sarcomatoid features. This is different from saying that it is a sarcoma of the kidney though.
This classification system is intended for clear cell type renal cell carcinoma only.
Why do we sometimes see a dilated renal vein with renal cell carcinoma?
the tumor can grow from the kidney into the renal vein and create thrombosis there. It isn’t a clot per se but it does clog up the vein.
What is the most common type of renal cell carcinoma?
clear cell type
What is the second most common renal cell carcinoma? How do theses generally compare with clear type renal cell carcinomas?
papillary renal cell carcinoma.
In general they are less invasive.
What are the basics of papillary renal cell carcinoma?
This is a multifocal cancer (many nodules around the kidney at differing depths).
The tumor itself is just along the lining of the papilla. The things you see inside the papilla are benign. Mostly they are macrophages. Other things like vasculature are functioning properly in this region and help to keep the tumor alive.
How do you classify papillary renal cell carcinoma?
Low grade- type 1
High grade- type 2
Type 2 is has much more cellularity which overlapping nuclei and it only occurs in 30% of papillary renal cell carcinomas. The other 70% have type 1.
Otherwise there is not a lot of distinguishing factors between the two.
How do chromophobe renal cell carcinomas rank in aggressiveness?
Less than both clear cell type and papillary.
mortality rate is vey low.
How can we tell a chromophobe renal cell carcinoma with oncocytic morphology from an oncocytoma (a different type of renal cell carcinoma)?
These can be hard to tell apart based on histologic morphology alone.
colloidal iron staining.
chromophobes generally have a high level of iron while oncocytomas are usually iron negative.
The three types of malignant kidney cancer reviewed so far (chromophobe, clear cell, and papillary) affect the _______ of the kidney.
nephrons
there are some general anatomical lines that distinguish layers a tumor can traverse as it grows from the kidney. What are these?
It can leave the kidney by crossing the capsule and enter the fat (perirenal).
It can leave the fat by crossing Gerota’s Fascia and enter different fat (perarenal).
What stage would a cancer be if it is 5 cm large, has no lymph node involvement, and metastasis in the brain?
This is automatically stage IV. If a tumor has any elements of a later stage it just to that stage.
He said that the other specifics of histological staging are probably not that important. Just know that you can have a low stage cancer histologically but if it has elements of a higher stage in the patient (like distant mets) it automatically jumps to a higher final stage regardless of the histology.
