Tumors of the Kidney & Urinary Tract Flashcards Preview

CVPR: Renal > Tumors of the Kidney & Urinary Tract > Flashcards

Flashcards in Tumors of the Kidney & Urinary Tract Deck (14)
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1

Common benign tumors of the kidney

  • renal papillary adenoma
  • renal fibroma or hamartoma
  • angiomyolipoma
  • oncocytoma
  • metanephric adenoma

2

Characteristics of renal paillary adenoma

  1. Well circumscribed nodules within the cortex, small
  2. 7 – 22 % at autopsy
  3. Surgically removed since they are considered “early cancers.”

3

Characteristics of renal fibroma or hamartoma

  • Renomedullary Interstitial Cell Tumor
  • Fibrous, less than 1 cm, within pyramids
  • no malignant tendency

4

Characteristics of angiomyolipoma


  • Vessels, smooth muscle and fat 

  • 25 -50% in patients with tuberous sclerosis.
     

5

Characteristics of oncocytoma

  • Eosinophilic epithelial cells, numerous mitochondria
  • 5 – 15% of all renal neoplasms.
  • Some cases are most common within family groups.

6

Clear cell carcinoma: incidence, clinical, imaging

  • Incidence: most common; male > female
  • Clinical:
    • Hematuria
    • Arises @ renal cortex ==> invade the renal vein + can extend into the inferior vena cava 
    • metastases: Regional lymph nodes + often as multiple nodules in the lungs.
  • Imaging:
    • Ball-like mass of renal cortex; 
    • Engorged, tumor-filled renal vein with extension to inferior vena cava.
    • Look for metastatic disease. 

7

Clear cell carcinoma: pathology

  • Gross: single tumor (multifocal and bilateral in Von Hippel-Lindau disease),
    •  spherical, yellowish gray mass, patchy
  • Histology:
    • cell types: clear, granular, and spindle.
    • most = clear + granula
    • Spindle cell types or sarcomas tend to grow and spread more quickly than the other kinds of RCCs. 

8

Clear cell carcinoma: genetics

  • VHL gene: both familial and sporadic tumors
    • lost or mutated
  • loss of sequences @ short arm chromosome 3

9

clear cell carcinoma: staging/grade & prognosis

  • Grading = Fuhrman's criteria (1-4)
    • 1-2 = better survival vs. 3-4
  • 45% 5-yr survival 
    • higher w/out metastasis and lower w/renal vein invations

10

Papillary carcinoma (Chromophillic): incidence, pathology, genetics, prognosis

  • Incidence: Represent 10% to 15% of renal cancers.
  • Pathology:
    • Gross: Unlike clear cell RCCs, papillary carcinomas are frequently multifocal.
    • Histology: Papillary growth pattern.
  • Genetics: Occurs in both familial and sporadic forms. Not associated with 3p deletions.
    • sporadic: trisomies 7, 16, and 17 and loss of Y 
    • familial: trisomy 7 (MET locus = protooncogene)
  • Prognosis: Better than clear cell RCC

11

Chromophobe renal carcinoma: incidence, pathology, genetics, prognosis

  • Incidence:  Represents 5% of renal cell cancers
  • Pathology:  prominent cell membranes and pale eosinophilic cytoplasm  + halo around the nucleus
  • Genetics: multiple chromosome losses and extreme hypodiploidy. 
  • Prognosis:  Excellent compared with that of the clear cell and papillary cancers; similar to oncocytomas.

12

Collecting duct carcinoma: incidence, pathology, genetics, prognosis

  • Incidence:  Represents approximately 1% or less 
  • Pathology:  Nests of malignant cells enmeshed within a prominent fibrotic stroma, typically in a medullary location.
  • Genetics: chromosomal losses/deletions; no distinct pattern
  • Prognosis: Associated with aggressive behavior and poor prognosis. 

13

Types of familial RCC

  • Von Hippel-Lindau (VHL) syndrome
    • gene implicated in both familial and sporadic
  • Hereditary papillary carcinoma
    • autosomal-dominant form
    • bilateral tumors w/papillary historlogy
    • MET protooncogene

14

TNM staging system

  • T=tumor size, N=lymph nodes, M=metastasis
  • Stage 1: small (<7cm), limited to kidney
  • Stage 2: >7cm, limited to kidney
  • Stage 3:
    • any size + spread to lymph node + no metastasis
    • spread into fatty/tissue or large veins + no lymph node spread + no metastasis
  • Stage 4: distant metastasis