Renal Tumors - Iczkowski

Question 1

What are the four different malignant renal cell carcinomas?

What are the two benign renal cell carcinomas?

Answer 1

Clear Cell, Papillary, Chromophore, Collecting Duct (also clear cell tubulopapillary mash-up?)

Renal Oncocytoma, Angiomyolipoma

Question 2

Which malignant renal cell carcinomas have the best prognosis?

Answer 2

Chromophore
Papillary
Clear cell
Collecting Duct

Question 3

Which malignant renal cell carcinomas are the most prevalent?

Answer 3

Clear Cell (83%)
Papillary (11%)
Chromophore (4%)
Collecting Duct (1%)

Question 4

What does clear cell renal carcinoma look like on histology?

Answer 4

pink stroma
large clear cells (look like fat cells)
Necrosis may be present (worse outcomes)

Clear cells accumulate glycogen and lipids leading to their “clear” appearance on histology

Question 5

What does papillary renal cell carcinoma look like on histology?

Answer 5

Papilla with blood vessels and macrophages surrounded by non-polarized nuclei

Question 6

What are the two types of papillary renal cell carcinoma?

Answer 6

Type 1: thin papillae, better outcome

Type 2: thick papillae, worse outcome

Question 7

What does a chromophobe renal cell carcinoma look like on histology?

On gross histology?

Answer 7

Cells appear to have a halo around a wrinkled nucleus
Cells may be binucleate

Tumor is well circumscribed, may have hemorrhages

Question 8

What does a collecting duct renal cell carcinoma look like on histology?

Answer 8

“Irregular aggregates of tumor cells”

No idea what that means

Question 9

What does a medullary renal cell carcinoma look like on histology?

Answer 9

Prominent nuclei

cell with indistinct borders

Question 10

What is the patient profile of someone with medullary renal cell carcinoma?

Answer 10

African or Mediterranean descent
Sickle Cell disease or trait
Cancer presents at advanced stage

Question 11

How does acquired cystic disease affect renal cell carcinoma?

Answer 11

Increases the risk of getting renal cell carcinoma 100x

Question 12

What does acquired cystic disease look like on histology?

Answer 12

Lots of vacuoles

oxalate crystals

Question 13

What does clear cell tubulopapillary renal carcinoma look like on histology?

Answer 13

papillas surrounded by cuboidal cells

apically polarized nuclei

Question 14

What is clear cell tubulopapillary renal carcinoma associated with?

Answer 14

3p mutation

End-stage kidney disease

Question 15

What is the biggest determinant of survival in renal cell carcinoma?

Answer 15

whether the cancer is confined to the kidney or has spread to the perinephric fat/renal vein

Question 16

What are the macroscopic stages for renal cell carcinoma?

Answer 16

T1- tumor is less than 7 cm, confined to kidney
T2- tumor is more than 7 cm, confined to kidney
T3a- tumor has spread to the perinephric fat
T3b- tumor has spread into vena cava

Question 17

What are the histologic stages for renal cell carcinoma?

Answer 17

Grade 1- nuclei are tiny dots
Grade 2- nucleoli are small, but can be seen on high power
Grade 3- nucleoli can be seen at high power
Grade 4- “bizarre cells”

Question 18

What does an oncocytoma look like grossly? On histology?

Answer 18

Central scar tissue

Clumps of tumor cells with edematous stroma

Question 19

What does an angiomyolipoma look like grossly? On histology?

Answer 19

well circumscribed, bloody, and fatty

Vessels, fats, and smooth muscle cells in close proximity, all look normal; will stain positive for melanin

Question 20

What is Wilms tumor?

Answer 20

A rare blastoma cancer seen in the pediatric patients

mesoderm derived

Question 21

What are the layers of the bladder wall?

Answer 21

Transitional epithelium
Tunica propria
Muscle
Adventitia
Blood vessels

Question 22

What are four non-neoplastic bladder growths that can be mistaken for cancer?

Answer 22

Cystitis cystica/glandularis
polypoid cystitis
papillary cystitis
nephrogenic adenoma

Question 23

What does cystitis cystica/glandularis look like histologically?

Answer 23

gland-like tissue, secreting mucin

Question 24

What causes polypoid or papillary cystitis?

Answer 24

Irritation from a stone, catheter, etc

Question 25

What does polypoid cystitis look like histologically and grossly?

Answer 25

grossly- it has blunt projections

histologically- it has normal thickness epithelium

Question 26

What does papillary cystitis look like histologically and grossly?

Answer 26

grossly- projections are thin, wispy

histologically- it has thickened epithelium

Question 27

What is associated with nephrogenic adenoma?

Answer 27

Male (2:1 more common)
GU surgery (61%)
chronic infection/cystitis

Question 28

What does nephrogenic adenoma look like on histology?

Answer 28

proliferation of tubules

inflammatory cells

Question 29

What are the grades of flat bladder cancers?

Answer 29

(In increasing grade)
Reactive
Indeterminate 
Dysplasia 
Carcinoma in situ

Question 30

What are the grades of papillary bladder cancers?

Answer 30

(In increasing grade)
Papilloma
Papillary neoplasm, uncertain potential
Low-grade urothelial cancer
High-grade urothelial cancer

Question 31

What are the stages of the TNM system in papillary bladder cancers? How do they determine treatment?

Answer 31

pTIS- Tumor in situ, confined to the urothelium
pTa- Low grade papillary tumor
pT1- Tumor extends into lamina propia
PT2- Tumor extends into the muscularis propria
PT3- Tumor extends into perivesical fat
pT4- Tumors past perivesical fat

pT1 and below can use conservative treatment; anything above requires a cystectomy

Question 32

What histological features do each papillary bladder cancer have?

Answer 32

papilloma- fibrovascular core, urothelium normal thickness, polarity, less than 1/2 cm

Low grade urothelial cancer- hyperplastic urothelium, loss of polarity but still parallel nuclei

High grade urothelial cancer- hyperplastic urothelium, huge nuclei, jumbled polarity

Question 33

What features are reported on a transurethral resection of bladder tumor?

Answer 33

• tumor invasion of lamina propia
• muscularis propria presence in biopsy
  - if present, tumor invasion
• percent of specimen tumor
• Necrosis

Question 34

How do reactive atypia, dysplasia, and carcinoma in situ relate to risk of cancer?

Answer 34

60% of carcinoma in situ will become cancer
15% of dysplasias will become cancer
Reactive atypia has no increased risk of cancer

Question 35

What does carcinoma in situ look like histologically?

Answer 35

Large nuclei
dyscohesive cells (loss of umbrella cells)
chromatin granularity