Tumors of the kidney

Question 1

Benign renal tumors

Answer 1

1. Papillary adenoma
2. Renomedullary Interstitial Tumor (Renal fibroma / Hamartoma)
3. Angiomyolipoma
4. Oncocytic adenoma (oncocytoma)
5. Metanephric adenoma

Question 2

Malignant Renal Tumor

Answer 2

1. Clear Cell Renal Cell Carcinoma (CCRCC)
2. Papillary renal cell carcinoma
3. Carcinoma of the collecting ducts of bellini
4. Renal medullary carcinoma
   (worst of them all)
5. Wilms tumor

Question 3

What type of grading is predictive of mortality

Answer 3

Fuhrman (nuclear) grading is predictive of mortality

Question 4

Most important benign tumor of the

• Urinary tract
• Calyx
• Pelvis
• Ureter
• Urinary bladder
• Urethra

Answer 4

Fibroepithelial polyps

more in the Left ureters

Question 5

Most important Malignant tumor of the
- Urinary tract
(anywhere from renal pelvis to urethra)

Answer 5

Transitional cell neoplasm
90% tumor in urinary tract
- no familial tendency
- lots of epithelial cells (Umbrella cells)
- smoking increases risk 3x (taken in and excreted renally)

Question 6

Clear Cell Carcinoma %

Familial Renal Tumors vs Spontaneous

Answer 6

4% familial

• VHL gene encodes protein that targets other protein for degradation
• MULTIFOCAl

95% sporadic

• containing VHL gene (tumor suppressor gene)
• UNIFOCAL

Question 7

VHL gene encode protein that targets other proteins for degradation. What are those proteins targeted?

Answer 7

HIF-1: induces VEGF and TGF-beta1 (proangiogenic, hypoxia-inducible)

Insulin-like growth factor-1: cell growth

(so with VHL mutation, both are upregulated)

Question 8

Most common malignant renal tumor in adults

Answer 8

CCRCC

clear cell renal cell carcinoma

Question 9

Fuhrman histological grades 1-4

Answer 9

1. Nuclei round, uniform,
   - 10um,
   nucleoli absent
2. Nuclei slightly irregular,
   - 15um,
   - nucleoli evident
3. Nuclei very irregular
   - 20um
   - nucleoli large and prom
4. Nuclei bizarre and multilobulated
   - >20 um
   - nucleoli prominent
   - chromatin clumped

Question 10

Colloidal iron stain

Answer 10

blue for chromophoebe RCC

Question 11

Umbrella cells

Answer 11

Transitional cell neoplasm

Question 12

Transitional cell tumors

Answer 12

Papillomas
Transitional cell carcinomas
Carcinoma in situ

Question 13

Keratin pearls

Answer 13

Squamous cell carcinoma