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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

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
where does the lower urinary tract start
collecting duct of the nephrons in the kidneys
26
what kind of epithelium lines the the lower urinary tract
urothelium (except for the distal portion of the urethra which is squamous) -> tumours will look similar
27
what cells line the top layer of the urothelium
umbrella cells
28
urothelial carcinomas epidemiology (3)
1. men 3:1 2. 50-80yro 3. urbanised areas
29
what part of the urinary tract is the renal pelvis part of
the lower
30
why can high grade urothelial carcinomas in the renal pelvis easily invade other structures
muscle wall is thin in this area => easy to penetrate through to other structures
31
what can occur in urothelial carcinoma of the ureter
hydronephrosis due to blockage and the build up of urine
32
what is hydronephrosis
kidneys become stretched and swollen as a result of a build-up of urine inside them
33
what are common primary sites for secondary bladder cancers (4)
1. prostate 2. vaginal 3. cervical 4. endometrial
34
4 urothelial tumours
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
how do bladder neoplasms present
1. painless haematuria 2. increased frequency 3. dysuria 4. urgency
36
risk factors for urothelial carcinoma of the bladder
1. smoking 2. occupational exposure to aromatic amines 3. chronic cystitis due to schistosoma haematobium 4. analgesics 5. cyclophasphamide 6. radiation
37
where do high grade urothelial carcinomas metastesise to
1. prostate 2. vagina (via vesicles with fistulas) 3. rectum 4. lymph nodes
38
what is the treatment for urothelial carcinoma in situ
1. intravesical (into the bladder) baciullus calmette-guerin (BCG) instillation (remission, not curative) 2. radical cystectomy (if non responsive)
39
what is urothelial carcinoma in situ associated with
high grade invasive carcinoma
40
what is intravesical baciullus calmette-guerin (BCG)
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
what is squamous cell carcinoma of the bladder assoicated with
parasitic infesation with schistosoma
42
how does the squamous cell carcinoma of the bladder present histologically
presents late with fungating deeply invasive tumour, cells are atypical, mass forming and have associated keratin
43
what is a primary adenocarcinoma of the bladder assoicated with
1. urachal remnant giving rise to adenocarcinoma in the dome of the bladder 2. intestinal metaplasia
44
what cancer is polycythemia associated with
renal adenocarcinoma
45
what is the classic triad of RCC
1. unilateral flank pain 2. frank haematuria 3. abdominal mass

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

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