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Questions and Answers
What is the main type of tissue from which renal tubular adenoma arises?
What is the main type of tissue from which renal tubular adenoma arises?
What is a significant characteristic of renal tubular adenoma's appearance under microscopy?
What is a significant characteristic of renal tubular adenoma's appearance under microscopy?
What indicates that renal tubular adenoma can progress to carcinoma?
What indicates that renal tubular adenoma can progress to carcinoma?
Which feature primarily distinguishes oncocytoma from renal cell carcinoma (RCC)?
Which feature primarily distinguishes oncocytoma from renal cell carcinoma (RCC)?
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What is the main microscopic feature of oncocytes found in oncocytoma?
What is the main microscopic feature of oncocytes found in oncocytoma?
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What is a rare form of chronic granulomatous cystitis?
What is a rare form of chronic granulomatous cystitis?
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Which type of lesions are associated with inflammation of the bladder due to UTIs?
Which type of lesions are associated with inflammation of the bladder due to UTIs?
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What are Michaelis-Gutmann bodies indicative of?
What are Michaelis-Gutmann bodies indicative of?
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What changes occur in the transitional epithelium due to chronic cystitis?
What changes occur in the transitional epithelium due to chronic cystitis?
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Which characteristic is most commonly associated with malakoplakia?
Which characteristic is most commonly associated with malakoplakia?
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What is a common cause leading to glandular changes in the bladder?
What is a common cause leading to glandular changes in the bladder?
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Chronic cystitis can develop into which of the following?
Chronic cystitis can develop into which of the following?
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What kind of deposition occurs in defective macrophages characterized by malakoplakia?
What kind of deposition occurs in defective macrophages characterized by malakoplakia?
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What is the primary characteristic of Xanthogranulomatous pyelonephritis?
What is the primary characteristic of Xanthogranulomatous pyelonephritis?
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Which of the following describes an Angiomyolipoma?
Which of the following describes an Angiomyolipoma?
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From where do the mutations leading to Tuberous Sclerosis arise?
From where do the mutations leading to Tuberous Sclerosis arise?
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What is often a common finding in patients with small renal papillary tumors?
What is often a common finding in patients with small renal papillary tumors?
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What does 'macro' refer to in the context of tumor pathology?
What does 'macro' refer to in the context of tumor pathology?
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What type of tissue is characterized by the presence of aggregates of foamy macrophages?
What type of tissue is characterized by the presence of aggregates of foamy macrophages?
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Which statement is true about the structural characteristics of Xanthogranulomatous pyelonephritis?
Which statement is true about the structural characteristics of Xanthogranulomatous pyelonephritis?
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What is the most common cause of sporadic Angiomyolipoma?
What is the most common cause of sporadic Angiomyolipoma?
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What can be a clinical manifestation of Tuberous Sclerosis?
What can be a clinical manifestation of Tuberous Sclerosis?
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What is the most common type of urinary tract cancer?
What is the most common type of urinary tract cancer?
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Which genetic alterations are commonly associated with urothelial carcinoma?
Which genetic alterations are commonly associated with urothelial carcinoma?
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What is the typical presentation of urothelial carcinoma?
What is the typical presentation of urothelial carcinoma?
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What environmental factor is a known contributor to urothelial carcinoma?
What environmental factor is a known contributor to urothelial carcinoma?
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What does 'Tis' indicate in the TNM staging system for urothelial carcinoma?
What does 'Tis' indicate in the TNM staging system for urothelial carcinoma?
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Which stage of bladder cancer indicates invasion into the muscle layers?
Which stage of bladder cancer indicates invasion into the muscle layers?
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What is the primary etiology for squamous cell carcinoma (SCC) in the urinary tract?
What is the primary etiology for squamous cell carcinoma (SCC) in the urinary tract?
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Which grade of bladder cancer is considered poorly differentiated?
Which grade of bladder cancer is considered poorly differentiated?
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What factor contributes to the inevitability of recurrence in bladder cancer?
What factor contributes to the inevitability of recurrence in bladder cancer?
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What is the significance of a T4 stage in the TNM classification for bladder cancer?
What is the significance of a T4 stage in the TNM classification for bladder cancer?
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What type of metaplasia involves the replacement of urothelium by glandular epithelium?
What type of metaplasia involves the replacement of urothelium by glandular epithelium?
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Which benign neoplasm is described as having an exophytic appearance with a fibrovascular core?
Which benign neoplasm is described as having an exophytic appearance with a fibrovascular core?
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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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Which risk factor is commonly associated with renal cell carcinoma?
Which risk factor is commonly associated with renal cell carcinoma?
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What is a common presentation feature of transitional cell carcinoma?
What is a common presentation feature of transitional cell carcinoma?
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What is usually the first line of treatment for localized renal cell carcinoma?
What is usually the first line of treatment for localized renal cell carcinoma?
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Which of the following describes the typical morphology of renal cell carcinoma?
Which of the following describes the typical morphology of renal cell carcinoma?
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Which paraneoplastic syndrome is commonly associated with renal cell carcinoma?
Which paraneoplastic syndrome is commonly associated with renal cell carcinoma?
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What condition is characterized by multiple papillary tumors at the renal pelvis urothelium?
What condition is characterized by multiple papillary tumors at the renal pelvis urothelium?
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What genetic abnormality is associated with Wilms tumor?
What genetic abnormality is associated with Wilms tumor?
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What is the typical prognosis for localized renal cell carcinoma post-treatment?
What is the typical prognosis for localized renal cell carcinoma post-treatment?
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Which type of carcinoma is characterized by the presence of lipid and glycogen in renal tubular epithelium?
Which type of carcinoma is characterized by the presence of lipid and glycogen in renal tubular epithelium?
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Which of the following is a feature of inverted papilloma?
Which of the following is a feature of inverted papilloma?
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What is a common complication associated with renal cell carcinoma metastasis?
What is a common complication associated with renal cell carcinoma metastasis?
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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
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Triad: hematuria, palpable renal mass, flank pain.
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Left-sided varicocele.
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Paraneoplastic syndromes: polycythemia, hypercalcemia, hypertension.
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Metastasis: lung (MC), bone.
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Risk factors (RF): smoking, obesity, hypertension, chronic kidney disease (CKD).
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Sporadic: most common
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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.
