Renal Neoplasia Flashcards Preview

Renal Week 3 > Renal Neoplasia > Flashcards

Flashcards in Renal Neoplasia Deck (41):

T or F: this kidney has no associated pathology.


True, the presence of a simple cyst is no big deal

This is what the inside of a normal kidney looks like - notice clearly demarcated medullary and cortical boundaries




What are the 3 types of renal cell carcinoma?

• Clear

• Papillary

• Chromophobe


*Wilms Tumor*


*Transitional/Urothelial Carcinoma*


Name this tumor.
• Cell Types
• Associated Mutations
• Key Features
• Epidemiology

Oncocytoma - make up LESS THAN 10% of renal tumors

Comes from the INTERCHELATED CELLS of the collecting duct, males are typically affected


Mutations in chromosome 1, 14, and Y are common

• Tumor is well circumscribed with a CENTRAL SCAR


Tumor may appear on CT as shown here


What are the KEY features on this H and E taken from a kidney tumor? Tumor Type? 

uniform round cells with abundant, intensely eosinophilic and granular cytoplasm = MITOCHONDRIA


•uniform small, round and central nuclei, Evenly dispersed chromatin



What is the Number 1 most common renal cancer?
• how does it commonly come to attention?
• What are the other renal cancers from most to least common?

Renal Clear Cell Carcinoma = 70% of renal Cancers

Often present in all types of cancer with HEMATURIA

Others Below are far less common.

–Papillary carcinoma (10%)

–Chromophobe carcinoma (5%)

–Oncocytoma (5%)

–Others (urothelial, squamous, 10%)


What is unique about the location of urothelial and renal pelvic carcinomas?

These are located in the MEDULLARY/Pelvic area whereas other Renal Cancers present at the POLES


What is shown here?

• key features?


Key Features:

Oncocytic = pink and grainy with sheets of pink and grainy PINK cells

• UNIFORM, not much pleomorphism

• smooth cell borders


How does a Renal Cell tumor present grossly?

Hemorrhage and Necrosis are common - hemorrhage most likely related to highly vascularized tissue arising from VHF mutations leading to HIF-1alpha and ultimately VEGF release


Where does Renal Cell Cancer (Clear Cell Carcinoma, Papillary Carcinoma, and Chromophore) most often spread?

Most common Sides:
1. Stays behind the Retroperitoneum under Renal (GEROTAs) Fascia

2. Seeds into Renal Vein => Inferior Vena Cava => Left Atria --> spread throughout the vascular system


For ALL Renal Cell Carcinomas.
• Cells that they're derived from?
• Risk Factors?
• Typical Patient that presents?
• Name the 3 types.

• Renal TUBULAR cells in the CORTEX, contrast this with the collecting duct cells in benign tumors (oncocytoma)


Risk Factors:
• Cadmium

• HTN, Diabetes, DIALYSIS


Typical Pt:
Male 60-70 y.o. - probably will have Hematuria


3 Types:

• Clear, Papillary, and Chromophobe


How does the most common type of Renal Cell Carcinoma Arise? • what mutation is associated with this disorder?

Most common type = CLEAR CELL Renal Carcinoma

• SPORADIC most commonly


• Less common but importantly associated with Von Hippel Lindau (VHF) mutation. VHL typically suppresses HIF-1alpha which is a transcription factor for VEGF.


VEGF production promoates vascularization allowing the tumor to proliferate quickly


What is the Best Prognostic Indicator of Clear Cell Renal Carcinoma?

• 2nd best?

Best Prognostic Indicator:
STAGE - i.e. where has the cancer invaded


2nd Best:
Fuhrman Grading - looks at Nuclear size etc.


What type of cancer is seen here?
• KEY Features?
• what would you expect to see on microscopic examination?

Renal Clear Cell Carcinoma

• Key Features
• solitary, well defined, polar
• YELLOW, cysts , necrosis, HEMORRHAGE


• Clear LIPID FILLED cells with CHICKEN WIRE vessel formation found between the cells


What is the general principle behind Fuhrman grading?
• Prognositic Significance?
• can you differentiate a stage 1 from a stage 4?

• Fuhrman grading is an assement of the cellular appearance of the cancer, not of its invasion into other tissues

• Really only has prognostic significance in Clear Cell Carcinoma - but has very close correlation


• Stage 1 (top left) cells have small, non-aggressive looking nuclei
• Stage 4 (bottom right) have hyperchormic nuclei and are pleomorphic



what is the whit arrow pointing to?


• Renal Carcinoma traveling into the renal vein


What distinguishes papillary renal cell carcinoma from other tumors?
• size cuff-offs?
• Gene alterations common in this cancer?

Papillary Carcinoma = BILATERAL and MULTIFOCAL
• Size greater than 5mm differentiates this tumor from papillary adenoma


Papilary Carcinoma is associated with mutations in the MET pro-oncogene


What tumor type is shown here?

* key features?

Papillary Adenocarcinoma

• MULTIFOCAL, Granular appearance is key

hemorrhage and necrosis may also be seen here but is less common than renal cell carcinoma


What is shown here?

• What are the KEY features?

Well-circumscribed, often with distinct fibrous capsule

PAPILLARY - little finger like projections in the cellular arrangment

•Have papillary FIBROVASCULAR CORES (seen in center)

Foamy macrophages (clear cells) in papillary cores and intracellular hemosiderin are sensitive/specific features


Chromophobe Renal Carcinoma
• Derived from what cell type
• Prognosis?
• Appears similar to what other tumor? DDx?

Intercalated Cells of the Collecting Ducts

Good Prognosis

• DDx between chromophobe renal carcinoma and oncocytoma made on basis of Hale's Iron Colloidal Stain


What are some key features of this chromophobe renal cell carcinoma?

Lacks a central scar BUT is well circumscribed with a brown hue


What is shown in this image?
• what are some KEY features?

Renal Cell CHROMOPHOBE carcinoma

Clearing (HALO) around the nuclei = another key feature to look for in addition to Hale's colloidal for differentiating this from oncomocytoma

Distinct cell membranes


This specimen taken from the kidney was positive for Hale's colloidal stain. What kind of cancer is it?

Chomophobe Carcinoma = Hale's Colloidal positive as seen here

Oncocytoma is Hale's Colloidal Negative


What is shown here?

Normal Uroepithelium - notice transitional epithelium up top


What is shown here?

Papillary protrusion from the Uroepithelium with a fibrovascular core - indicative of cancer


What is abnormal about this uroepithelium?
• what could you still diagnosis even if the cells under the top layer could not be visualized?

• There is some sloughing off of the transitional epithelium


• Even without these underlying cells it would be Urothelial carcinoma in situ


What are some key features of this tumor?
• what type of cells?

Transitional cells urothelial carcinoma

KEY features:
• Notice Granular Appearance
• Pay attention to location these are located in the pelvis NOT the medulla



Would this renal Urothelial Carcinoma be considered a high or low grade tumor?

HIGH GRADE - you can see this from the high N/C ratio and multiple mitosis


**Shown below is a low grade urothelial tumor


Wilms Tumor (MUST KNOW)
• Epidemiology
• Prognosis

•An embryonal (*just means we see immature elements) pediatric tumor of the kidney

•The peak incidence of Wilms tumor is between the second and fifth year of life (95% of kidney cancer in children).

•Post therapy 5 yr survival 90%

•Defects in WT1 gene chromosome 11


What type of gene defects might you suspect if you see anaplasia of Wilms Tumor?

p53, this is a BAD prognostic indicator as usual


What syndrome that causes Hemihypertrophy is associated with Wilms Tumor?



What is shown here?
• Key features?

Wilms Tumor - appears grossly as lobulated tan and white mass


What is Wilms Tumor also known as?



What are the key histologic features seen here?

• diagnosis?

3 key elements:

• Top/left/middle – EPITHELIAL component - glandular appearance

• Filling in the most space -  BLASTEMAL – small round blue/purple cells

• Clearish part - STROMAL component – can be any mesenchymal compoenent – muscle etc.


What is seen here?

• Focal Anaplasia within a wilms tumor


What is shown here?

Metastatisis to kidneys multiple nodules found bilaterally indicates that this is not a primary tumor


What is seen here?

• Metastatic Cancer Crushing the glomerulus


What is shown here?
• key features?
• gene associations?

Fat, Vessel, Muscle =>  angiomyolipoma => Tubular Sclerosis TSC1, TSC2 code for hammerin and tuberin