Epidemiology and Classification of Kidney Tumors

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Questions and Answers

Which type of renal tumor is most commonly associated with the Tuberosic Sclerosis syndrome?

Angiomyolipoma

What is the most common histological feature that is present in clear cell renal cell carcinoma?

Clear (white) cells due to deposit of glycogen inside the cells

What is the most common cause of death in patients with collecting duct carcinoma?

  • Metastasis (correct)
  • Bleeding
  • Kidney failure
  • Infection

Which type of renal tumor is typically characterized by a peri-nuclear halo (white ring around the nucleus)?

<p>Chromophobe renal cell carcinoma (A)</p> Signup and view all the answers

A cystic version of a clear cell renal cell carcinoma is considered to be malignant and aggressive.

<p>False (B)</p> Signup and view all the answers

What are some of the common gross features of papillary renal cell carcinoma?

<p>Common hemorrhages and smooth borders of the tumor</p> Signup and view all the answers

What is the most common benign tumor of the kidney?

<p>Oncocytoma</p> Signup and view all the answers

What is the main difference between papillary adenoma and papillary carcinoma?

<p>Size</p> Signup and view all the answers

What are the three classic clinical triad that can indicate an advanced disease in renal cell carcinoma?

<p>Costovertebral pain, palpable mass and hematuria</p> Signup and view all the answers

Which of the following is NOT a type of renal tumor?

<p>Hepatocellular carcinoma (D)</p> Signup and view all the answers

The presence of necrosis in a renal cell carcinoma is a good prognostic sign.

<p>False (B)</p> Signup and view all the answers

What is the most common location for a mixed epithelial and stromal tumor of the kidney?

<p>Medulla</p> Signup and view all the answers

What is the main histological feature of angiomyolipoma?

<p>Proliferation of vessels, smooth muscle cells and fat</p> Signup and view all the answers

What is the most important prognostic factor for renal cell carcinoma?

<p>Stage</p> Signup and view all the answers

What is the most important thing to remember when diagnosing a collecting duct carcinoma histologically?

<p>To exclude papillary carcinoma</p> Signup and view all the answers

What is the main difference between a clear cell renal cell carcinoma and a chromophobe renal cell carcinoma?

<p>The staining characteristics of the cytoplasm</p> Signup and view all the answers

Sarcomatoid change in a renal cell carcinoma is always a sign of a low-grade tumor.

<p>False (B)</p> Signup and view all the answers

The use of grading in chromophobe renal cell carcinoma is highly recommended for prognostic purposes.

<p>False (B)</p> Signup and view all the answers

What is the main histological feature that distinguishes oncocytoma from chromophobe renal cell carcinoma?

<p>Oncocytoma does not have a malignant counterpart</p> Signup and view all the answers

The presence of tumor in the renal pelvis is always a sign of a malignant tumor.

<p>False (B)</p> Signup and view all the answers

Which of the following is NOT a common location for metastasis from a renal cell carcinoma?

<p>Pancreas (D)</p> Signup and view all the answers

Why is a renal tumor that develops in the polar region of the kidney considered more dangerous?

<p>It can more easily infiltrate sinus fat and successively nearby vessels</p> Signup and view all the answers

The presence of hemorrhage in a renal tumor is a sign of malignancy.

<p>False (B)</p> Signup and view all the answers

What is the main reason why collecting duct carcinoma is more aggressive than clear cell renal cell carcinoma?

<p>It is less common, but more people die from it</p> Signup and view all the answers

A renal tumor that is infiltrating the outside fat is considered to be pT3

<p>True (A)</p> Signup and view all the answers

Which of the following is NOT a characteristic of collecting duct carcinoma?

<p>Presence of cribriform patterns (D), Presence of intracystic papillary patterns (F)</p> Signup and view all the answers

What is the most common type of renal cell carcinoma?

<p>Clear cell RCC</p> Signup and view all the answers

Angiomyolipoma is a type of epithelial tumor.

<p>False (B)</p> Signup and view all the answers

Sarcomatoid change in a renal tumor is a common finding in chromophobe renal cell carcinoma.

<p>False (B)</p> Signup and view all the answers

The presence of a scar in the center of a renal tumor is always a sign of malignancy.

<p>False (B)</p> Signup and view all the answers

"Italian tumor of the kidney" is the nickname used for angiomyolipoma.

<p>True (A)</p> Signup and view all the answers

The ISUP system is based on the size of the tumor.

<p>False (B)</p> Signup and view all the answers

A renal tumor that is infiltrating the fat of the sinus of the kidney, without invading the perirenal fat, is considered to be a pT2 tumor.

<p>True (A)</p> Signup and view all the answers

What is the most common type of renal tumor in the adult kidney?

<p>Epithelial tumor</p> Signup and view all the answers

The Fuhrman grading system is the most widely used system for grading renal cell carcinoma.

<p>False (B)</p> Signup and view all the answers

Distant metastasis is a common finding at presentation in renal cell carcinoma.

<p>False (B)</p> Signup and view all the answers

A core biopsy is always required before surgery for renal cell carcinoma.

<p>False (B)</p> Signup and view all the answers

The TNM staging system is used to assess the size and spread of the tumor and is a critical factor in determining treatment and prognosis.

<p>True (A)</p> Signup and view all the answers

A pT4 renal cell carcinoma has a high probability of survival at 15 years.

<p>False (B)</p> Signup and view all the answers

What is the most common location for a papillary renal cell carcinoma to develop?

<p>Upper pole of the kidney</p> Signup and view all the answers

Which of the following is NOT considered a common pattern for collecting duct carcinoma?

<p>Sieve-like (D), Cribriform (G)</p> Signup and view all the answers

A tumor that has infiltrated the renal sinus fat but not the perirenal fat is considered a pT3 tumor.

<p>True (A)</p> Signup and view all the answers

What is the most common type of renal tumor that occurs in patients with the Von Hippel - Lindau syndrome?

<p>Collecting duct carcinoma</p> Signup and view all the answers

A rhabdoid cell is a type of mesenchymal cell that is commonly seen in renal tumors.

<p>False (B)</p> Signup and view all the answers

A renal tumor that is less than 1.5 cm in size is considered to be a malignant tumor.

<p>False (B)</p> Signup and view all the answers

What is the main histological feature of a chromophobe renal cell carcinoma?

<p>Eosinophilic cells with a peri-nuclear halo</p> Signup and view all the answers

The presence of a melanocytic protein in a renal tumor is a specific finding for a renal cell carcinoma.

<p>False (B)</p> Signup and view all the answers

A tumor that is infiltrating the outside fat is considered to be a pT2 tumor.

<p>False (B)</p> Signup and view all the answers

The ISUP grading system is based on the size of the nucleoli in the nucleus of cells.

<p>True (A)</p> Signup and view all the answers

When a tumor is infiltrating the renal vein, what might be the potential complication?

<p>Embolic disease of the lung</p> Signup and view all the answers

A renal tumor that presents with a cystic degeneration is always considered to be benign.

<p>False (B)</p> Signup and view all the answers

A tumor that is found in the medulla of the kidney is always a sign of a malignant tumor.

<p>False (B)</p> Signup and view all the answers

The presence of a central scar in a renal tumor is a sign of oncocytoma.

<p>True (A)</p> Signup and view all the answers

What is the most common type of renal mesenchymal tumor?

<p>Angiomyolipoma</p> Signup and view all the answers

Distant metastasis is a rare finding at presentation in renal cell carcinoma.

<p>True (A)</p> Signup and view all the answers

What is the main histological feature that distinguishes a clear cell renal cell carcinoma from a chromophobe renal cell carcinoma?

<p>Clear cells due to glycogen</p> Signup and view all the answers

The Fuhrman grading system is still widely used for grading renal cell carcinoma.

<p>False (B)</p> Signup and view all the answers

Sarcomatoid change is associated with a higher grade tumor and a poorer prognosis.

<p>True (A)</p> Signup and view all the answers

What is the main histological feature that distinguishes an oncocytoma from other renal tumors?

<p>Eosinophilic cells in tubules or small nests</p> Signup and view all the answers

A renal tumor that is infiltrating the outside fat is considered to be a pT2 tumor.

<p>False (B)</p> Signup and view all the answers

Flashcards

Renal cell carcinoma (RCC)

A type of kidney tumor that originates from the epithelial cells of the renal tubules.

Von Hippel-Lindau (VHL) syndrome

A genetic syndrome associated with an increased risk of developing RCC and other tumors.

Clear cell RCC

The most common type of RCC, characterized by clear-appearing cells due to glycogen accumulation.

pT Stage

An indicator of tumor size and extent of invasion.

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ISUP grading system

A histological grading system for RCC that categorizes the tumor based on the presence and size of nucleoli in the tumor cells.

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Sarcomatoid differentiation

A change in the appearance of tumor cells, where they lose their epithelial characteristics and resemble mesenchymal cells.

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Necrosis

A feature seen in some RCCs where cell degeneration and tissue death occur within the tumor.

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Oncocytoma

A benign tumor of the kidney that originates from collecting duct cells and is characterized by a distinctive eosinophilic appearance.

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Chromophobe RCC

A type of RCC characterized by cells with a distinctive peri-nuclear halo (white ring around the nucleus).

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Mixed epithelial and stromal tumors (MESTs)

Kidney tumors that have both epithelial and mesenchymal components.

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Angiomyolipoma

A common mesenchymal tumor of the kidney consisting of vessels, smooth muscle cells, and fat.

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Epithelioid Angiomyolipoma

A variant of Angiomyolipoma with epithelioid cell features, which could potentially be malignant.

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Papillary RCC

A type of RCC characterized by papillary structures visible histologically.

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Papillary adenoma

A benign tumor of the kidney with papillary features.

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TNM staging system

Tumor staging system based on size and extent of invasion.

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Peri-renal fat

The fat surrounding the kidney.

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Core biopsy

An invasive procedure where a small sample of tissue is taken from the kidney for diagnosis.

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Radical nephrectomy

A procedure where the entire kidney is removed.

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Multifocality

The presence of multiple tumor foci within the kidney.

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Metastasis

The spread of cancer cells to distant sites in the body.

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Histological features

The microscopic examination of tumor cells to determine their characteristics and differentiate them from normal cells.

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Spindle cells

Cells with a spindle-like shape, often associated with mesenchymal tumors.

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Rhabdoid cells

A type of cell with a specific differentiation, resembling skeletal muscle cells.

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Eosinophilic cells

A type of cell with a cytoplasm that stains darkly and is often present in tumors with a high mitochondrial content.

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Clear cells

A type of cell with a cytoplasm that appears clear due to the presence of glycogen or fat.

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Peri-nuclear halo

A type of cell with a clear halo around the nucleus, often seen in chromophobe RCC.

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Nucleoli

Large, prominent structures within the nucleus of some tumor cells.

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Papilla

A small, solid protrusion located within a larger mass or structure.

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Umbrella cells

A type of cell lining the renal pelvis, characterized by a distinctive umbrella-shaped appearance.

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Polygonal cells

Cells with a distinct, polygonal shape.

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Sawtooth appearance

A feature seen in some tumors, characterized by a sawtooth-like appearance of the tubules.

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Study Notes

Epidemiology of Kidney Tumors

  • Approximately 50,000 new cases of kidney tumors per year
  • Represents 5% of all male cancers, 3% of female cancers
  • 4% of all cancer deaths are due to kidney tumors

Kidney Tumor Classification

  • Primarily epithelial origin (over 95% of cases)
  • Other less common, non-epithelial variants
  • 2022 WHO classification updated from 2016
  • Includes clear cell tumors, papillary tumors, other rare/aggressive tumors, molecularly defined tumors
  • Variants like medullary carcinoma now classified as molecularly defined due to specific mutations

Renal Cell Carcinoma (RCC)

  • Most common kidney tumor (90%)
  • Epithelial origin, usually in older adults, males more often
  • Mostly somatic/sporadic, but some cases have mutations in the VHL gene (associated with Von Hippel-Lindau syndrome) and chromosomal 3 rearrangements/deletions
  • Symptoms are often non-specific (fever, weakness, weight loss), but hematuria (often intermittent) is common
  • Metastasis to other organs (lungs, bones, lymph nodes, brain) is frequent

Clear Cell RCC

  • Most aggressive kidney tumors (80-85%)
  • Spherical mass, bright yellow/gray/white appearance, often with hemorrhages/necrosis.
  • Commonly affects upper pole of kidney
  • Typically invades perirenal fat, sinus fat, and renal vein

Grading System

  • Fuhrman grading system (outdated) used to evaluate nuclei size and shape
  • Current ISUP system is based on the presence and size of nucleoli
  • Grade 1: no visible nucleoli, small nuclei
  • Grade 2 and 3: increasing nucleoli
  • Grade 4: polymorphic cells, bizarre nuclei
  • Higher grades generally indicate worse prognosis (50% survival in 10 years for grade 4)

Papillary Adenocarcinoma

  • Second most common kidney tumor
  • Papillary structures present under a microscope
  • Often large size with characteristic hemorrhages
  • Well-circumscribed borders (no infiltration)
  • Less aggressive than many others, and good prognosis often

Chromophobe Renal Cell Carcinoma (RCC)

  • Less aggressive than clear cell RCC
  • Cells have a unique eosinophilic (pink) appearance due to abundant mitochondria
  • Often solitary
  • Usually found in the renal cortex
  • Rare metastases

Oncocytoma

  • Most common benign kidney tumor
  • Smooth borders, eosinophilic cells, central scar (often visible on imaging)
  • Excellent prognosis, no malignant potential

Mixed Epithelial-Stromal Tumors

  • Transition tumors showing both epithelial and mesenchymal features
  • Usually benign, but case of potential recurrence exists
  • Many cysts present histologically, often showing spindle cell proliferation

Angiomyolipoma

  • Most common mesenchymal renal tumor
  • Contains vessels, smooth muscle cells, and fat (adipocytes)
  • Usually benign (except when epithelioid)
  • Can mimic other tumors with various histological features, and sometimes requires confirmation based on the presence of a particular melanocytic protein

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