Urinary Tract Tumors

Question 1

3 main urinary tract tumors

Answer 1

Wilms’ tumor
Renal cell carcinoma
Urothelial cell carcinoma

Question 2

Renal cell carcinoma

Answer 2

No strong risk factors identified
Occurs in older people
50% survive 5 years
Genetic abnormalities

Question 3

Renal cell carcinoma clinical features

Answer 3

Hematuria is most common finding
Typical triad
Nonspecific symptoms common
Paraneoplastic syndromes: hypercalcemia, erythrocytosis*, or amylodosis

Question 4

Typical triad in RCC

Answer 4

Hematuria
Flank pain
Palpable abdominal mass

Question 5

Clear cell renal carcinoma

Answer 5

Cells with clear cytoplasm that is rich in glycogen and fat (also yellow macroscopically)
Small capillaries in between the nests
Progress very quickly, so can be deadly
Nuclear grade = aggressiveness (small and round vs big and irregular)

Question 6

Papillary RCC

Answer 6

10-15% incidence
Often necrotic
See a lot of papillary projections in the tumor
Sporadic (solitary papillae) or hereditary (multiple papillae)
Papillae have fibrovascular cores covered with an epithelial lining
Also aggregates of groups of macrophages

Question 7

Chromophobe RCC

Answer 7

5% incidence
Very good prognosis
Multiple losses of chromosomes

Question 8

3 histological signs of Chromophobe RCC

Answer 8

Distinct cell borders (prominent cell membranes)
‘Reisinoid’ nuclei (pleomorphic nuclei)
Perinuclear halo

Question 9

Wilms’ Tumor

Answer 9

Tumor or infancy and childhood
Composed of immature cells resembling fetal tubules, fetal glomeruli or renal blastema
Related to deletion of mutation of 2 TSGs WT1 and WT2
May be bilateral
Good prognosis with surgery and chemo

Question 10

3 things to look for to diagnose Wilms’

Answer 10

Immature cells resembling fetal tubules, fetal glomeruli or renal blastema
Also loose stroma

Question 11

3 most common causes of abdominal masses in infants

Answer 11

Multicystic renal dysplasia
Wilms’ tumor
Neuroblastoma of the adrenals

Question 12

Urothelium

Answer 12

Transitional epithelium (7 layers)
Essentially waterproof and can withstand prolonged exposure to urine
Renal calices, pelvis, ureters, urinary bladder and most of the urethra

Question 13

Risk factors for urothelial tumors

Answer 13

Smoking main one
Occupational exposure (paint, rubber, leather industries exposure to organic chemicals, beta-naphthylamine)
Analgesic drugs - Phenacetin
Schistosoma hematobium

Question 14

A 60-year-old man noticed blood in the urine. What should the workup include?

Answer 14

The bleeding could be caused by cystitis or a tumor
The physician should send the urine for cytologic examination to determine whether there are tumor cells in the urine
Cystoscopy might also be performed to determine whether the urinary bladder contains tumors or stones or whether it is only inflamed (cystitis). Cystitis in this age group could be secondary to prostatic hyperplasia