Neoplasms of Kidney and Bladder Flashcards Preview

Renal Exam > Neoplasms of Kidney and Bladder > Flashcards

Flashcards in Neoplasms of Kidney and Bladder Deck (53):
1

Key differences in Adult form auto.dominant PKD vs auto.recessive PKD vs aquired cystic diseaes

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

Aquired cycstic disease: dialysis pts, kidneys don't get so big

2

What changes do we see in hydronephrosis?

Cortex and medulla compressed to a rim

Pelvicalyceal system (pelvis and calyces) are very dilated

3

Kidney cancer is ____ most common and ____ leading cause in death from cancer for men. 

(also serious in women)

6th

10th

4

Classic triad for renal cell carcinoma

*most prominent feature?

 Painless hematuria, a palpable abdominal mass, and dull flank pain is classic triad
- Most frequent presenting manifestation is hematuria (gross or microscopic), occurring in more than 50% of cases
 

5

In Renal cell carcinoma, polycythemia in 5% to 10% of cases due to 

erythropoietin production by the tumor (paraneoplastic syndrome)

6

Most frequent benign kidney tumor

Angiomylolipoma

7

represents 83% of renal cell carcinomas with the second worst outcome

The worst outcome is:

Clear cell

worst outcome = Collecting duct (subtype: medullary)

8

kidney tumor that is NOT cancer but occurs at 5-10% of the rate of kidney cancer

Renal oncocytoma; benign, rarely recurs

9

Renal cell tumor with best outcome

chormophobe

10

occurs in end stage kidneys whether cystic or non-cystic

Clear cell type (most common); second worst oucome

11

Papillary type tumors have a ____core with macrophages and blood vessels

Type 1 has ____papillae

Type 2 has ____ papillae

stromal core

thin = 1

thick = 2

12

Your attending surgically removes a tumor from the patient. The tumor itself is well circumscribed and sent to pathology. HE comes back and you notice binucleate cells. The pathologist says there are 'halos aroud wrinkled nucleus'. This is a dead giveaway for:

Chromophobe!

Normal glomerulus

halo around wrinkled nucleus

binuclueate

circumscribed tumor

13

A collecting duct carcinoma has _______ of tumor cells and is based in the ______

irregular aggregates of tumor cells

based in medulla/collecting system and spreads outwards

14

Medullary Carcinoma
•Restricted to individuals who have some _____ or _______descent
•Patients have ________disease or _______trait
 

African or Mediterranean 

sickle cell 

15

•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)

Medullary Carcinoma

16

Acquired cystic disease-associated renal ca.
•Patients with acquired cystic disease due to 
chronic dialysis dependency have a 100x risk of 
getting______
•Variety of patterns but lots of vacuoles

 RCC Oxalate crystals.

17

Staging of renal cell carcinoma
•Average 5-year survival of___%, but varies greatly according to histologic subtype
 

50

18

Usually RCC has 5 yr survival of 50%... what lowers it to 15%

•If renal vein invasion or extension into perinephric fat, 5-year survival is reduced to 15%. 

19

Describe STAGING of RCC

T1; <7 cm in kidney

T2 >7 cm still confined

T3 extends into fat outside kidney

T4: spread to other locations/ renal vein

20

GRADING system for RCC

Grade 1: nuclei are like tiny dots

Grade 2: nucleoli inconspicuous

Grade 3: nucleoli appreciated at low power

Grade 4: bizarre cells

21

Tumor that Arises from intercalated cells of collecting duct

Oncocytoma

22

Angiomyolipoma: a________ tumor
Vessels + smooth muscle + fat
•The most common benign tumour of the kidney; most common serious complication of it is _____

 

 

mesenchymal

hemorrhage

23

Angiomyolipoma is simular to what other cancer?

melanoma bc has same derivative.. thus it will stain + with the same stains used to Dx melanoma

24

Almost always a pediatric tumor; rarely seen in adults
Contain a variety of cell and tissue components, all derived from the mesoderm

Wilms Tumow

25

The bladder has a large detrusor (sm muscl) covered with tunica propria. What cell type sits on top of that?

Trasitional epithelium (helps accomidate stretch)

26

You see glandular tissue in the bladder, why is this concerning?

Cystitis cystica or glandularis

you shouldn't have glands in the bladder

27

Cystitis cystica/ cystitis glandularis
Polypoid and papillary cystitis
Nephrogenic adenoma

are all examples of:

Acquired non-neoplastic anomalies of Urinary Bladder

28

•Polypoid and papillary cystitis arise from: 

are both examples of:
•In setting of submucosal edema, usually :

catheter, stone, etc. 

Undulated lesions

mixed inflammation

29

=more blunt projections; has a tip that is wider than its base and is grossly more apt to mimic a tumor

Polypoid cystitis

*brooooad based best diagnosed at low power

30

Benign proliferation of tubules (w/ inflammatory cells)

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

 

Nephrogenic Adenoma (Nephrogenic Metaplasia)

31

bening proliferation of tubules

32

Bladder cancer

M:F ratio?

What forms does it take on?

M:F is 3:1

can be flat (ulcerated/red) or mass (papillary or exophytic

33

Progression in grades for papillary bladder cancer

 

papilloma (benign)

Papillary neoplasm, uncertain potential

Low grade urothelial cancer

high grade urothelial cancer

34

Progression in grades for flat lesion in bladder

Reactive

Intermediate

Dysplasia

Carcinoma in situ

35

TNM Staging:

A key determination is whether _______ is invaded: 
leads to conservative management (≤pT1) versus cystectomy 
(≥pT2)

 

muscularis propria

36

What staging would we do conservative management for

 (≤pT1)

37

What TNM staging would we do cystectomy on?

(≥pT2)

38

Minimally branching delicate papillae with fibrovascular core 
lined by urothelium of normal thickness and polarity and no significant cytologic atypia.

Urothelial papilloma:

*more common in young patients (under 40)

39

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

Papillary urothelial neoplasms of low malignant potential:

40

Urothelial carcinoma with no invasion and nuclei stay parellel but jumbled

Low grade

41

Urothelial carcinoma thats invasive, jumbled polarity and huge nuclei

High Grade

42

Features of exophytic or papillary carcinoma to report on TURBT 
(transurethral resection of bladder tumor) or bx
 

•Whether tumor is invasive
•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

43

What are 3 nuclear findings in flat intra-urothelilal neoplasias?

•Nuclear clustering – touch each other
•Increased nuclear size
•Nuclear pleomorphism

44

What's going on in the following in flat intra-urothelial neoplasia?

• polarity
• chromatin 
•nucleoli

•Loss of polarity
•Increased chromatin granularity
•Scattered nucleoli

45

15% with ______developed biopsy-proven cancer

urothelial dysplasia 

46

Dysplasia:_____ increased risk of cancer
Reactive atypia: ____increased risk of cancer
 

mildly

no 

47

In urothelial carcinoma in situ the nuclei is ____xs the size of lymphocyte with jumbled polarity and atypical cells

6xs

48

____% with carcinoma in situ devo biopsy proven cancer

In situ often present with ________ which mimicks some benign conditions

60%

ulcerations

49

Denuding cystisis and carcinoma in situ are characterized by 

dyscohesive cells (aka... molecular pins are coming apart)

50

Upper urothelial tract urothelial carcinoma invovles:
•Most cases are ______and half are locally advanced, that is, stage pT2 or higher

•Renal pelvis and ureter

high grade 

51

Upper urothelial tract urothelial carcinoma

•More aggressive because:
What do we see on a genetic basis?

– muscle wall is thin
mismpatch repair genes and instability of at least 2 microsatellite markers seen in 1/5 cases

52

What is the type of kidney cancer that presents at the most advanced stage?

clear cell

53

Upper urotehalial tract cancer compared to bladder urothelial cancer is:

higher in grade on average and higher in stage on average