pathology of kidney tumours

Question 1

which classidication is uded for kidney tumours?

Answer 1

Heildelberg classification

Question 2

heidelberg classification

Answer 2

categorises into benign and malignant

parenchymal tumours only, exlcudes chldhood

Question 3

benign?

Answer 3

• Metanephric adenoma and
metanephric fibroma
- rare
• Papillary renal cell adenoma -
common
• Renal onocytoma 3 - 5%

Question 4

malignant

Answer 4

• Common or conventional
RCC - 75%
• Papillary - 10%
• Chromophobe - 5%
• Collecting duct - 1%
• Unclassified - 3-5%

Question 5

oncocytoma

Answer 5

• 3-5% surgical series
• Macroscopic appearance: tan
brown well delineated :
central fibrous scar

• Microscopic uniform cuboidal
columnar cells eosinophilic:
mitochondria

Question 6

conventional or clear cell carcinoma

Answer 6

• Macro / wide variety
including cystic, yellow
colour common.

• Histo: solid/ trabecular/ tubular/
cystic/ focally papillary.
• Cell type clear : eosinophilic
“granular”.
• Deletions : 3p (6q 8p 9p14q)
• Mutation VHL - 57% with LOH
in 98% (none in 100 other tumours
including 12 papillary RCCs)

Question 7

papillary renal cell adenoma

Answer 7

• Incidental at autopsy or
accompanying papillary RCC in
surgical specimens
• Less than 1cm

• Cytology “small blue” cells
• Trisomy 7, 17
• Loss/deletions Y

• Multifocal 24/62 - 3 bilateral
• Predilections for occurrence in end
stage renal disease and cystic change.
Hereditary predisposition.
• Macro : Circumscribed: haemorrhage:
• Micro : more than 50% papillary -
stroma may have foam cells - Cell type
small blue cells or granular.
Eosinophilic cells tend to be high
grade.
• Trisomy : 7 17 + 3q 8 12 16 20

• Papillae and tubular
structures covered by small
cells with pale cytoplasm

Question 8

other rcc types

Answer 8

• Eg Chromophobe
• Sarcomatoid

Question 9

impact of classification based on genetic changes

Answer 9

• Basis for refinement
– Papillary cancers
• Inherited tumours
.• Genetic changes define the genetic drive-
– magic bullets
• new drugs

Question 10

Von Hippel Linday (VHL)

Answer 10

• Dominantly inherited syndrome:
– Retinal and cerebella haemangioblastomas
– Renal cysts
– RCC
– Phaeochrocytoma

Question 11

clinical pres of VHL

Answer 11

• Mass-
• Haematuria
• Incidental-

• Metastasis
– Esp: bone; lung.

• Non metastatic effects :
Fever, PUO, High ESR
Polycythaemia,
Hypercalcaemia.

Question 12

stagin

Answer 12

UICC
• T1 - Small tumour less than 7cm
• T2 – Tumour > 7cm
• T3 - Spread to perinephric fat, or renal vein (or IVC).
• T4 - Extension into neighbouring organs.

Question 13

other tumours

Answer 13

• Wilms (nephroblastoma) in children
• Urothelial tumours
• Non-epithelial tumours- lymphomas sarcomas

Question 14

aetiology

Answer 14

• Genetic evidence
– Most sporadic
• The usual suspects
• Obesity
• Chronic renal failure

• Smoking: RR: 2
• Occupation

Question 15

chronic renal failure

Answer 15

• Acquired cystic disease
– Papillary adenomas; papillary carcinomas

• Long term dialysis
– RR: 3.6

• Relationship to time on dialysis:
– RR after 10yrs dialysis: 9
– Higher in younger patients