L61 Flashcards Preview

P&T Block 5 Renal > L61 > Flashcards

Flashcards in L61 Deck (30)
1

Renal cell carcinoma:
M v W
Biggest risk factor
Genetic associations

M > F
Smoking!!!!
VHL syndrome

2

RCC symptom triad

CVA tenderness
Hematuria
Flank mass

3

What paraneoplastic effect is most common with RCC?

↑EPO -> polycythemia

4

Remind yourself of the tumors you can see with Von Hippel Lindau

Bilat clear cell RCC
Retinal angiomatosis
Cerebellar hemangioblastoma

5

Describe clear cell RCC

Most common RCC
Unilat
Solid, clear margins mass
Lipid + glycogen in cells
Might be in area of necrosis or hemorrhage

6

Histo clear cell RCC

TEST Q: ID the histo for this
Clear to eosinophil granular cytoplasm
Branching vasculature

7

What is papillary RCC

Well circumscribed, encapsulaed
Often @ cortex
+/- necrosis/hemorrhage

8

Papillary RCC histo

Fibrovasc stalks form papillary structures
Foamy macrophages (lipid)
Psammoma bodies (calcification)

9

Genetics of papillary RCC

Sporadic = trisomy of 7 + 16 + 17 + lose Y in men
Hereditary = mutation c-met gene

10

Gross + histo chromophobe RCC

Well circumscribed mass
Cells w/ plant cell like membranes aka prominent cell membranes
- Halo around nucleus
- Pale/pink cytoplasm
- Cells in sheets

11

EM of chromophobe RCC - what might you confuse this with?

Cytoplasm filled w/ empty microvesicles
Vs oncocytoma - ↑mitochondria

12

Genetics of chromophobe RCC

Chromosome losses

13

Describe sarcomatoid RCC

Spindle cells + giant cells
Poorly differenitated: worse prognosis

14

RCC prognosis

Good!
Worse if mets - most likely w/ sarcomatoid

15

How stage RCC

Stage 1 + 2 - based on size
Stage 3 - if extended beyond kidney locally
Stage 4 - regional LN involvement

16

Where are you worried about invasion with RCC?

Renal vein
Can creep up the IVC

17

Treat RCC

Nephrectomy - complete or partial
Cryotherapy ablation
Resect or chemo for mets

18

Where does urothelial carcinoma arise? Symptoms?

From renal pelvis
Hematuria
Hydronephrosis
Histo loos the same as bladder urothelial cancer

19

What is a nephroblastoma? Presentation

Wilm's tumor
Childhood renal tumor

20

Nephroblastoma gross appearance

Sphere, demarcated
@ upper pole of kidney
Tan/grey
+/- Hemorrhage, necrosis, cysts
Often will extend beyond renal capsule

21

Histo nephroblastoma

Small blue cells
Aspects of other embryo tissues: muscle, fat, bone

22

What is anaplasia?

A nephroblastoma may or may not demonstrate anaplasia - will resist chemo
Atypical mitosis and/or large, dark nuclei 3x size of normal

23

What is the precursor of a Wilm's tumor?

Nephrogenic rest = small small blue cell lesion
Watch BOTH kidneys for development of Wilm's tumor

24

Genetics of nephroblastoma

Chromosome 11 mutate/delete

25

What is the WAGR dysmorphic syndrome?

Wilms tumor
Aniridia - no iris in the eye
GU malformation
mental Retardation

26

Treat nephroblastoma + common mets site

Met to lungs
Good outcome unless tumor w/ anaplasia
Surg + chemo

27

Name 3 benign renal tumors

1. Renal papillary adenoma - asymptomatic + benign version of papillary RCC (smaller lesion)
2. Oncocytoma - asymptomatic, vs RCC
3. Angiomyolipoma - BV + SM + fat, tuberous sclerosis

28

Describe oncocytoma grossly

Central scar
Well circumscribed - but no capsule, histo shows ending right next to normal kidney

29

Tuberous sclerosis lesions

Hamartomas CNS
Ash leaf patches, cutaneous angio-fibromas
Angiomyolipomas in kidney
Retinal glial hamartoma
Cardiac rhabdomyoma

30

Describe simple renal cysts

1+, clear fluid
Observation but rule out cysts associated with RCC