Kidney Benign Tumours Overview
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Kidney Benign Tumours Overview

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Questions and Answers

What is the main type of tissue from which renal tubular adenoma arises?

  • Muscle tissue
  • Glandular tissue (correct)
  • Nervous tissue
  • Connective tissue

    • What is a significant characteristic of renal tubular adenoma's appearance under microscopy?

  • Nodular growth structure
  • Papillary/tubular pattern (correct)
  • Solid mass formation
  • Cystic spaces

    • What indicates that renal tubular adenoma can progress to carcinoma?

  • Presence of necrosis
  • Size ≥ 1.5 cm or high grade (correct)
  • Location in the medulla
  • Presence of a fibrous capsule

    • Which feature primarily distinguishes oncocytoma from renal cell carcinoma (RCC)?

    <p>Formation of a pseudo-capsule</p> Signup and view all the answers

    What is the main microscopic feature of oncocytes found in oncocytoma?

    <p>Abundant eosinophilic mitochondria</p> Signup and view all the answers

    What is a rare form of chronic granulomatous cystitis?

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

    Which type of lesions are associated with inflammation of the bladder due to UTIs?

    <p>Tumour-like lesions</p> Signup and view all the answers

    What are Michaelis-Gutmann bodies indicative of?

    <p>Defective macrophages</p> Signup and view all the answers

    What changes occur in the transitional epithelium due to chronic cystitis?

    <p>Cystic formation</p> Signup and view all the answers

    Which characteristic is most commonly associated with malakoplakia?

    <p>Soft plaque formation</p> Signup and view all the answers

    What is a common cause leading to glandular changes in the bladder?

    <p>Repeated urinary tract infections</p> Signup and view all the answers

    Chronic cystitis can develop into which of the following?

    <p>Cystitis glandularis cystica</p> Signup and view all the answers

    What kind of deposition occurs in defective macrophages characterized by malakoplakia?

    <p>Calcium and iron</p> Signup and view all the answers

    What is the primary characteristic of Xanthogranulomatous pyelonephritis?

    <p>Presence of lipid-laden macrophages</p> Signup and view all the answers

    Which of the following describes an Angiomyolipoma?

    <p>A benign neoplasm characterized by disorganized tissue with blood vessels, smooth muscle, and fat</p> Signup and view all the answers

    From where do the mutations leading to Tuberous Sclerosis arise?

    <p>TSC1 and TSC2 gene mutations</p> Signup and view all the answers

    What is often a common finding in patients with small renal papillary tumors?

    <p>Asymptomatic or incidental findings</p> Signup and view all the answers

    What does 'macro' refer to in the context of tumor pathology?

    <p>The gross appearance of tumors</p> Signup and view all the answers

    What type of tissue is characterized by the presence of aggregates of foamy macrophages?

    <p>Granulomatous tissue in Xanthogranulomatous pyelonephritis</p> Signup and view all the answers

    Which statement is true about the structural characteristics of Xanthogranulomatous pyelonephritis?

    <p>It results in an enlarged kidney with yellow nodules</p> Signup and view all the answers

    What is the most common cause of sporadic Angiomyolipoma?

    <p>Tuberous sclerosis syndrome</p> Signup and view all the answers

    What can be a clinical manifestation of Tuberous Sclerosis?

    <p>Increased seizures and skin lesions</p> Signup and view all the answers

    What is the most common type of urinary tract cancer?

    <p>Urothelial carcinoma</p> Signup and view all the answers

    Which genetic alterations are commonly associated with urothelial carcinoma?

    <p>FGFR3, p53, and HRAS mutations</p> Signup and view all the answers

    What is the typical presentation of urothelial carcinoma?

    <p>Painless hematuria</p> Signup and view all the answers

    What environmental factor is a known contributor to urothelial carcinoma?

    <p>Smoking and industrial carcinogens</p> Signup and view all the answers

    What does 'Tis' indicate in the TNM staging system for urothelial carcinoma?

    <p>In situ carcinoma</p> Signup and view all the answers

    Which stage of bladder cancer indicates invasion into the muscle layers?

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

    What is the primary etiology for squamous cell carcinoma (SCC) in the urinary tract?

    <p>Schistosomiasis leading to squamous metaplasia</p> Signup and view all the answers

    Which grade of bladder cancer is considered poorly differentiated?

    <p>Grade III</p> Signup and view all the answers

    What factor contributes to the inevitability of recurrence in bladder cancer?

    <p>Field effect due to malignant stem cells</p> Signup and view all the answers

    What is the significance of a T4 stage in the TNM classification for bladder cancer?

    <p>Invasion of adjacent organs or fixed to pelvic wall</p> Signup and view all the answers

    What type of metaplasia involves the replacement of urothelium by glandular epithelium?

    <p>Glandular metaplasia</p> Signup and view all the answers

    Which benign neoplasm is described as having an exophytic appearance with a fibrovascular core?

    <p>Urothelial papilloma</p> Signup and view all the answers

    What is the most common type of renal cell carcinoma?

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

    Which risk factor is commonly associated with renal cell carcinoma?

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

    What is a common presentation feature of transitional cell carcinoma?

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

    What is usually the first line of treatment for localized renal cell carcinoma?

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

    Which of the following describes the typical morphology of renal cell carcinoma?

    <p>Heterogeneous tumor with cystic areas</p> Signup and view all the answers

    Which paraneoplastic syndrome is commonly associated with renal cell carcinoma?

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

    What condition is characterized by multiple papillary tumors at the renal pelvis urothelium?

    <p>Transitional cell carcinoma</p> Signup and view all the answers

    What genetic abnormality is associated with Wilms tumor?

    <p>WT1 inactivation</p> Signup and view all the answers

    What is the typical prognosis for localized renal cell carcinoma post-treatment?

    <p>5-year overall survival up to 90%</p> Signup and view all the answers

    Which type of carcinoma is characterized by the presence of lipid and glycogen in renal tubular epithelium?

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

    Which of the following is a feature of inverted papilloma?

    <p>Endophytic growth pattern</p> Signup and view all the answers

    What is a common complication associated with renal cell carcinoma metastasis?

    <p>Lung metastasis</p> Signup and view all the answers

    Study Notes

    Kidney Benign Tumours

    • Xanthogranulomatous Pyelonephritis (XGP):
      • Rare form of chronic granulomatous pyelonephritis
      • Macroscopically: Enlarged kidney with yellow nodules
      • Microscopically: Aggregates of foamy macrophages, loss of functional parenchyma (medulla + cortex)
    • Angiomyolipoma:
      • Hamartoma (disorderly mixed tissue)
      • Macroscopically: Single or multiple masses
      • Microscopically: Vessels (angio-), smooth muscle (myo-), fat (lipo-)
      • Etiology: Sporadic (most common) or tuberous sclerosis (genetic syndrome)
      • Tuberous sclerosis is a multisystem hamartoma with a triad of mental retardation (MR), seizures, and skin lesions
      • Genetic basis: Mutations in TSC1 & TSC2 genes (TSG): hamartin and tuberin
    • Renal Papillary Adenoma:
      • Asymptomatic, often incidental findings
      • Macroscopically: Single or multiple nodules of ≤1cm at the cortex
      • Microscopically: Papillary/tubular pattern
      • Considered a precursor to carcinoma if size ≥1.5cm or high grade
    • Oncocytoma:
      • Difficult to distinguish from renal cell carcinoma (RCC) even with biopsy
      • Macroscopically: Dark brown, with a pseudo-capsule compressing normal parenchyma
      • Microscopically: Eosinophilic cells with abundant mitochondria (oncocytes)
      • Determined only by evidence of metastasis or aggressive infiltration into adjacent structures
    • Medullary Fibroma:
      • Within the cortex

    Urinary Tract Benign Tumours

    • Malakoplakia:
      • Rare form of chronic granulomatous cystitis
      • Macroscopically: “Soft plaque”
      • Microscopically: Michaelis-Gutmann bodies (defective macrophages with intracellular deposition of calcium and iron)
      • Most commonly found in the bladder as a result of bacterial infection
      • Pathogenesis: Macrophages partially digest bacteria, leading to glandular changes with cystic formation
      • Glandular changes: Chronic cystitis can progress to cystitis glandularis cystica with repeated UTIs

    Metaplasia

    • Replacement of urothelium by another type of epithelium.
    • Glandular metaplasia: increased risk of adenocarcinoma.
    • Squamous: schistosomiasis, urinary calculi, chronic irritation.
    • Chronic inflammation of urothelium.

    Benign neoplasms

    • Urothelial papilloma: exophytic, nipple-like projection, fibrovacular core, visible on cystoscopy.
    • Inverted Papilloma: endophytic.

    Malignant neoplasms: Kidney

    Renal cell carcinoma

    • Triad: hematuria, palpable renal mass, flank pain.

    • Left-sided varicocele.

    • Paraneoplastic syndromes: polycythemia, hypercalcemia, hypertension.

    • Metastasis: lung (MC), bone.

    • Risk factors (RF): smoking, obesity, hypertension, chronic kidney disease (CKD).

    • Sporadic: most common

    • Hereditary (5%): von Hippel-Lindau disease (VHL).

    • Pathological characteristics:

      • Macro: heterogeneous tumor with areas of hemorrhage, yellowish tissue, and cystic areas.
      • Micro:
        • Clear cell carcinoma (most common): contain lipid and glycogen in renal tubular epithelium.
        • Papillary cell carcinoma: intercalated cells of the renal tubule.
        • Chromophobe carcinoma.
        • Collecting duct carcinoma.

    • Prognosis:

      • Fuhrman grading: nuclear size.
      • TNM staging:
        • T1: tumor < 7cm, within kidney.
        • T2: tumor > 7cm, within kidney.
        • T3: tumor extends into perinephric tissues or major veins.
        • T4: tumor extends beyond Gerota's capsule.

    • Treatment:

      • Surgery
      • Growth factor inhibitors: sorafenib, bevacizumab, interferon.
      • Cytokine: immune response.
      • Targeted therapy.

    • **

    Malignant neoplasms: Urinary Tracts

    Urothelial carcinoma (TCC)

    • More common in men > 50 years old.
    • Painless hematuria.
    • Recurrent UTIs
    • Risk factors (RF): smoking, alkylating agents used in chemotherapy (cyclophosphamide), industrial carcinogens, Schistosoma haematobium infection.
    • Genetics: FGFR3, p53, HRAS.
    • Field effect: common malignant stem cell; inevitable recurrence.
    • Pathological characteristics:

      • Staging (TNM):

        • Ta: non-invasive papillary carcinoma.
        • Tis: non-invasive flat carcinoma in situ.
        • T1: invades lamina propria.
        • T2: invades muscle.
        • T3: invades perivesical fat.
        • T4: invades adjacent organs or fixed to pelvic side wall.
        • N ≥1 or M1: stage IV.

      • Grading:

        • Low grade (grade I/II): well-differentiated.
        • High grade (grade III): poorly differentiated.

    Squamous cell carcinoma (SCC)

    • 5% of urinary tract cancers.
    • Risk factor: Schistosomiasis (MC).
    • Schistosomiasis leads to squamous metaplasia, which can lead to SCC.

    Wilms tumor

    • Most common renal tumor in children (5% childhood cancers)
    • Nephrogenic cysts: of nephrogenic mesoderm (embryonic remnant).
    • Pathological characteristics:
      • Macro: very large, pale-grey tumor.
      • Micro: triphasic (blastemal, epithelial, stromal, primitive connective tissue), may contain bone.
    • Risk factors (RF):
      • Sporadic: most common
      • Genetics: suppressor gene WT1 inactivation:
        • WAGR syndrome (Wilms tumor, aniridia, genitourinary anomaly, mental retardation)
        • Denys-Drash syndrome (DDS)
        • Beckwith-Wiedemann syndrome (BWS)
    • Prognosis:
      • Staging, size, anaplasia.
      • Undifferentiated (mitosis #)
      • Loss of differentiation.
      • Hyperchromatic nuclei (high ratio)
    • Treatment:
      • Surgery.
      • Chemotherapy.
      • Radiation.
      • With treatment: 90% cure rate.

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    Description

    This quiz explores various benign tumours of the kidney, including Xanthogranulomatous Pyelonephritis, Angiomyolipoma, and Renal Papillary Adenoma. Each condition is described with its macroscopic and microscopic features, etiology, and genetic implications. Test your knowledge on the characteristics and differences of these kidney disorders.

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