Path 3 Renal and Bladder Tumors

Question 1

Renal Papillary Adenoma

Answer 1

Bening tumor of Renal Tubular Epithelium

Question 2

Renal Papillary Adenoma histo

Answer 2

Complex, branching, papillomatous structures (typical adenoma)

Question 3

Oncocytoma

Answer 3

Benign tumor of Collecting Duct Intercalated Cells

Question 4

Oncocytoma gross, histo

Answer 4

Well circumscribed with central scar

-Large eosinophilic epithelial cells (numerous mitochondria)

Question 5

Angiomyolipoma

Answer 5

Benign tumor of vessels, muscle, and fat

• Tuberous Sclerosis association
• Bleeds spontaneously

Question 6

Tuberous Sclerosis

Answer 6

Loss of function of TSC tumor suppressor gene

• Cerebral Cortex lesions, Epilepsy, Mental Retardation
• SEGA (subependymal giant cell angiosarcoma)
• Angiofibromas, Rhabdomyomas, Angiomyolipomas

Question 7

Renal Cell Carcinoma causes

Answer 7

Most common malignant tumor

• Tobacco use
• Chronic renal failure, acquired cystic disease, tuberous sclerosis

Question 8

Familial causes of Renal Cell Carcinoma (3)

Answer 8

• VHL disease (renal cysts, multiple bilateral RCCs)
• Hereditary (familial) Clear Cell Carcinoma (same gene as VHL)
• Hereditary Papillary Carcinoma (MET proto-oncogene mutation)

Question 9

Von Hippel-Lindau disease

Answer 9

Deletion of VHL on ch. 3p

• Multiple Clear cell renal carcinomas
• CNS & retinal hemangioblastomas

Question 10

Renal cell carcinoma typical features

Answer 10

Arise in poles of kidney

-Invade renal vein

Question 11

Clear Cell Carcinoma

Answer 11

95% are sporadic

• Mutation on chromosome 3
• Polygonal cells containing glycogen and lipid

Question 12

Papillary carcinoma

Answer 12

Associated with dialysis cystic disease

-Frequently multifocal

Question 13

Papillary carcinoma histo

Answer 13

Psammoma bodies

-Foamy macrophages

Question 14

Chromophobe renal carcinoma

Answer 14

Excellent prognosis

Question 15

Chromophobe renal carcinoma histo

Answer 15

Distinction from oncocytoma difficult

• Eosinophilic cytoplasm with halo around nucleus
• Prominent cell membranes

Question 16

Collecting (Bellini) duct carcinoma histo

Answer 16

Nests of malignant cells in medullary fibrotic stroma

-Irregular channels

Question 17

Renal cell carcinoma clinical

Answer 17

• Costovertebral pain
• Palpable Mass
• Hematuria

Question 18

Renal cell carcinoma metastasis locations

Answer 18

Lungs (50%)

Bones (30%)

Question 19

Urothelial Carcinoma of Renal Pelvis clinical

Answer 19

• Clinically apparent quickly (obstruction, hematuria)
• Poor prognosis
• 50% preexisting bladder tumor

Question 20

Urothelial carcinoma cause

Answer 20

Analgesic nephropathy

Preexisting bladder urothelial tumor

Question 21

Urothelial bladder carcinoma clinical

Answer 21

Prognosis depends on invasion of muscularis propria (detrusor muscle)

Question 22

Urothelial bladder carcinoma precursors

Answer 22

• Non-invasive papillary tumor (reg, inverted)

- Flat non-invasive urothelial carcinoma

Question 23

Bladder papillary tumor Tx

Answer 23

Excision

Question 24

Low grade papillary urothelial carcinomas

Answer 24

-Can recur and invade

Question 25

High grade papillary urothelial carcinoa

Answer 25

80% invade into muscularis | -May produce fistulas

Question 26

Pagetoid spread

Answer 26

Flat urothelial carcinoma (in situ)

Question 27

Squamous cell carcinoma of the bladder

Answer 27

Shistosomiasis

Question 28

Adenocarcinoma of the bladder

Answer 28

Urachal remnants or extensive intestinal metaplasia

Question 29

Bladder cancer etiology (5)

Answer 29

- Tobacco - Arylamines - Schistosoma - Analgesics - Cyclophosphamide (immunosuppressant)

Question 30

Bladder cancer clinical

Answer 30

Painless hematuria | -Tendency for higher grade recurrence after excision

Question 31

Bladder cancer Dx

Answer 31

Urine FISH | Cytoscopy & biopsy

Question 32

Bladder cancer Tx

Answer 32

Excision - Intravesicular BCG to prevent recurrence - Radical cystectomy for invasive cancer

Question 33

Urethral caruncle

Answer 33

-Painful inflammatory lesion of urethra in older females

Question 34

Peyronie disease

Answer 34

Fibrous bands involving corpus cavernosum