Urinary Tract Tumours - Final Exam

Question 1

Neoplasms of urinary tract

Answer 1

More often malignant than benign
Wilm’s tumour is only neoplasm found in children
Originate from epithelial cells of kidneys or urothelium

Question 2

Urothelium

Answer 2

Urothelial cell lining of renal pelvic, ureter, urinary bladder, posterior urethra
Transitional epithelium
Essentially waterpoof

Question 3

Renal cell carcinoma

Answer 3

No strong risk factors identified
Found in 5% of chronic end-stage kidney disease patients
Occurs in older adults
Prognosis is guarded (50% survive 5 years)

Question 4

Clinical features of renal cell carcinoma

Answer 4

Typical triad (10%):
1. Hematouria (50%)
2. Flank pain
3. Palpable abdominal mass
Non-specific symptoms are common, often found accidentally
Endocrine symptoms
Paraneoplastic syndromes

Question 5

Paraneoplastic syndromes of renal cell carcinoma (3)

Answer 5

1. Hypercalcemia
2. Erythrocytosis
3. Amyloidosis

Question 6

Clear cell renal cell carcinoma

Answer 6

Most common type of renal cell carcinoma
Large, yellow, heterogeneous cancer
Cells with clear cytoplasm, rich in glycogen and fat
Small capillaries in between
Progresses really rapidly
Nuclear grade determines aggressiveness - small, round vs. big irregular nuclei

Question 7

Papillary renal cell carcinoma

Answer 7

10-15% of RCC
Often necrotic
Sporadic (solitary) or hereditary (multiple)
Papillae with fibrovascular core, epithelial lining, foamy cells

Question 8

Chromophobe renal cell carcinoma

Answer 8

5% incidence
Very good prognosis
Multiple losses of chromosomes
Distinct cell borders, reisinoid nuclei, perinuclear halo

Question 9

Renal cell carcinoma prognostic factors

Answer 9

Histological type - clear cell is more aggressive
Stage (TNM)
Histologic/nuclear grade
Margin status (positive or negative)

Question 10

Sarcomatoid differentiation

Answer 10

Can occur in any type of RCC
Poor prognosis
Sarcoma-like marked cellular variability and spindling

Question 11

Wilm’s tumour

Answer 11

Infancy and childhood
Composed of immature cells resembling fetal tubules, fetal glomeruli, or renal blasterna
Cellular areas alternating with “cell poor” areas
Loose stroma
Related to deletion or mutation of WT1 and WT2
May be bilateral (5%)
Good prognosis with surgery and chemotherapy

Question 12

Urothelial carcinoma (lower urinary tract)

Answer 12

Arises from urothelium

Hematuria is main symptom

Question 13

Risk factors of urothelial carcinoma

Answer 13

Smoking
Occupational exposure: paint, rubber, leather industries exposure to organic chemicals, beta-naphthylamine
Analgesic drugs: phenacetin
Schistosoma hematobium

Question 14

Carcinoma of urinary bladder

Answer 14

Most common cancer of urinary tract
Most tumors re urothelial carcinomas (but may be squamous or adenocarcinomas)
Variable prognosis

Question 15

Bladder cancer

Answer 15

Localized or diffuse thickening of mucosa with papillary growth formation

Question 16

Papillary urothelial carcinoma

Answer 16

Delicate papillary fronds with thin fibro-vascular stalks

Question 17

Urothelial carcinoma in situ

Answer 17

High-grade flat abnormality within the bladder mucosa
Can exist alone or in association with urothelial carcinoma
No umbrella cells, exfoliates easily (mucosal red granularity)

Question 18

Urothelial carcinoma of renal pelvis

Answer 18

Associated often with lower UT tumours

Histological features are similar to urothelial carcinomas of lower tract

Question 19

Bladder cancer staging

Answer 19

Diagnosis made on urine cytology and cytoscopic biopsy
Grade 1 tumours localized to mucosa: 98%, 5 year survival, but tend to reoccur
Grade 3 tumours with metastases: 15%, 5 year survival