Tumors of the Kidney & Urinary Tract Flashcards Preview

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Flashcards in Tumors of the Kidney & Urinary Tract Deck (19):

What's this?

Papillary adenoma

Benign tumor that grows very little.


Explain Fuhrman Nuclear Grades

Fuhrman Nuclear Grades is predictive of mortality rates and only looks at the nuclei.

The larger and more irregular the nuclei, the worse the prognosis.


Which Fuhrman grades are depicted here?

Grades 1 and 2.

Grade 1 is top right and grade 2 is bottom left.

Pathology will typically only mention the grade 2 as it has worse prognosis.


What Fuhrman grade is depicted here?

Grade 3


What Fuhrman grade is depicted here?

Grade 4.

Large nuclei with irregular shape and all kind of different.


What Fuhrman grade is depicted here?

Grade 4 with sarcomatoid features


What is the most common type of renal cell carcinoma?

Clear cell


What is the 2nd most common type of renal cell carcinoma?



What's this?

Chromophobe renal cell carcinoma (rare, 5% of cases, low malignant potential)


Chromophobe renal cell carcinoma is often confused with oncocytomas. How can you tell the difference?

Do an iron stain.

A = chromophobe

B = chromophobe with iron stain

C = oncocytoma

D = oncocytoma with iron stain


Explain the genetics of clear cell renal cell carcinomas.

Both sporadic (95%) and familial (4%) renal cell carcinoma is caused by abnormalities in the VHL (Von Hippel-Lindau) gene (3p25.3) tumor suppressor gene.

It can be caused by a deletion, translocation, somatic mutation, or even hypermethylation.

In familial, all cells have this problem so there are usually hemangioblastomas of the cerebellum and retina, bilateral renal cysts, and multiple RCCs.

In sporadic, there is typically just one RCC.



Explain the genetics of papillary renal cell carcinoma

These are not associated with the VHL (3p) changes.

These are most commonly caused by these cytogenetic abnormalities:

Familial: Trisomy 7, mutated activated MET

Sporadic: Trisomy 7, 16, 17, or loss of Y. Mutated, activated MET


Locus on chromosome 7 (MET locus) protooncogene:

Tyrosine kinase receptor for hepatocyte growth factor

Mutated in a proportion of the sporadic cases of PC


What is an important difference between sporadic and hereditary renal cell carcinomas?



What is the most important risk factor for Urothelial Carcinomas?


Other risk factors include chronic infections, solvents, and cyclophosphamide


Are urothelial carcinomas more common in males or females?

Males. 3:1

Usually over 50 y/o


Where can urothelial carcinomas occur?

Anywhere in the urinary tract (from renal pelvis to urethra)


What's the prognosis of urothelial carcinomas?

Depends on stage.


What is being shown here?

Left: Dysplasia urothelial mucosa

Right: Carcinoma in situ of urothelial mucosa


Which immunostain is diagnostic for urothelial carcinoma in situ?


It will show full thickness stain.