Renal Neoplasia

Question 1

Angiomyolipoma

Answer 1

Benign, mass effect, hemorrhage, Tuberosclerosis
90% sporadic, 10% TSC (target is mTOR so tx with mTOR inhibitor everolimus)
Three cell types (adipose, thick walled vessels, SMCs)

Question 2

Oncocytoma

Answer 2

Benign
Unilateral and single- sporadic
Bilateral and multiple- TSC or Burt-Hogg-Dubé syndrome
Can get large (brown color, stellate central scar)
From intercalated cells of CD
Large cells with small nuclei and prominent nucleoli and many mitochondria

Question 3

Renal cell carcinoma (general)

Answer 3

Renal cortex
Older people, M>F
Risk: Smoke, obesity, HTN, asbestos, petrol products, metals ESRD, cysts, TSC; VHL
Triad: abdominal pain, hematuria, flank mass
IVC involvement, paraneoplasias (PTHrP), hepatic issues, amyloid, polycythemia, HTN

Question 4

Clear cell carcinoma

Answer 4

Affects poles (PCT epithelium), solitary and unilateral, invade RV and IVC
Big, yellow lipid-y
95% sporadic otherwise Ch3p del (VHL)
Clear cytoplasm in round/polygonal cells

Question 5

Papillary carcinoma

Answer 5

Multifocal and bilateral, hemorrhagic and cystic
Trisomy 7/17, linked to MET or fumarate hydrase
PCT, cuboidal/low columnar cells, low grade is MET, high is FH
Psammoma bodies

Question 6

Wilms Tumor

Answer 6

Childhood, usually solitary, present with mass, pain, hematuria, varicocoele, HTN, fever Early is called RENAL REST
10% syndromic
WAGR (WT1 del 11p13) Wilms, Aniridia, GU (hypospadia), Retardation
Looks like not fully developed kidney
Also Beckwith-Weidmann- Wilms, macroglossia, organomegaly, hemihyperplasia (WT2)
Denys-Drash: wilms, nephrotic, male pseudophermaphritidism (WT1)
Triphasic: blastema, stoma, epithelium
Anaplasia associated with poor outcome

Question 7

Bladder cancer

Answer 7

Transitional epithelium
Risk: tobacco, aromatic amines, schstosoma, phenacetin, CT, irradiation
Precursor: noninvasive papillary tumor (papillary urothelial hyperplasia- low grade OR flat noninvasive urothelial carcinoma- in situ, progressive, hight grade

Question 8

Squamous cell carcinoma

Answer 8

Chronic bladder inflammation (schistosoma, chronic UTI, stones, radiation)
Painless hematuria, dysuria, urgency, frequency, pain, LE edema, pain
Histo can see schistosoma eggs