ACP-L25 Tumours of Kidney and Urinary Tracts PDF

72 ACP-L25 Tumours of kidney and urinary tracts Kidney benign tumours Disease Characteristics Patho...

72 ACP-L25 Tumours of kidney and urinary tracts Kidney benign tumours Disease Characteristics Pathology Xanthoma cell : lipid-laden macrophage Tumour-like lesions 1 ,Xanthogranulomatous Rare form of chronic granulomatous pyelonephritis Macro: enlarged kidney with yellow nodules forming of granulomal : Micro: aggregates of foamy macrophages, loss of pyelonephritis (XGP) aggregationof macrophagetion ( functional parenchyma (medulla + cortex) Hamartoma F Macro: single or multiple masses 2Angiomyolipoma blood IsMI fa ① E NEE Q Micro: vessels (angio-), smooth muscle (myo-), Cause: sporadic (MC) or tuberous sclerosis (genetic syndrome) fat (lipo-)[Disorderly mixed tissue) langiomyolipoma Multisystem hamartoma with triad of MR, ↑ seizures and skin lesions 1 Mutation in TSC1 & TSC2 (TSG): hamartin, 2 tuberin (Xgene Xhamartin + Tuberin) Cell growth proliferation + Benign neoplasms 1 Renal papillary Asymptomatic, often incidental findings Macro: single or multiple nodules of ≤1cm at cortex. Arised from renal tubular epithelium adenoma (from glandular tissue) Micro: papillary/ tubular pattern, considered ROC precursor to Within cortex carcinoma if size ≥1.5cm or high grade 2 Oncocytoma Difficult to distinguish from RCC, even with Macro: dark brown, with pseudo-capsule compressing normal parenchyma. biopsy: determined only by evidence of metastasis Cepithelial) Micro: eosinophilic cells of abundant or aggressive infiltration into adjacent structures mitochondria => oncocyte. 3 medullary fibroma Urinary tract benign tumours Disease Characteristics Pathology Tumour-like lesions inflammation of bladder UTI Malakoplakia Rare form of chronic granulomatous cystitis : Michaelis-Gutmann bodies: defective macrophages → intracellular deposition of Ca & Fe “Soft plaque”, MC found in bladder bacterial infection * machrophage partially digest bacteria glandular changes with Cystic formation transitional epithelium (lining of UT).g e repeated UTI Glandular: chronic cystitis → cystitis gladularis cystica →. - Metaplasia Replacement of urothelium by another type glandular metaplasia (risk of adenoCa) of epithelium renal Stone Squamous: schistosomiasis, urinary calculi · ↳ chronicirritationfrom so inflammation of a chronic urothelium Benign neoplasms Papilloma Urothelial papilloma: exophytic sextend outward Cytoscopy) , visible from nipple-like projection extend outward from surface of epithelium fibrovasular core surrounded by layer of , Inverted papilloma: endophytic epithelial cells  73 Malignant neoplasms Kidney Presentations Pathogenesis Pathology Prognosis Treatment diversity of cellular composition Renal cell carcinoma Triad: haematuria, RF: smoking, obesity, HT, CKD Macro: heterogeneous tumour ① Fuhrman grading (nuclear size) Surgery Growth factor Xformnewbodene gascular endothelial Tumors ②TNM staging: Y RCC palpable renal mass, flank Sporadic: MC with areas of haemorrhage, & VEGF inhibitor: sorafenib, clear cell Carcinoma pain Hereditary (5%): von Hippel- yellowish tissue and cystic areas T1: < 7cm, within kidney bevacizumab with IFN interferon Left-sided varicocele Lindu disease (VHL) Micro: T2: > 7cm, within kidney Starget Therapy) 11 immune system : antibodies hormone Cytokine : immune response , Paraneoplastic syndrome: Clear cell carcinoma (MC) – T3: extend into perinephric for antiproliferative /immunomodulatoryis polycythaemia, hyperCa, contain lipid, glycogen tissues or major veins A RBC in renal tubular epithelium HT, etc Papillary cell carcinoma T4: beyond Gerota’s capsule intercalated cell of renal tubule Metastasis: lung (MC), Chromophobe carcinoma urothelial carcinoma bone Collecting duct carcinoma Transitional cell Haematuria, obstruction, RF: smoking Multiple papillary tumours at Staging survival rate overall carcinoma (TCC) infection (symptoms resembling infection) renal pelvis urothelium 5-year OS up to 90% Wilms tumour MC 1o renal tumour in Sporadic (MC) Macro: very large, pale-grey Staging, size, anaplasia Surgery children (5% child CA) Genetics: tumour undifferentiated (mitosis #) With treatment: 90% cure Chemotherapy suppressor ge Nephrogenic cysts: TumorWT1 inactivation: WAGR Micro: triphasic (blastemal, loss of differentiation Radiation of nephrogenic mesoderm tubular structures NO ratio 1: / stromal, primitive connectivetissue embryonic remnant, syndrome (Wilms tumour, epithelial), may contain nuclei I hyperchromatic abnormal/absence of genitourinary iris UgiantCl - - precursor of Wilms aniridia, GU anomaly, MR), other materials, e.g. bone & DDS (Denys-Drash syndrome) WT2 inactivation: BWS (Beckwith-Wiedermann syndrome) Urinary tracts Presentations Pathogenesis Pathology agent used in chemo I Urothelial carcinoma. MC urinary tract CA Environmental: smoking,alkylating cyclophosphamide, industrial Staging (TNM): (TCC) More common in M > 50 carcinogens Ta: non-invasive papillary carcinoma* urothelial carcinoma Painless haematuria, Genetics: FGFR3, p53, HRAS Tis: non-invasive flat carcinoma in situ* papillary recurrent UTI (cause) Schistosoma haematobium infection T1: invade lamina propria Field effect: due to common malignant stem cell; T2: muscle involved^ recurrence inevitable T3: perivesical fat involved alterations large area of urothelium undergo carcinogenic T4: invade 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. 2 Squamous cell CA (SCC) 5% CA of urinary tract Schistosomiasis (MC)→ squamous metaplasia → SCC 3. Adenocarcinoma 3% CA of urinary tract MC cause: urachal remnants recurrent infection - metaplasia > glandular > - ADC Skeletal muscle maglinant to mour originate from mesenchymal cells arachus (fetus cord bladder- umbilicus) => ladult) : Fibrous cor ebilical ligament 4 Rhabdomyosarcoma / MC sarcoma fat in children bone , muscle soft arised tissue sarcoma from primitive mesenchymal cells eg. *TCC as the only exception of tumour that even without stromal invasion (carcinoma in situ), it is still considered malignant; papillary carcinoma is non-invasive by default but can be invasive ^Whether it invaded muscle has significant impact on treatment plan: ≤T1 for endoscopic resection or TURBT, ≥T2 for radical cystectomy