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Questions and Answers
Which type of renal tumor is most commonly associated with the Tuberosic Sclerosis syndrome?
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?
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?
What is the most common cause of death in patients with collecting duct carcinoma?
Which type of renal tumor is typically characterized by a peri-nuclear halo (white ring around the nucleus)?
Which type of renal tumor is typically characterized by a peri-nuclear halo (white ring around the nucleus)?
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A cystic version of a clear cell renal cell carcinoma is considered to be malignant and aggressive.
A cystic version of a clear cell renal cell carcinoma is considered to be malignant and aggressive.
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What are some of the common gross features of papillary renal cell carcinoma?
What are some of the common gross features of papillary renal cell carcinoma?
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What is the most common benign tumor of the kidney?
What is the most common benign tumor of the kidney?
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What is the main difference between papillary adenoma and papillary carcinoma?
What is the main difference between papillary adenoma and papillary carcinoma?
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What are the three classic clinical triad that can indicate an advanced disease in renal cell carcinoma?
What are the three classic clinical triad that can indicate an advanced disease in renal cell carcinoma?
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Which of the following is NOT a type of renal tumor?
Which of the following is NOT a type of renal tumor?
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The presence of necrosis in a renal cell carcinoma is a good prognostic sign.
The presence of necrosis in a renal cell carcinoma is a good prognostic sign.
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What is the most common location for a mixed epithelial and stromal tumor of the kidney?
What is the most common location for a mixed epithelial and stromal tumor of the kidney?
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What is the main histological feature of angiomyolipoma?
What is the main histological feature of angiomyolipoma?
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What is the most important prognostic factor for renal cell carcinoma?
What is the most important prognostic factor for renal cell carcinoma?
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What is the most important thing to remember when diagnosing a collecting duct carcinoma histologically?
What is the most important thing to remember when diagnosing a collecting duct carcinoma histologically?
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What is the main difference between a clear cell renal cell carcinoma and a chromophobe renal cell carcinoma?
What is the main difference between a clear cell renal cell carcinoma and a chromophobe renal cell carcinoma?
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Sarcomatoid change in a renal cell carcinoma is always a sign of a low-grade tumor.
Sarcomatoid change in a renal cell carcinoma is always a sign of a low-grade tumor.
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The use of grading in chromophobe renal cell carcinoma is highly recommended for prognostic purposes.
The use of grading in chromophobe renal cell carcinoma is highly recommended for prognostic purposes.
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What is the main histological feature that distinguishes oncocytoma from chromophobe renal cell carcinoma?
What is the main histological feature that distinguishes oncocytoma from chromophobe renal cell carcinoma?
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The presence of tumor in the renal pelvis is always a sign of a malignant tumor.
The presence of tumor in the renal pelvis is always a sign of a malignant tumor.
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Which of the following is NOT a common location for metastasis from a renal cell carcinoma?
Which of the following is NOT a common location for metastasis from a renal cell carcinoma?
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Why is a renal tumor that develops in the polar region of the kidney considered more dangerous?
Why is a renal tumor that develops in the polar region of the kidney considered more dangerous?
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The presence of hemorrhage in a renal tumor is a sign of malignancy.
The presence of hemorrhage in a renal tumor is a sign of malignancy.
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What is the main reason why collecting duct carcinoma is more aggressive than clear cell renal cell carcinoma?
What is the main reason why collecting duct carcinoma is more aggressive than clear cell renal cell carcinoma?
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A renal tumor that is infiltrating the outside fat is considered to be pT3
A renal tumor that is infiltrating the outside fat is considered to be pT3
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Which of the following is NOT a characteristic of collecting duct carcinoma?
Which of the following is NOT a characteristic of collecting duct carcinoma?
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What is the most common type of renal cell carcinoma?
What is the most common type of renal cell carcinoma?
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Angiomyolipoma is a type of epithelial tumor.
Angiomyolipoma is a type of epithelial tumor.
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Sarcomatoid change in a renal tumor is a common finding in chromophobe renal cell carcinoma.
Sarcomatoid change in a renal tumor is a common finding in chromophobe renal cell carcinoma.
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The presence of a scar in the center of a renal tumor is always a sign of malignancy.
The presence of a scar in the center of a renal tumor is always a sign of malignancy.
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"Italian tumor of the kidney" is the nickname used for angiomyolipoma.
"Italian tumor of the kidney" is the nickname used for angiomyolipoma.
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The ISUP system is based on the size of the tumor.
The ISUP system is based on the size of the tumor.
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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.
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.
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What is the most common type of renal tumor in the adult kidney?
What is the most common type of renal tumor in the adult kidney?
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The Fuhrman grading system is the most widely used system for grading renal cell carcinoma.
The Fuhrman grading system is the most widely used system for grading renal cell carcinoma.
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Distant metastasis is a common finding at presentation in renal cell carcinoma.
Distant metastasis is a common finding at presentation in renal cell carcinoma.
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A core biopsy is always required before surgery for renal cell carcinoma.
A core biopsy is always required before surgery for renal cell carcinoma.
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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.
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.
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A pT4 renal cell carcinoma has a high probability of survival at 15 years.
A pT4 renal cell carcinoma has a high probability of survival at 15 years.
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What is the most common location for a papillary renal cell carcinoma to develop?
What is the most common location for a papillary renal cell carcinoma to develop?
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Which of the following is NOT considered a common pattern for collecting duct carcinoma?
Which of the following is NOT considered a common pattern for collecting duct carcinoma?
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A tumor that has infiltrated the renal sinus fat but not the perirenal fat is considered a pT3 tumor.
A tumor that has infiltrated the renal sinus fat but not the perirenal fat is considered a pT3 tumor.
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What is the most common type of renal tumor that occurs in patients with the Von Hippel - Lindau syndrome?
What is the most common type of renal tumor that occurs in patients with the Von Hippel - Lindau syndrome?
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A rhabdoid cell is a type of mesenchymal cell that is commonly seen in renal tumors.
A rhabdoid cell is a type of mesenchymal cell that is commonly seen in renal tumors.
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A renal tumor that is less than 1.5 cm in size is considered to be a malignant tumor.
A renal tumor that is less than 1.5 cm in size is considered to be a malignant tumor.
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What is the main histological feature of a chromophobe renal cell carcinoma?
What is the main histological feature of a chromophobe renal cell carcinoma?
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The presence of a melanocytic protein in a renal tumor is a specific finding for a renal cell carcinoma.
The presence of a melanocytic protein in a renal tumor is a specific finding for a renal cell carcinoma.
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A tumor that is infiltrating the outside fat is considered to be a pT2 tumor.
A tumor that is infiltrating the outside fat is considered to be a pT2 tumor.
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The ISUP grading system is based on the size of the nucleoli in the nucleus of cells.
The ISUP grading system is based on the size of the nucleoli in the nucleus of cells.
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When a tumor is infiltrating the renal vein, what might be the potential complication?
When a tumor is infiltrating the renal vein, what might be the potential complication?
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A renal tumor that presents with a cystic degeneration is always considered to be benign.
A renal tumor that presents with a cystic degeneration is always considered to be benign.
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A tumor that is found in the medulla of the kidney is always a sign of a malignant tumor.
A tumor that is found in the medulla of the kidney is always a sign of a malignant tumor.
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The presence of a central scar in a renal tumor is a sign of oncocytoma.
The presence of a central scar in a renal tumor is a sign of oncocytoma.
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What is the most common type of renal mesenchymal tumor?
What is the most common type of renal mesenchymal tumor?
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Distant metastasis is a rare finding at presentation in renal cell carcinoma.
Distant metastasis is a rare finding at presentation in renal cell carcinoma.
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What is the main histological feature that distinguishes a clear cell renal cell carcinoma from a chromophobe renal cell carcinoma?
What is the main histological feature that distinguishes a clear cell renal cell carcinoma from a chromophobe renal cell carcinoma?
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The Fuhrman grading system is still widely used for grading renal cell carcinoma.
The Fuhrman grading system is still widely used for grading renal cell carcinoma.
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Sarcomatoid change is associated with a higher grade tumor and a poorer prognosis.
Sarcomatoid change is associated with a higher grade tumor and a poorer prognosis.
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What is the main histological feature that distinguishes an oncocytoma from other renal tumors?
What is the main histological feature that distinguishes an oncocytoma from other renal tumors?
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A renal tumor that is infiltrating the outside fat is considered to be a pT2 tumor.
A renal tumor that is infiltrating the outside fat is considered to be a pT2 tumor.
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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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Description
This quiz covers the epidemiology and classification of kidney tumors, including the most common types and their origins. Dive into the details of renal cell carcinoma and the latest WHO classification updates. Understand the statistics related to kidney tumors and their impact on male and female cancer rates.
