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SYSTEMIC PHARMACOLOGY > Urogenital - kidney/bladder/related structures tumours > Flashcards

Urogenital - kidney/bladder/related structures tumours Flashcards

1
Q

KIDNEY tumours

  • malignant types
  • benign types
A

Malignant

  • Renal cell carcinoma (RCC)
  • Urothelial carcinoma
  • Nephroblastoma (Wilms tumour) – in children

Benign
- Angiomyolipoma

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2
Q

renal cell carcinoma (RCC)

- association

A

most common renal tumour! (85%)

- Associated with chromosome 3p deletions and mutations of the VHL gene -> VHL (von Hippel Lindau) syndrome

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3
Q

types of RCC

A
  • Clear cell RCC*
  • Papillary RCC
  • Chromophobe RCC
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4
Q

clinical symptoms of RCC

A
  • Painless haematuria
  • Mass in flank.
  • Fever due to necrosis
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5
Q

clear cell RCC

  • gross (3) and micro (3) features
  • metastasis?
A

Gross features:

  • Solitary, unilateral, circumscribed
  • Yellowish cut surfaces with foci of necrosis and haemorrhage.
  • possible invasion of renal vein

Microscopic features

  • Polygonal cells with clear cytoplasm.
  • Delicate branching vasculature
  • Invasion of renal vein and its branches
  • Tendency to metastasize widely; metastasis may be late.
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6
Q

Urothelial Carcinoma

  • 2 types
  • involves which part of the renal system
A
  • non-invasive papillary urothelial carcinoma
  • invasive urothelial carcinoma
  • Involves the areas of the kidney lined by urothelium (pelvi-calyceal system)
  • May be multifocal
  • associated with urothelial carcinoma of the ureter and bladder
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7
Q

Wilms Tumor (Nephroblastoma)

  • affects who
  • association
A
  • paeds tumour (2-5yrs old)
  • Associated with congenital malformations:
    WAGR syndrome, Denys-Drash Syndrome and Beckwith-Wiedemann syndrome
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8
Q

Wilms tumour

  • clinical symptoms
  • treatment and prognosis
A
  • Large abdominal mass
  • Fever due to necrosis and hemorrhage
  • Treatment: combination of nephrectomy (remove the kidney) and chemotherapy
  • good prognosis with prompt treatment, even for tumors that have spread beyond the kidney
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9
Q

Wilms tumour

  • gross (2) and
  • micro features - based on component (4)
  • metastasis
A

Gross features

  • Well circumscribed grayish white, soft mass.
  • Begins in renal cortex -> replaces entire kidney

Microscopic features

  • (blastemal component): sheets of small blue cells
  • (epithelial component): abortive tubular and glomeruloid structures
  • (stromal component): spindle-shaped cells
  • presence of striated/smooth muscle and cartilage

Haematogenous and lymphatic spread to lungs, liver, brain and lymph nodes

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10
Q

Angiomyolipoma

  • type of tumour
  • location
  • precursor
  • age of pts
  • diagnosis
A
  • Most common mesenchymal tumour of the kidney
  • contains perivascular epithelioid cells (PECs)
  • Most commonly found in the kidneys, but may occur in the liver, retroperitoneum and lungs
  • precursor: tuberous sclerosis (TS)
  • usually affecting >40yrs
  • diagnosed using CT imaging - high fat content
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11
Q

Angiomyolipoma

  • malignancy
  • gross and micro appearance
A
  • Benign, but may rupture or bleed, with serious or fatal clinical outcome

Gross appearance

  • not encapsulated
  • Variegated cut surfaces, with yellow (fatty) areas

Microscopic findings

  • Mixture of myoid spindle and epithelioid cells, adipocytes and blood vessels, often thick-walled
  • myoid cells show immunostaining for HMB-45
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12
Q

BLADDER tumours

- malignant (4) and benign (3) types

A

Malignant

  • Papillary urothelial carcinoma (non-invasive)
  • Invasive urothelial carcinoma
  • Squamous cell carcinoma
  • Adenocarcinoma

Benign

  • Papilloma
  • Inverted papilloma
  • Nephrogenic adenoma
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13
Q

risk factors for bladder carcinoma

A

occupational - found in dyes

  • 2-naphthylamine
  • 4-aminobiphenyl (also used as an antioxidant)
  • Benzidine

non-occupational
- Cigarette smoking
- Schistosomiasis (infection by parasite)
- Drugs:
cyclophosphamide (suppress immune system as part of cancer treatment - so ironic lol)
phenacetin (fever/pain relief)

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14
Q

Urothelial Carcinoma
(non-invasive urothelial papillary carcinoma & invasive urothelial carcinoma)
- precursors to invasive UC
- complications

A

Invasive urothelial carcinoma may progress from:

  • previously non-invasive papillary urothelial carcinoma/
  • urothelial carcinoma in situ (flat, high grade dysplasia)
  • urothelial carcinoma -> are at risk of having other urothelial tumours anywhere in the urothelial tract/ recurrence
    = most expensive carcinoma to treat cause it just keeps coming back!!
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15
Q

PROSTATE GLAND diseases (2)

A
  • Nodular hyperplasia (Benign prostatic hyperplasia, BPH)

- Prostatic Carcinoma

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16
Q

nodular hyperplasia

  • affects who
  • pathogenesis
A

men >50yrs

  • in the prostate, type 2 5α-reductase in the stromal cells converts testosterone to dihydrotestosterone (DHT).
  • > DHT binds to androgen receptors in the epithelial and stromal cells
  • > induces the production of growth factors
  • > hyperplasia of the nodular epithelial and stromal cells

Prostatic smooth muscle tone (mediated via α1−adrenergic receptors) worsens the lower urinary tract obstruction

17
Q

nodular hyperplasia

  • location
  • clinical symptoms
A
  • transitional zone
  • causes compression of prostatic urethra -> partial obstruction:
    urinary hesitancy,
    urinary urgency,
    nocturia (needing to pee at night)
    poor urinary stream
18
Q

nodular hyperplasia complications

A

bladder outlet obstruction, causing:

  • Bladder hypertrophy.
  • Bladder distension with hypotonia (decrease muscle tone)
  • Bladder diverticulum (outpouching)
  • Urinary tract infection (due to stasis or urine).
  • Urolithiasis.
  • Hydronephrosis and hydroureter.
  • Chronic kidney disease disease
19
Q

prostatic carcinoma

  • affects who
  • diagnostic testings
A

> 50yrs (same as BPH)

  • Serum Prostate Specific Antigen (PSA) levels: significantly elevated levels could signify PC - but may be false positive/negative
  • Prostate core biopsy done to test for presence of prostatic carcinoma. But has inherent false negative rate due to sampling
20
Q

prostatic carcinoma

  • types (2)
  • metastasis
A
  • acinar adenocarcinoma (more common)
  • ductal adenocarcinoma
  • may metastasise to bones
  • metastasis is fatal
21
Q

PENIS tumours

A
  • Condyloma acuminatum (benign)

- Squamous cell carcinoma (malignant)

22
Q

Condyloma acuminatum

  • location
  • micro
  • virus type
A
  • Coronal sulcus (crown - tip of penis), inner surface of prepuce
  • Clear vacuolation
  • HPV 6 & 11
23
Q

Squamous cell carcinoma of penis

  • virus type
  • lowered risk
A
  • HPV 16 & 18

- Circumcision in early life appears to be associated with lower risk

24
Q

TESTICULAR tumours

  • types (4)
  • predisposing factors
A
  • germ cell tumour - most common
  • embryonal carcinoma
  • yolk sac tumour
  • teratoma

predisposing factors

  • Cryptorchidism (undescended testes)
  • Genetic factors
  • Testicular dysgenesis (malfunction of testes)
25
Q

2 types of germ cell tumours

A
  • Seminomatous & non-seminomatous (NSGCT)
26
Q

Seminomatous vs non-seminomatous (NSGCT) testicular tumour

A
  • Seminomas tend to remain localized for a long time, are very radiosensitive and spread by lymphatics to paraaortic nodes
    more common
  • NSGCT are relatively radioresistant, metastasize earlier and by haematogenous route
27
Q

testicular tumour clinical presentations

A
  • Painless enlargement of testis
  • Raised serum alpha-fetoprotein
  • Raised serum human chorionic gonadotrophin hCG (beta subunit)
28
Q

embryonal carcinoma

  • who it affects
  • metastasis
A
  • 20-30 yrs

- Radioresistant, haematogenous spread

29
Q

yolk sac tumour

  • who it affects
  • pathogenesis
A
  • infants

- neoplastic germ cells differentiate along extra-embryonic lines

30
Q

teratoma

A

Contains a variety of mature and/or immature tissue types, most often from more than one germ layer

SYSTEMIC PHARMACOLOGY (22 decks)

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