Kidney Flashcards Preview

Anatomic pathology > Kidney > Flashcards

Flashcards in Kidney Deck (379)
Loading flashcards...
30

Acquired cystic disease: Parenchymal changes.

Fibrosis, atrophy.

31

Acquired cystic disease: Complication.

Renal-cell carcinoma (can arise in a cyst or in the parenchyma).

32

Xanthogranulomatous pyelonephritis: Clinical significance.

Can form mass(es) and mimic renal neoplasia.

33

Xanthogranulomatous pyelonephritis: Most common agents (2).

Proteus spp.

E. coli.

34

Xanthogranulomatous pyelonephritis: Associated renal disease.

Calculi.

35

Xanthogranulomatous pyelonephritis: Progression.

Begins in renal pyramids and spreads to renal pelvis and then to capsule and to perinephric fat.

36

Xanthogranulomatous pyelonephritis: Gross-pathologic types (2).

Diffuse: More common.

Segmental: Polar; occurs in children.

37

Xanthogranulomatous pyelonephritis: Histopathologic zones of a nodule.

Inner: Necroinflammatory debris that is rich in neutrophils.

Outer: Lipid-laden macrophages.

Outermost (sometimes): Multinucleate giant cells, spindled fibroblasts.

38

Xanthogranulomatous pyelonephritis: Histopathologic pitfalls (2).

Lipid-laden macrophages may be confused with RCC.

Multinucleate giant cells and spindled fibroblasts may be confused with sarcomatoid carcinoma.

39

Angiomyolipoma: Inheritance.

Most tumors are sporadic.

40

Angiomyolipoma: Relation to tuberous sclerosis (2).

20% of tumors as associated with TS.

Most patients with TS develop an angiomyolipoma.

41

Angiomyolipoma: Relation of inheritance to gross pathology (2).

Sporadic: Large, single, unilateral.

TS: Smaller, multiple, bilateral.

42

Angiomyolipoma: Components.

Thick-walled hyalinized blood cells.

Smooth muscle.

Mature fat.

43

Angiomyolipoma: Possible atypical gross findings (2).

Presence of tumor in renal vein or in regional lymph nodes.

44

Angiomyolipoma: Possible atypical histopathologic features (3).

Nuclear pleomorphism.

Mitotic activity.

Epithelioid smooth-muscle cells.

45

Angiomyolipoma: Immunohistochemistry (2,1).

Positive: Melanocytic markers, smooth-muscle markers.

Negative: Epithelial markers.

46

Angiomyolipoma: Importance of careful sampling.

To exclude a coexisting renal-cell carcinoma.

47

Epithelioid angiomyolipoma:

A. Behavior.
B. Presentation.

A. Potentially malignant but unlikely to metastasize.

B. Flank pain or no symptoms.

48

Epithelioid angiomyolipoma: Radiography.

Lack of fat imparts resemblance to RCC.

49

Epithelioid angiomyolipoma: Association.

Tuberous sclerosis.

50

Epithelioid angiomyolipoma: Gross pathology (3).

Solid, hemorrhagic cut surface.

More likely than conventional angiomyolipoma to be necrotic.

51

Epithelioid angiomyolipoma: Cellular components (3).

Short spindle cells.

Large epithelioid cells.

Pleomorphic cells that resemble ganglion cells or multinucleate giant cells.

52

Epithelioid angiomyolipoma: Immunohistochemistry.

Similar to that of conventional angiomyolipoma.

53

Epithelioid angiomyolipoma: Significance of invasion of renal vein.

Observed more frequently in clinically malignant cases.

54

Epithelioid angiomyolipoma: Sites of metastasis (4).

Lymph nodes.

Lungs.

Liver.

Mesentery.

55

Metanephric adenoma:

A. Age group.
B. Possible "paraneoplastic" finding.

A. Most common in the fifth decade.

B. Polycythemia.

56

Metanephric adenoma: Cytology.

Small, bland cells with dark nuclei and scant cytoplasm.

57

Metanephric adenoma: Histologic architecture (3).

Small, tightly packed acini in an acellular stroma.

Variations:
− Papillary foci.
− Solid (blastema-like) foci.

58

Metanephric adenoma: Immunohistochemistry (3,2).

Positive: Pancytokeratin, CD57, WT-1.

Negative: CK7, AMACR, CD56.

59

Metanephric adenoma: Electron microscopy (2).

Basal lamina, microvilli.