Flashcards in Kidney Deck (379)
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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.
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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.
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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.
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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.
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Epithelioid angiomyolipoma: Radiography.
Lack of fat imparts resemblance to RCC.
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Epithelioid angiomyolipoma: Association.
Tuberous sclerosis.
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Epithelioid angiomyolipoma: Gross pathology (3).
Solid, hemorrhagic cut surface.
More likely than conventional angiomyolipoma to be necrotic.
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Epithelioid angiomyolipoma: Cellular components (3).
Short spindle cells.
Large epithelioid cells.
Pleomorphic cells that resemble ganglion cells or multinucleate giant cells.
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Epithelioid angiomyolipoma: Immunohistochemistry.
Similar to that of conventional angiomyolipoma.
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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.
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Metanephric adenoma: Cytology.
Small, bland cells with dark nuclei and scant cytoplasm.
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Metanephric adenoma: Histologic architecture (3).
Small, tightly packed acini in an acellular stroma.
Variations:
− Papillary foci.
− Solid (blastema-like) foci.
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Metanephric adenoma: Immunohistochemistry (3,2).
Positive: Pancytokeratin, CD57, WT-1.
Negative: CK7, AMACR, CD56.
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