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Flashcards in Kidney and Bladder Pathology Deck (29):
1

Child vs. Adult Polycystic Kidney Disease

  1. Adult form - Autosomal dominant - cortical based cysts (picture) 1/500 prevalence
  2. Child form - Autosomal recessive - medulla based cysts 1/20,000 prevalence

2

How can you tell the difference between polycystic kidney disease and acquired cystic kidney disease based on morphology?

  • PKD: these kidneys weigh 1000-2000 g (normal, 100 g)
  • AKD: dialysis patients get an acquired cystic disease but the kidney is normal-sized, not so huge

3

How will hydronephrosis appear morphologically?

  • Cortex and medulla compressed to a rim
  • Pelvicalyceal system (pelvis and calyces) are very dilated

A image thumb
4

  • What is the classic triad for renal cell carcinoma?  
  • What are other manifestations for renal cell carcinoma?

  • Classic triad: Painless hematuria, a palpable abdominal mass, and dull flank pain
  • Most frequent presenting manifestation is hematuria (gross or microscopic), occurring in more than 50% of cases
  • Polycythemia in 5% to 10% of cases due to erythropoietin production by the tumor (paraneoplastic syndrome)

5

Main types of renal tumors

  • % of renal cancers & Outcome

  • Clear cell
    • 83%; Second worst
  • Papillary
    • 11%; Second best
  • Chromophobe
    • 4%; Best
  • Collecting duct (subtype: Medullary carcinoma)
    • 1% (medullary, <1%); Worst
  • Renal oncocytoma
    • NOT cancer but occurs at 5-10% the rate of kidney cancer; Benign, rarely recurs
  • Angiomyolipoma
    • Most frequent benign tumor; Benign

6

What is the histological difference between Papillary Type I vs. Papillary Type II renal cell cancer?

  1. Papillary Type I
    • thin papillae
  2. Papillary Type II
    • thick papillae

7

What can be seen histologically in chromophobe carcinoma?

  • Normal glomerulus
  • Halo around a wrinkled nucleus
  • Binucleate cell

8

  • What are the characteristics of medullary carcinoma?
  • What is the outcome?

  • Restricted to individuals who have some African or Mediterranean descent
    • Patients have sickle cell disease or sickle cell trait
  • Presents at very high stage, resists chemotherapy, and has worst outcome of all kidney cancers with median survival times of 3 months (range 1–7 months)

9

  • How is acquired cystic disease associated with renal cancer?  
  • What is common histological finding?

  • Patients with acquired cystic disease due to chronic dialysis dependency have a 100x risk of getting RCC
  • Variety of patterns but lots of vacuoles
    • Also will see oxalate crystals

10

_____ ____ ___________ cancer occurs in end stage kidneys whether cystic or non-cystic

Clear Cell (Tubulo)papillary cancer occurs in end stage kidneys whether cystic or non-cystic

11

Renal Cell Carcinoma Nucleolar Grading:

  1. Grade 1: 
  2. Grade 2: 
  3. Grade 3: 
  4. Grade 4: 

  1. Grade 1: nuclei are like tiny dots
  2. Grade 2: nucleoli inconsipicuous
  3. Grade 3: nucleoli appreciated at low power
  4. Grade 4: bizarre cells

12

__________ arises from intercalated cells of collecting duct

Oncocytoma arises from intercalated cells of collecting duct

13

  • What is the most common benign tumour of the kidney?
  • What is its most serious complication?

Angiomyolipoma

  • most common serious complication of it is hemorrhage

14

In which renal tumor will premelanosomes be present?

angiomyolipoma

15

Which renal tumor is almost always pediatric?

Wilms tumor

  • Contain a variety of cell and tissue components, all derived from the mesoderm

16

List the Acquired non-neoplastic anomalies of Urinary Bladder:

  • Cystitis cystica/ cystitis glandularis
  • Polypoid and papillary cystitis
  • Nephrogenic adenoma

17

  • What are the characteristics of polypoid and papillary cystitis?
  • How can you distinguish between the them?

  • Polypoid and papillary cystitis arise from catheter, stone, etc.
  • In setting of submucosal edema, usually mixed inflammation
  • Polypoid cystitis = more blunt projections
    • has a tip that is wider than its base
    • this distinguishes it from Papillary cystitis 
  • Polypoid type is grossly more apt to mimic a tumor

18

What are the characteristics of Nephrogenic Adenoma (Nephrogenic Metaplasia)?

  • Males 2:1, can affect children
  • 61% of cases following GU surgery
  • Often associated with chronic cystitis/ longstanding infection

19

Nephrogenic Adenoma is a benign proliferation of ...

tubules

20

What are the different grades of bladder cancer (flat and papillary) from lower to higher grade?

  • FLAT lesions: (low to high)
    • Reactive
    • Indeterminate
    • ​​Dysplasia
    • ​​Carcinoma in situ
  • PAPILLARY lesions: (low to high)
    • Papilloma
    • Papillary neoplasm, uncertain potential
    • Low-grade urothelial cancer
    • High grade urothelial cancer

21

Bladder TMN Staging:

  • Urothelium:
  • Lamina propria: 
  • Muscularis propria: 
  • Perivesical fat: 
  • Other organs: 

  • Urothelium:
    • pTIS, pTa
  • Lamina propria: 
    • pT1
  • Muscularis propria: 
    • pT2a, pT2b
  • Perivesical fat: 
    • pT3
  • Other organs: 
    • pT4

A image thumb
22

What is the key determinant in bladder TMN staging?

whether muscularis propria is invaded

23

  • What are the histologic characteristics of urothelial papilloma?
  • In which patients is it more common in?

  • Histology:
    • Minimally branching delicate papillae with fibrovascular core lined by
    • Urothelium of normal thickness and polarity and no significant cytologic atypia.
  • Urothelial papilloma is more commonly encountered in young patients

24

What are the histologic characteristics of papillary urothelial neoplasms with low malignant potential?

  • branching discrete papillae with fibrovascular core lined by:
    • hyperplastic urothelium with minimal loss of polarity and minimal to absent cytologic atypia

25

Why would a transurethral resection of bladder tumor (TURBT) or bx be performed?

  • Whether tumor is invasive (into lamina propria) or not
  • Muscularis propria is / is not present
    • If present, it is/ is not invaded by tumor (pT1 vs. pT2)
  • Percent involved or whether “specimen is entirely tumor”
  • Necrosis

26

FLAT Intra- Urothelial Neoplasia:

Histology

  • Loss of polarity
  • Nuclear clustering – touch each other
  • Increased nuclear size
  • Nuclear pleomorphism
  • Increased chromatin granularity
  • Scattered nucleoli

27

How do dysplasia and reactive atypia differ with regards to cancer risk?

  • Dysplasia: mildly increased risk of cancer
  • Reactive atypia: no increased risk of cancer

28

  • __% with urothelial dysplasia developed biopsy-proven cancer
  • __% with carcinoma in situ developed biopsy-proven cancer 

  • 15% with urothelial dysplasia developed biopsy-proven cancer
  • 60% with carcinoma in situ developed biopsy-proven cancer 

29

Upper urothelial tract urothelial carcinoma

  • What does it affect? 
  • How are genetics potentially involved?

  • Renal pelvis and ureter
    • Most cases are high grade and half are locally advanced, that is, stage pT2 or higher
    • More aggressive – muscle wall is thin
  • Mismatch repair genes (as with Lynch Syndrome – hereditary nonpolyposis colon cancer)
    • Instability of at least two microsatellite markers (MSI-high) was detected in 21% of cases