Busy. Please wait.

Forgot Password?

Don't have an account?  Sign up 

show password


Make sure to remember your password. If you forget it there is no way for StudyStack to send you a reset link. You would need to create a new account.

By signing up, I agree to StudyStack's Terms of Service and Privacy Policy.

Already a StudyStack user? Log In

Reset Password
Enter the email address associated with your account, and we'll email you a link to reset your password.

Remove ads
Don't know (0)
Know (0)
remaining cards (0)
To flip the current card, click it or press the Spacebar key.  To move the current card to one of the three colored boxes, click on the box.  You may also press the UP ARROW key to move the card to the "Know" box, the DOWN ARROW key to move the card to the "Don't know" box, or the RIGHT ARROW key to move the card to the Remaining box.  You may also click on the card displayed in any of the three boxes to bring that card back to the center.

Pass complete!

"Know" box contains:
Time elapsed:
restart all cards

Embed Code - If you would like this activity on your web page, copy the script below and paste it into your web page.

  Normal Size     Small Size show me how

Renal 17 Renal Tumor

Leonard: Renal Tumors

Wilms Tumor Pediatric tumor compromised of embryonal nephrogenis elements
Wilms Tumor Triphasic Neoplasm 3 possible tissue types Blastema: small densely packed cells with little cytoplasm Epithelium: abortive tubules and glomeruli Stroma: spindle cells
Wilms Tumor Clinical 98% before 10, peak 1-3 85% of pediatric renal neoplasms Lung metastases are common
Wilms Tumor Rules of 5's Accounts for ~5% of kid cancers 5% bilateral 5% multicentric 5% anaplastic- worse prognosis
Wilms Tumor Typical Clinical Presentation Abdominal mass Abdominal pain Intestinal obstruction Hematuria
Wilms Tumor Prognosis Poor Px if anaplastic, age >2, large size 80-90% overall cure rate
Wilms Tumor Treatment Nephectomy plus chemotherapy Second neoplasms can occur form chemo
Wilms Tumor Pathogenesis Loss/mutation of tumor suppressor genes on chromosome 11 WT1: regulates transcription of growth-promoting genes WT2: also interacts with growth promoting factors
Congenital Mesoblastic Nephroma Tumor compromised of spindled cells with varying resemblance to immature tissues from mesoderm Most common renal tumor of infancy (only 2% or pediatric neoplasms)
Congential Mesoblastic Nephroma 5-10% recur or metastasize by 1 y/o Metastases are rare: lungs, brain, rarely bone Tx: resection with wide margins
Adult Renal Neoplasms Majority show histogenesis from epithelial components
Benign Adult Renal Neoplasms Papillary adenoma -Importance of size of neoplasm Renal oncocytoma Angiomyolipoma
Renal papillary adenoma Tumor size distinguishes papillary adenoma form carcinoma <5mm = adenoma >5mm = carcinoma
Renal papillary adenoma Clinical Most common renal tubular epithelial neoplasm found in ~33% of cases of acquired cystic renal disease
Renal papillary adenoma Morphologic features Well circumscribed, nonencapsulated Generally subcapsular
Renal Oncocytoma Clinical Accounts for ~5% of restricted renal neoplasms M:F = 2:1 median age 60-65 No recorded deaths from metastases Central scar within lesion
Renal Oncocytoma Pathology Well circumscribed tan/yellow/mahogany brown Central stellate scar (~1/3) Typically solitary Avg size = 6cm
Angiomyolipoma Mesenchymal tumor ~1% of renal neoplasms Although benign, fatality may result from: Massive hemorrhage Renal failure from loss of parenchyma
Angiomyolipoma Associated with hereditary disorders Tuberous sclerosis von Recklinhausen disease von-Hippel Lindau syndrome Autosomal dominant polycystic kidney disease
Angiomyolipoma Pathology Usually solitary Multifocality suggests tuberous sclerosis LM: mature adipose, spindled cells w/smooth muscle features, thick walled blood vessels
Angimyolipoma Pathology (cont) May involve veins and regional lymph nodes -probably indicative of multifocal growth, NOT metastases May coexist with other renal neoplasms
Malignant Renal Neoplasms (Adults) Renal cell carcinoma The most common malignant renal neoplasm in adults Clear cell RCC is the most common type
Malignant Renal Neoplasms (Adults) Urothelial carcinoma (Transitional cell carcinoma) Involves the collecting system Caylces and Pelvis
Renal Cell Carcinoma General ~85% of diagnosed renal cancers in adults 2/3 are men, 1% are bilateral Bilaterally strongly suggestive of underlying syndrome Risk factors: tobacco
Renal Cell Carcinoma Clinical symptoms Classic Triad - flank pain - palpable mass - hematuria* Only seen in 10% of cases
Renal Cell Carcinoma Metastases ~25% of the time, metastases at time of Dx Typically metastases to lung, bone, lymph nodes, adrenals, liver, brain
Renal Cell Carcinoma Prognosis Occasionally regress w/o Tx Overall 5 year survival=70% Tumor stage and nuclear grade most important Px factors
Renal Cell Carcinoma Treatment Surgical resection - extent depends upon location and extent of disease Chemotherapy minimally effective
Renal Cell Carcinoma Clear cell RCC Conventional/classic type Accounts for ~70% of adult renal cancers VHL gene-mutation at this locus seen in >90% of cases
Clear Cell RCC VHL gene VHL gene acts as a tumor suppressor gene Mutation causes not enough degradation resulting in high levels of proangiogenic factors (VEGF)
Clear Cell RCC Prognosis 50% die of dz Tumor stage: T-size of primary tumor N-presence of metastases to regional lymph node M-distant metastasis
Clear Cell RCC Nuclear grade Fuhrman grade 1-4
Papillary RCC 10-15% of RCC (second most common RCC) Hereditary tumors-mutation in c-met gene Associated ESRD (dialysis kidneys)
Papillary RCC (cont) More multiple than RCC >5mm by definition Typically present at early tumor stage Sig. better Px than Clear Cell RCC
Collecting Duct Carcinoma Rare 50-66% die in first 2 years Worst Px of typical RCC subtypes Painless gross hematuria 50% coexisting urinary bladder urothelial carcinoma
Renal Medullary Carcinoma Very rare, Very aggressive African-American or Mediterranean Die within 4-6 months of Dx Associated with sickle cell trait/dz
Renal Urothelial Carcinomas Neoplasms of transitional cell epithelium (TCC) 5% of primary renal neoplasms
Renal Urothelial Carcinomas (cont) Typically ass. with urothelial neoplasms elsewhere Multifocal Carcinogenic "field effect" (tobacco) Histologic grade and invasion
Created by: bcriss