Renal Neoplasia Flashcards Preview

Renal Week 3 > Renal Neoplasia > Flashcards

Flashcards in Renal Neoplasia Deck (41):
1

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

2

*Oncocytoma*

3

What are the 3 types of renal cell carcinoma?

• Clear

• Papillary

• Chromophobe

4

*Wilms Tumor*

5

*Transitional/Urothelial Carcinoma*

6

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

KEY FEATURES:
• Tumor is well circumscribed with a CENTRAL SCAR

 

Tumor may appear on CT as shown here

7

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

 

***NOTABLY no PLEOMORPHISM***
•uniform small, round and central nuclei, Evenly dispersed chromatin
 

 

8

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%)

9

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

10

What is shown here?

• key features?

Oncocytoma

Key Features:

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

• UNIFORM, not much pleomorphism

• smooth cell borders

11

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

12

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

13

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

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

 

Risk Factors:
• SMOKING
• Cadmium

• HTN, Diabetes, DIALYSIS

 

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

 

3 Types:

• Clear, Papillary, and Chromophobe

14

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

Mutation:
• SPORADIC most commonly

 

FAMILIAL Form:
• 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

15

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.

16

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

 

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

17

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

 

18

what is the whit arrow pointing to?

 

• Renal Carcinoma traveling into the renal vein

19

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

20

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

21

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

22

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

23

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

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

24

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

25

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

26

What is shown here?

Normal Uroepithelium - notice transitional epithelium up top

27

What is shown here?

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

28

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

29

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

 

30

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

31

Wilms Tumor (MUST KNOW)
• Epidemiology
• Prognosis
 • DISTINCTIVE GENE MUTATIONS

•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

32

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

p53, this is a BAD prognostic indicator as usual

33

What syndrome that causes Hemihypertrophy is associated with Wilms Tumor?

Beckwith-Wiedemann

34

What is shown here?
• Key features?

Wilms Tumor - appears grossly as lobulated tan and white mass

35

What is Wilms Tumor also known as?

Nephroblastoma

36

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.

37

What is seen here?
.

• Focal Anaplasia within a wilms tumor

38

What is shown here?

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

39

What is seen here?

• Metastatic Cancer Crushing the glomerulus

40

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

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

41