Urinary tumours Flashcards
Papillary adenoma
insignificant, small, discrete and benign
Angiomyolipoma
associated with tuberous sclerosis
- large ones may lead to haemorrhage
- increase in size during pregnancy
- usually find in CT scan with fat attenuation
- bilateral and multiple
Angiomyolipoma histological features
- blood vessels ensheathed by smooth muscles
- clusters of adipocytes
Oncocytoma
- originates from IC of collecting duct
- usually solitary
- large eosinophilic cells, with small round nuclei and large nucleoli
Presentations of renal cell carcinoma
Classical triad: loin pass, mass and haematuria
Paraneoplastic syndrome: unexplained fever, polycythaemia
metastasis may present before symptoms
Renal cell carcinoma, clear cell type
- mostly sporadic, might be associated with Von Hippel-Lindau syndrome (dominant)
- some show sarcomatoid changes
- clear cells, some might have eosinophilic or granular cytoplasm
- capillary network surround the tumour cells
Papillary renal cell carcinoma
- mostly sporadic, some associated with hereditary papillary renal cancer syndrome or trisomy 7
- thought to be from distal tubule
- cuboidal or low columnar cells in papillary arrangement
- foam cell papillary core
- highly vascular stroma
Chromophobe renal cell carcinoma
- originate from the IC of collecting duct
- associated with monosomy
- better prognosis than clear cell type and papillary
Histology: - pale eosinophilic cells with prominent cell membrane and halos around nucleus
Collecting duct carcinoma
- Originates from collecting duct, usually medulla
- aggressive, with high grade nucleus and necrosis
- poor prognosis with early metastasis
Urothelial carcinoma of renal pelvis
- very similar to urinary bladder tumours, might involve the ureters and bladder
- Small upon presentation: haematuria, obstruction leading to flank pain and hydronephrosis
- invasion of renal pelvis wall and calyces
Nephroblastoma/ Wilms tumour
- associated with WT-1/-2 gene deletion or mutation
- might have bilateral: synchronous or metachronous
- same presentation and spreading method as renal cell carcinoma
Histological features of nephroblastoma
triphasic: blastemal (undifferentiated round cells), stromal (spindle cells), epithelial (columnar epithelial cells)
Presentations and features of urinary bladder tumours
- usually in middle aged men (more than female)
- usually urothelial carcinoma, others include squamous cell carcinoma and adenocarcinoma
- painless gross haematuria
Benign bladder tumour
Urothelial papilloma and inverted papilloma
- normal urothelium
- finger like papillae with fibrovascular core
- single and small usually
Malignant bladder tumour
papillary carcinoma and flat carcinoma (can be invasive/ non-invasive)
Papillary carcinoma
- papillary urothelial neoplasm with little malignant potential
- Papillary urothelial carcinoma, low grade
- high grade
Thickened urothelium, and bigger in size
Can spread/seed by implantation
Grading of papillary carcinoma
Increased cellularity Nuclear pleomorphism High mitotic rate Loss of cell polarity Poor differentiation Nuclear crowding
determines the probability of invasion
Flat carcinoma
Default high grade, also known as urothelial carcinoma in situ
commonly multifocal
Cytological malignant cells with flat apppearance
Depth of invasion/ staging
T1 lamina propria invasion
T2/3 Muscularis propria
Treatment of bladder cancer
- urothelial neoplasm with low malignant potential or low grade- transurethral resection
- high grade or T1 invasion- transurethral resection and intravesicle instillation of BCG
- T2 invasion- radical cystectomy
Urine cytology
- used in screening or follow up after transurethral resection
- low sensitivity for the low grade carcinoma
- FISH used to detect aneuploidy
