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Repro/GU by Minnie (she/her) > 233/234/235 - Renal and Urothelial Pathology, Cancer > Flashcards

233/234/235 - Renal and Urothelial Pathology, Cancer Flashcards

1
Q

Which hereditary tumor syndrome is associated with upper tract urothelial cancer?

A

Lynch 2

Mutation in DNA mismatch repair genes

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2
Q

Which type of renal cell cancer will have “chicken wire vasculature”?

A

Clear cell carcinoma

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3
Q

List the 3 malignant types of renal cell carcinoma

A

Clear cell

Papillary

Chromophobe

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4
Q

Which type of cancer is most stronly associated with mutations in the VHL gene?

A

Clear cell RCC

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5
Q

Which structures constitute the urothelial system? (4)

A
  • Kidney
  • Ureter
  • Bladder
  • Proximal urethra
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6
Q

List 2 risk factors for developing urothelaial cancer

A

Smoking

Chronic inflammation

Inflammation can be due to toxins, cystitis, stones, schistosoma, etc

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7
Q

Posterior urethra

  • Blood supply:
  • Lymph drainage:
A
  • Blood supply: Inferior vesical and middle rectal arteries
  • Lymph drainage: Deep pelvic nodes

Anterior = internal pudendal artery, inguinal nodes

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8
Q

What is the classic symptom triad in patinets with tumors of the renal parenchyma?

A

Hematuria

Flank pain

Flank mass

All 3 present in only 10% of new RCC cases

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9
Q

What are 2 common presenting symptoms/signs of bladder tumors?

A

Gross hematuria

And/or irritative voiding symptoms

  • Ureter/upper collecting system tumor: Flank pain, gross hematuria*
  • Urethral: obstructive voiding symptoms, hematuria, papable mass*
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10
Q

What is the mainstay of treatment for localized renal cell cancer?

A

Surgery

Remove all or part of the kidney

  • Legions are basically incurable if metastatic - refractory to chemo and radiation*
  • New immune-modulation therapy is more promising*
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11
Q

How are kidney cancers staged?

(What is the system)

A

TNM staging

  • Fuhrman calssification used for clear cell RCC*
  • *Honestly I am between maybe 5 and infinity years away from the responsibility of staging cancer so cards on this will not be extensive sorryyy**
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12
Q

List 4 ways to prevent urothelial cancer

A
  • Smoking cessation
  • Fruits and veggies
  • Less intake of fat and cholesterol
  • Increase intake of non-chlorinated water

Antioxidants *may* be helpful, but not a ton of evidence to support

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13
Q

What landmarks help us determine the level of a renal vein/IVC tumor thrombus?

  • Level 1:
  • Level 2:
  • Level 3:
  • Level 4:
A
  • Level 1: <2cm from RV ostium
  • Level 2: >2cm, but below hepatic veins
  • Level 3: In the intrahepatic IVC, but below hepatic veins
  • Level 4: Above the hepatic veins
    • Includes into the right atrium
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14
Q

What diagnostic studies comprise the gold standard work-up for hematuria? (4)

A

CT urogram (no contrast)

Cystoscpy

Digital rectal exam

PSA

New onset hematuria is concerning for bladder/urothelial cancer

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15
Q

Are environmental exposures more likley to contribute to renal cell carcinoma or urothelial cell carcinoma?

A

Urothelial

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16
Q

What is the key difference between a renal papillary adenoma and a papillary renal cell carcinoma?

A

Size

  • Papillary adenomas are <1.5cm w/low nuclear grade
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17
Q

What is the most common type of bladder cancer?

A

Low-grade papillary urothelial carcinoma

<10% will be invasive, but likely to reccur

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18
Q

Which renal tumor has the lowest 5-year survival rate?

A

Sarcomatoid RCC

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19
Q

Anterior urethra

  • Blood supply:
  • Lymph drainage:
A
  • Blood supply: Internal pudendal artery
  • Lymph drainage: Inguinal lymph nodes

Posterior = inferior vesical and middle rectal arteries, drains into deep pelvic nodes

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20
Q

Schistosoma hematobium is a risk factor for what kind of cancer?

A

Squamous cell carcinoma of the bladder

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21
Q

List 2 risk factors for renal cell carcinoma

A
  • Smoking
  • Family history w/autosomal dominant genotype
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22
Q

A mutation in which gene is associated wtih hereditary papillary RCC?

A

MET oncogene on 7q31

23
Q

What is the function of the VHL gene?

A

Degrades hypoxia-inducible factor alpha

Mutation results in increased angiogenesis

  • Mutation -> Renal cell carcinoma more likely*
  • Why anti-VEGF therapies may be helpful*
24
Q

Which type of repro/GU cancer is most strongly associated with paraneoplastic syndromes?

What are the paraneoplastic syndromes?

A

Renal cell carcinoma

  • Cachexia/weight loss
  • Hepatic dysfunction
  • Anemia
  • Erythrocytosis
  • Hypercalcemia
  • Hypertension
  • Caused by RCCs that secrete PTHrP, EPO, ACTH, and/or renin​*
  • Thank you @Alba!*
25
Q

Which paraneoplastic condition associated with RCC may be caused by increased IL-6 production?

A

Stauffer’s syndrome

26
Q

Is alcohol consumption a risk factor for renal cell carcinoma?

A

NO

27
Q

What genomic abnormality is typical of most clear cell RCC?

A

Problem with VHL gene on 3p

Deletion, mutation, or hypermethylation

28
Q

List 4 types of drugs that can be used to treat metastatic renal cancer

A
  • Anti-VEGF drugs
    • Stop tumor-associated angiogenesis
  • Signal transduction inhibitors
    • Tarket tyrosine kinase and mTOR pathways
  • CTLA-4 inhibitors
  • Checkpoint inhibitors
    • PD-1, PDL-1

Metastatic renal disease is refractory to both chemotherapy and radiation

29
Q

Which variant of urothelial carcinoma will show spindle cells?

A

Sarcomatoid - very aggressive!

In general, I think anything that has “sarcoma” in it is pretty bad?

30
Q

In staging renal cell carcinoma:

What feature determines progression from T1 to T2?

What about T2 to T3?

A

T1 to T2 determined by size

T2 to T3 determined by invasion into adjacent structures/veins

31
Q

How does does the presentation of urothelial cancer change with a mass in the ureter and upper collecting system vs. the urethra?

A
  • Ureter/upper collecting system:
    • Flank pain
    • Gross hematuria
    • May have clots, microhematuria, obstruction
  • Urethra:
    • Obstructive voiding sx
    • Palpable mass
    • Urethral discharge
    • Hematuria
    • Fistula
32
Q

List 3 topical therapies that can be used to manage superficial bladder cancer

A

Mitiomycin

Thiotepa

BCG

33
Q

What is the standard treament for tumors of the distal ureter?

A

Resection + ureteral re-implantation

34
Q

Which type of urothelial cancer is assocaited with chronic irritation?

A

Squamous cell carcinoma

Risk factors include:

  • Inflammation
  • Cystitis
  • Kidney stones
  • Schistosoma
  • Smoking
35
Q

What is the natural course of a flat, urothelial carcinoma in situ?

A

Aggressive!

Can progress to invasive disease in weeks-months

Even CIS ill have high nuclear grade with +urine cytology

36
Q

A stage T1 urothelial cancer may invade up to which layer of the bladder wall?

A

Lamina propria

  • Will not touch the muscle*
  • T2 will have invaded partway through the muscular layers*
37
Q

What is the treatment for metastatic urothelial cancer?

A

Chemotherapy

MVAC or GC

  • MVAC = Methotrexate + vinblasine + adriamycin + cysplatin
  • GC = Gemcitabine + cisplastin

PD-1 or PD-L1 inhibitors may be helpful

Key: Metastatic urothelial cancers can be treated with chemo, metastatic renal cancers cannot

38
Q

How does the managment of urethral cancer change if the tumor is in the anterior vs. posterior urethra?

A
  • Anterior
    • Ammenable to organ-preserving therapy
    • Usually presents at an earlier stage
  • Posterior
    • Requires aggressive, multi-modality therapy
    • Usually presents at a later stage

Both will require systemic chemo if locally advanced or metastatic

39
Q

Which GU cancers are refractory to chemotherapy and radiation

What can bu used to treat them instead?

A

Metatsatic renal cell carcinoma

  • Anti-VEGF
  • Signal transduction inhibitors (Tyrosine kinase, MTOR)
  • Anti-CTLA4 agents*
  • Checkpoint inhibitors*
    • Anti-PD1 or Anti-PDL1

Both are considered new-age immune modulators

40
Q

Which type of renal ccell cancer will have vague, flocculent, pale cytoplasme rich in lysosomes?

A

Chromophobe renal cell carcioma

  • Arises from collecting duct cells*
  • Best prognosis of all malignant RCC*
41
Q

What is the most common benign renal tumor?

A

Oncocytoma

42
Q

Which UG cancer is more common in women than men?

A

Urethral urothelial carcinoma

I think this is the only one but not completely sure

43
Q

Which malignant renal tumor is derived from the intercalated cells of the collecting duct?

A

Chromophobe RCC

44
Q

What is the standard treatment for muscle-invasive bladder cancer?

A

Radial cystectomy

Often preceded by neoadjuvant MVAC or GC chemotherapy

  • MVAC = Methotrexate, vinblastine, adriamycin**, cisplatin*
  • GC = Gemcitabine + cysplatin*
45
Q

Which cancer is the most lethal urologic cancer?

A

Kidney cancer

(RCC)

46
Q

Will TURBT cure an invasive urothelial carcinoma?

A

No

  • TURBT gets down to the muscular layer, but cant get through the muscle
  • Invasive tumors penetrate the muscle by definition
  • Gold standard to cure invasive urothelial tumors = radical cystectomy, can give neoadjuvant chemo beforehand (cisplatin)
47
Q

From which cells do most urothelial carcinoma arise?

A

Transition cells

Most commonly in the bladder, but can affect other parts of the UG system

Transition cell carcioma = most common urothelial carcinoma

Can also have squamous and adeno

  • The urothelium is made up of transition cells that line the bladder and UG lumen, plus some squamous celsl.*
  • Cancer most common in the bladder b/c whatever toxins are in the lumen hang out there the longest*
48
Q

Which chemotherapy agents constitute the MVAC regimen?

A

Methotrexate

Vinblastine

Adriamycin

Cisplatin

49
Q
A

B - Hereditary Papillary RCC

50
Q

A superficial baldder cancer becomes invasive when it invades which layer of the urothelium?

A

Tunica muscularis propria

51
Q

List the 4 growth patterns exhibited by urothelial tumors of the bladder

A

Invasive

Noninvasive

Papillary

Flat

52
Q

9q deletion and/or upregrulation of FGFR3 is most commonly associated with which type of cancer?

A

Non-muscle invasive blader cancer

53
Q

What histologic finding is characteristic of malakoplakia?

A

Michaelis-gutman bodies

Small, laminated, calcified concretions

54
Q

Which renal cell carcinomas arise from proximal convoluted tubule cells?

A

Clear cell RCC

Papilary RCC

Chromophobe comes from intercalated cells of the collecting duct

Repro/GU by Minnie (she/her) (31 decks)

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