Tumors of the Kidney

Question 1

Kidney tumors may be

Answer 1

• Benign

- Malignant

Question 2

Types of benign kidney tumors

Answer 2

• Renal adenoma
• Renal oncocytoma
• Angiomyolipoma
• Renal fibroma
• Mesoblastic nephroma
• Juxtaglomerular cell tumor

Question 3

Renal (papillary) adenoma basics

Answer 3

• Common

- Metastasis can occur

Question 4

Renal adenoma gross findings

Answer 4

• Pale yellow-gray

- Well-circumscribed nodules

Question 5

Renal adenoma microscopic findings

Answer 5

• Papillary / complex fronds
• Tubules, glands, cords, sheets
• Cells / cuboidal to polygonal
• Regular, small central nuclei
• Scanty cytoplasm
• No atypia

Question 6

Renal oncocytoma gross findings

Answer 6

• Benign
• Homogeneous tan / mahogany
• Well encapsulated
• Small to large (~12 cm in diameter)
• Does not metastasize

Question 7

Renal oncocytoma microscopic findings

Answer 7

• Large, eosinophilic cells

- Small, round, benign-appearing nuclei / large nucleoli

Question 8

Angiomyolipoma

Answer 8

Benign tumor consisting of:

• Vessels
• Smooth muscle
• Fat

Question 9

Angiomyolipoma concerns

Answer 9

• Spontaneous hemorrhage

Question 10

Angiomyolipoma prevalence

Answer 10

• Present in 25% to 50% of patients with tuberous sclerosis

Question 11

Single most important risk factor for malignant renal cell carcinoma

Answer 11

• Cigarette smoking

Question 12

Hereditary syndromes associated with renal cell carcinoma

Answer 12

• Familial Clear Cell Carcinoma
• von Hippel Landau Disease
• Hereditary Papillary RCCA

Question 13

Histological categories of renal cell carcinoma

Answer 13

• Clear cell renal cell carcinoma
• Papillary renal cell carcinoma
• Chromophobe renal cell carcinoma
• Collecting duct renal cell carcinoma

Question 14

Clear cell RCCA

Answer 14

• Most common type
• Arise from proximal tubular epithelium
• Solitary unilateral lesions
• Spherical masses
• Bright yellow-gray-white tissue

Question 15

Clear cell RCCA gross/histological findings

Answer 15

• Rounded or polygonal
• Abundant clear or granular cytoplasm
• Glycogen and lipids
• Branching vasculature
• Cystic and solid areas
• Well differentiated / marked nuclear atypia

Question 16

Renal cell carcinoma manifestations/clinical

Answer 16

• Hematuria
• Flank pain
• Mass in flank or abdomen
• Weight loss
• Fever
• Malaise
• Paraneoplastic Syndrome

Question 17

Renal cell carcinoma prognosis

Answer 17

• Metastasis – Early Extensively (via bloodstream)
• Lung
• Soft tissues
• Bone
• Liver

Question 18

Wilms Tumor (Nephroblastoma)

Answer 18

• Neoplasm of embryonal nephrogenic elements
• 4th most common malignancy in childhood
• 1 in 100,000 bimodal at 2.5 and 3.5

Question 19

Two forms of Wilms Tumor (Nephroblastoma)

Answer 19

• Hereditary

- Sporadic

Question 20

Hereditary syndromes related to Wilms Tumor (Nephorblastoma)

Answer 20

• Denys-Drash syndrome
• WAGR syndrome
• Beckwith-Wiedemann syndrome

Question 21

Morphology/gross findings of Wilms Tumor (Nephroblastoma)

Answer 21

• Large / well circumscribed tumor
• Tan / gray mass
• Focal areas of necrosis
• Hemorrhage
• Cyst formation

Question 22

Microscopic findings of Wilms Tumor (Nephroblastoma)

Answer 22

• Primitive / undifferentiated cells
• Primitive renal tubules
• Immature glomeruli

Question 23

Manifestations/clinical presentation of Wilms Tumor (Nephroblastoma)

Answer 23

• Abdominal mass (most common)
• Unilateral
• Bilateral (5% sporadic, 20% familial)
• Hematuria
• Hypertension
• Abdominal pain
• Intestinal obstruction