Urinary tumours

Question 1

Papillary adenoma

Answer 1

insignificant, small, discrete and benign

Question 2

Angiomyolipoma

Answer 2

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

Question 3

Angiomyolipoma histological features

Answer 3

• blood vessels ensheathed by smooth muscles

- clusters of adipocytes

Question 4

Oncocytoma

Answer 4

• originates from IC of collecting duct
• usually solitary
• large eosinophilic cells, with small round nuclei and large nucleoli

Question 5

Presentations of renal cell carcinoma

Answer 5

Classical triad: loin pass, mass and haematuria
Paraneoplastic syndrome: unexplained fever, polycythaemia
metastasis may present before symptoms

Question 6

Renal cell carcinoma, clear cell type

Answer 6

• 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

Question 7

Papillary renal cell carcinoma

Answer 7

• 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

Question 8

Chromophobe renal cell carcinoma

Answer 8

• 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

Question 9

Collecting duct carcinoma

Answer 9

• Originates from collecting duct, usually medulla
• aggressive, with high grade nucleus and necrosis
• poor prognosis with early metastasis

Question 10

Urothelial carcinoma of renal pelvis

Answer 10

• 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

Question 11

Nephroblastoma/ Wilms tumour

Answer 11

• associated with WT-1/-2 gene deletion or mutation
• might have bilateral: synchronous or metachronous
• same presentation and spreading method as renal cell carcinoma

Question 12

Histological features of nephroblastoma

Answer 12

triphasic: blastemal (undifferentiated round cells), stromal (spindle cells), epithelial (columnar epithelial cells)

Question 13

Presentations and features of urinary bladder tumours

Answer 13

• usually in middle aged men (more than female)
• usually urothelial carcinoma, others include squamous cell carcinoma and adenocarcinoma
• painless gross haematuria

Question 14

Benign bladder tumour

Answer 14

Urothelial papilloma and inverted papilloma

• normal urothelium
• finger like papillae with fibrovascular core
• single and small usually

Question 15

Malignant bladder tumour

Answer 15

papillary carcinoma and flat carcinoma (can be invasive/ non-invasive)

Question 16

Papillary carcinoma

Answer 16

1. papillary urothelial neoplasm with little malignant potential
2. Papillary urothelial carcinoma, low grade
3. high grade

Thickened urothelium, and bigger in size
Can spread/seed by implantation

Question 17

Grading of papillary carcinoma

Answer 17

Increased cellularity
Nuclear pleomorphism
High mitotic rate
Loss of cell polarity
Poor differentiation
Nuclear crowding

determines the probability of invasion

Question 18

Flat carcinoma

Answer 18

Default high grade, also known as urothelial carcinoma in situ
commonly multifocal
Cytological malignant cells with flat apppearance

Question 19

Depth of invasion/ staging

Answer 19

T1 lamina propria invasion

T2/3 Muscularis propria

Question 20

Treatment of bladder cancer

Answer 20

1. urothelial neoplasm with low malignant potential or low grade- transurethral resection
2. high grade or T1 invasion- transurethral resection and intravesicle instillation of BCG
3. T2 invasion- radical cystectomy

Question 21

Urine cytology

Answer 21

• used in screening or follow up after transurethral resection
• low sensitivity for the low grade carcinoma
• FISH used to detect aneuploidy