B5-081 Renal and Urinary Tumors Flashcards
(89 cards)
1
Q
biggest risk factor for renal cell carcinoma
A
smoking
2
Q
familial variants of renal cell carcinoma
A
- von Hippel Lindau
- Hereditary papillary carcinoma
often bilateral
3
Q
most common renal cell carcinoma
A
clear cell
4
Q
A
clear cell carcinoma
5
Q
98% of clear cell RCC is caused by an abnormality on chromosome
A
3
loss of VHL tumor suppressor
6
Q
most common subtype of RCC found in dialysis patients
A
papillary carcinoma
7
Q
- papillary growth with interstitial foam cells
- multifocal
A
papillary carcinoma
8
Q
associated with trisomy 7 and 17, loss of Y
A
papillary carcinoma
9
Q
MET locus (proto onocogene)
A
papillary carcinoma
10
Q
A
papillary carcinoma
11
Q
- tumor cells have prominent cell membranes and pale cytoplasm “vegetable cells”
- halo around nucleus
A
chromophobe RCC
12
Q
does chromophobe RCC have a good prognosis?
A
yes
13
Q
A
chromophobe RCC
14
Q
RCC triad
A
- flank pain
- palpable mass
- hematuria
15
Q
why is RCC called a great mimicker?
A
- variety of systemic symptoms
- paraneoplastic syndromes
polycythemia, HTN, hypercalcemia
16
Q
most common sites of metastasis of RCC
2
A
lungs
bones
17
Q
RCC tends to invade which vessel?
A
renal vein
can reach vena cava, right heart eventually
18
Q
treatment RCC
A
- nephrectomy or partial nephrectomy
- chemotherapy if metastatic
19
Q
- present with hematuria, urinary obstruction
- 50% of patients have previous or concurrent bladder tumor
A
urothelial carcinoma of renal pelvis
20
Q
risk factors for urothelial carcinoma of renal pelvis
A
- analgesic nephropathy
- lynch syndrome
21
Q
most common pediatric renal tumor
A
Wilm’s tumor
22
Q
WAGR syndrome
A
- Wilm’s
- Aniridia
- Genital anomalies
- mental Retardation
23
Q
protein affected by germline 11p13 mutation
A
WT1 -Wilm’s
PAX6 -aniridia
24
Q
- critical for normal renal and gonadal development
- encodes DNA binding transcription factor in embryogenesis
A
WT1 protein
25
* causes gonadal dysgenesis and early onset nephropathy
* diffuse mesangial sclerosis
* 90% risk of wilms
Denys-Drash syndrome
26
Denys-Drash syndrome is caused by germline mutations in
WT1
| missense mutation
27
* organomegaly
* macroglossia
* omphalocele
* adrenal cytomegaly
Beckwith-Wiedermann Syndrome
28
11p15.5 (WT2) imprinting mutation
Beckwith-Wiederman
29
* caused by loss of imprinting of normally maternally silenced IGF2 allele
* or duplication of active paternal allele
Beckwith-Wiederman
30
* small blue bastemal cells
* fibrous or myxoid stromal cells
* epithelial cells
Wilms
31
[...] mutations indicated a worse prognosis for Wilms
p53
| **cause anaplasia**
32
wilms
33
precursor for Wilms
nephrogenic rests
34
* seen in renal parenchyma adjacent to tumor in 25-40% of cases
* seen in 100% of bilateral cases
nephrogenic rests
| precursor to Wilms, increases risk of WIlms in **other kidney**
35
* large abdominal mass
* hematuria
* abdominal pain
* intestinal obstruction
* hypertension
* may have pulmonary mets
Wilms
36
key determinant of prognosis of Wilms
anaplastic histology
37
survivors of Wilms have an increased risk of
secondary tumors
38
can occur in renal calyces, renal pelvis, ureters and bladder
urothelial cell carcinoma
39
painless hematuria without casts may indicate
urothelial carcinoma
40
syndromes causing Wilms
| 3
* WAGR
* Deny-Drash
* Beckwith-Wiederman
41
* most common renal malignancy of early childhood (2-4 yrs)
* contains embryonic glomerular structures
Wilms
42
* most often presents with large palpable, unilateral flank mass
* and/or hematuria
* possible HTN
Wilms
43
caused by WT1 deletion
| 2
WAGR, Denys-Drash
44
caused by WT2 mutation
beckwith-weidermann
45
* polygonal clear cells filled with accumulated lipids and carbohydrates
* often golden yellow due to high lipid content
RCC
46
originates in PCT --> invades renal vein --> IVC --> hematogenous spread --> metastasis to lung and bone
RCC
47
* flank pain, palpable mass, hematuria
* anemia, polycythemia, fever, weight loss
RCC
48
90% of bladder cancer is
urothelial carcinoma
49
biggest risk factor for bladder cancer
smoking
50
precursor lesions to UCC
* non-invasive papillary urothelial carcinoma
* non-invasive flat urothelial carcinoma (always high grade)
51
prognosis for low grade noninvasive papillary carcinoma
excellent
52
* prognosis of high grade invasive papillary carcinoma
* invasion of muscularis propria
25%, not good
53
papillary noninvasive low grade UCC
54
* orderly architecture and cytology
* evenly spaced
* maintain polarity
* cohesive
* minimal nuclear atypia
* papillary architecture
low grade papillary UCC
55
high grade papillary UCC
56
* dyscohesive
* large, hyperchromic nuclei
* pleomorphism and atypia
* frequent mitoses
* disordered, loss of polarity
* higher risk of invasion and progression
high grade papillary UCC
57
UCC in situ
| always high grade
58
* flat lesion
* dyscohesive
* hyperchromatic enlarged cells
* little cytoplasm
* multifocal
UCC in situ
59
on cytoscopy, there is no mass, just erythema
UCC in situ
60
most common site of metastasis for bladder cancer
lymph node
61
deletion of tumor suppressors on chr 9 leads to
| bladder cancer
low grade papillary tumors
| acquire p53 mutation --> able to invade
62
initial p53 mutation leads to
| bladder cancer
high grade tumors/UCC in situ
| acquire loss of chr 9 --> invasion
63
T2 staging of bladder cancer indicates
muscularis propria invasion
64
* rare in US but more common in countries with endemic schistosomias
* caused by chronic bladder irritation/infection
squamous cell carcinoma of bladder
65
schistosoma hematobium
| possible buzzword: patient from Eygpt ??
66
squamous cell carcinoma of bladder
| **keratin pearls**
67
what is the limit of urine cytology?
can't detect low grade tumors
68
treatment of small localized low grade papillary tumors
| UCC
* transurethral resection
* follow with cysto/urine cytology forever due to tendency to regenerate
69
treatment of high grade UCC
tuberculous bacillus (BCG)
70
treatment for T2 UCC
radical cystectomy
chemo if metastatic
71
why is urine cytology the best initial test for suspected cancer?
highly specific for high grade tumors
72
good for monitoring patients who have bladder cancer or patients you suspect have cancer
urine cytology
73
RCC with excellent prognosis
chromophobe RCC
74
many invasive high grade UCs show deletions in
17p
| p53
75
papillary low grade UCs are associated with deletions in
chr 9
76
deletion of WT1 on chr 11
wilms
77
reddening or granularity of the bladder mucosa but no evident mass
UC in situ
78
papillary urothelial carcinoma and invasive high grade UC show a [...] on cytoscopy
mass
79
treatment for low grade papillary UC
transurethral resection and periodic follow up
80
cystectomy, chemotherapy, and radiation are used to treat
high grade tumors
81
topical BCG therapy is used to treat
| 2
* in situ carcinoma
* multifocal high grade papillary carcinoma
82
cuboidal cells arranged in papillary formations with foam cells
papillary renal cell carcinoma
83
clear cytoplasm without papillary architecture
clear cell RCC
84
pale eosinophillic cells with perinuclear halo and prominent cytoplasmic membranes arranged in solid sheets
chromophobe carcinoma
85
urothelial cells in solid sheets with or without papillary projections
UC
86
* blastemal
* stromal
* epithelial
Wilms
87
origin site of RCC
PCT
88
* anemia
* hematuria
* elevated creatinine
RCC
89
golden yellow tumor due to high lipid content
RCC
