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3B week 4 - haematuria etc. > tumours of the urinary tract > Flashcards

tumours of the urinary tract Flashcards

1
Q

why do renal tubular cells have a grainy appearance on histology

A

due to the presence of many mitochrondria

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2
Q

what are the 4 parts of the urinary tract

A
  1. kidneys
  2. ureters
  3. bladder
  4. urethra
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3
Q

what are the 2 types of renal tumours (hsitologically)

A
  1. epithelial
  2. stromal
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4
Q

what is the most common benign stromal renal tumour

A

angiomyolipoma (greek etymology -> angio = blood, myo = muscle lipo = fat)

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5
Q

what condition are angiomyolipomas associated with

A

20% are associated with phakomatoses -> a group of neurocutaneous disorders characterised by involvement of structures that arise from the embryonic ectoderm

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6
Q

what inheritance pattern are angiomyolipoma

A

autosomal dominant - tubulin coding mutation (Cr9 q34 and Cr16 p13)

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7
Q

examples of what other conditions are seen in phakomatoses (5)

A
  1. renal tumours
  2. epilepsy
  3. cortical haematomas
  4. mental retardation
  5. skin abnormalities
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8
Q

when might an angiomyolipoma be symptomatic

A

spontaneous retroperitoneal bleeding (can lead to haemorrhagic shock) -> lesion is very rich in blood vessels, risk of bleeding is proprotional to size of bleed

aka wunderlich syndrome

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9
Q

when may perinephric fat be visible on CT

A

when haemorrhagic (i.e. bleeding from an angiomyolipoma)

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10
Q

what is the presentation of angiomyolipoma

A

usually asymptomatic -> if flank pain, haematemesis and harmorrhagic shock (from rupture)

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11
Q

what is the most common benign epithelial renal tumour

A

oncocytoma -> tumours of epithelial cells

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12
Q

what can oncocytomas be confused with on imaging

A

renal cell carcinoma

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13
Q

what is the appearance of an oncocytoma

A

tumour with a tan coloured central scar

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14
Q

what does oncocytoma look like on microscopy

A
  1. eosinophilic cytoplasm
  2. round bland nuclei forming tubules (normal looking)
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15
Q

what are the main bengin renal tumours

A
  1. angiomyolipoma
  2. oncocytoma
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16
Q

what is the main histologcal change seen in oncocytomas

A

change in architecture of the tissue -> lack of tubular formation, nest formation

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17
Q

examples of malignant renal tumours

A

from tubular epithelium - RCC:
1. clear cell carcinoma
2. papillary carcinoma
3. chromophobe renal cell carcinoma
from mesenchymal/stromal tissue:
4. leiomyosarcoma

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18
Q

what score can be used to give a prognosis of renal cell carcinoma

A

leibovich score:
1. pathological T stage
2. nodal stage
3. tumour size
4. nuclear grade
5. histological tumour necrosis

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19
Q

clear cell renal cell carcinoma appearance

A
  1. well circumbscribed
  2. haemorrhagic areas
  3. areas of necrosis
20
Q

what is the cytoplasm of a clear cell renal cell carcinoma rich in

A

glycogen

21
Q

how do the nuclei in clear cell renal cell carcinoma change as the tumour grades increase

A

nuclei get larger and more bizzare looking

22
Q

what is the modified fuhrman a grading sytem for

A

renal cell carcinoma

23
Q

what is the most common type of renal cell carcinoma (and second)

A
  1. clear cell
  2. papillary renal cell carcinoma
24
Q

papillary renal cell carcinoma histological appearance

A

“cauliflower” like growth of cells which surround macrophages

25
Q

where does the lower urinary tract start

A

collecting duct of the nephrons in the kidneys

26
Q

what kind of epithelium lines the the lower urinary tract

A

urothelium (except for the distal portion of the urethra which is squamous) -> tumours will look similar

27
Q

what cells line the top layer of the urothelium

A

umbrella cells

28
Q

urothelial carcinomas epidemiology (3)

A
  1. men 3:1
  2. 50-80yro
  3. urbanised areas
29
Q

what part of the urinary tract is the renal pelvis part of

A

the lower

30
Q

why can high grade urothelial carcinomas in the renal pelvis easily invade other structures

A

muscle wall is thin in this area => easy to penetrate through to other structures

31
Q

what can occur in urothelial carcinoma of the ureter

A

hydronephrosis due to blockage and the build up of urine

32
Q

what is hydronephrosis

A

kidneys become stretched and swollen as a result of a build-up of urine inside them

33
Q

what are common primary sites for secondary bladder cancers (4)

A
  1. prostate
  2. vaginal
  3. cervical
  4. endometrial
34
Q

4 urothelial tumours

A
  1. inverted papilloma (benign)
  2. urothelilal tumours of low malignant potential (PUNLMP, bengin with bland nuclei)
  3. urothelial carcinoma (malignant)
  4. urothelial carcinoma in situ (flat urothelium replaced w flat caricnoma -> high grade cells but non invasive)
35
Q

how do bladder neoplasms present

A
  1. painless haematuria
  2. increased frequency
  3. dysuria
  4. urgency
36
Q

risk factors for urothelial carcinoma of the bladder

A
  1. smoking
  2. occupational exposure to aromatic amines
  3. chronic cystitis due to schistosoma haematobium
  4. analgesics
  5. cyclophasphamide
  6. radiation
37
Q

where do high grade urothelial carcinomas metastesise to

A
  1. prostate
  2. vagina (via vesicles with fistulas)
  3. rectum
  4. lymph nodes
38
Q

what is the treatment for urothelial carcinoma in situ

A
  1. intravesical (into the bladder) baciullus calmette-guerin (BCG) instillation (remission, not curative)
  2. radical cystectomy (if non responsive)
39
Q

what is urothelial carcinoma in situ associated with

A

high grade invasive carcinoma

40
Q

what is intravesical baciullus calmette-guerin (BCG)

A

introduction of the mycobacterium into the bladder which triggers an immunologic reaction ->bladder wall sheds, causing the shedding of tumour cells as well and hopefully the replacement with benign cells

41
Q

what is squamous cell carcinoma of the bladder assoicated with

A

parasitic infesation with schistosoma

42
Q

how does the squamous cell carcinoma of the bladder present histologically

A

presents late with fungating deeply invasive tumour, cells are atypical, mass forming and have associated keratin

43
Q

what is a primary adenocarcinoma of the bladder assoicated with

A
  1. urachal remnant giving rise to adenocarcinoma in the dome of the bladder
  2. intestinal metaplasia
44
Q

what cancer is polycythemia associated with

A

renal adenocarcinoma

45
Q

what is the classic triad of RCC

A
  1. unilateral flank pain
  2. frank haematuria
  3. abdominal mass

3B week 4 - haematuria etc. (5 decks)

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