Adam Shared "Renal Cancers" - 4 Picmonics
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Renal Cancers
Renal Cell Carcinoma
- Originates from PCT epithelium
- Polygonal clear cells (pictured, A) filled with accumulated lipids and carbohydrates
- Often golden-yellow due to increased lipid content (pictured, B)
- Most common in men 50–70 years old; non-hereditary (unilateral upper kidney pole)
- Increased incidence with smoking, obesity and hypertension
- Manifests clinically with hematuria, palpable mass, 2° polycythemia, flank pain, fever, weight loss
- Invades renal vein then IVC and spreads hematogenously; metastasizes to lung and bone; Or retroperitoneal lymph nodes
- Most common 1° renal malignancy (pictured, C)
- Associated with gene deletion on chromosome 3 (sporadic or inherited as von Hippel-Lindau syndrome); Bilateral
- Associated with paraneoplastic syndromes (eg, ectopic EPO, ACTH, PTHrP, renin)
- Often silent until mestasis
- Left sided varicocele (only the left spermatic vein drains into renal vein, right goes direct to IVC)
- U. painless hematuria
- Vimentin positive
- Staging: T - size and renal vein involvement, N - spread to retroperitoneal lymph nodes
- Treatment
- Resect localized disease
- Immunotherapy (aldesleukin) or targeted for advanced/metastatic disease; resistant to chemotherapy and radiation therapy
- U. Can also cause anemia of chronic disease and technically iron deficiency anemia from blood loss
Renal Oncocytoma
- Benign epithelial cell tumor arising from collecting ducts (arrows in A point to well circumscribed mass with central scar)
- Large eosinophilic cells with abundant mitochondria without perinuclear clearing (Pictured, B)
- Presents with painless hematuria, flank pain, abdominal mass
- Often resected to exclude malignancy (eg, renal cell carcinoma)
- Often has central scarring
Transitional Cell (Urothelial) Carcinoma
- Most common tumor of urinary tract system (can occur in renal calyces, renal pelvis, ureters, and bladder) (Pictured)
- Painless hematuria (no casts) suggests bladder cancer
- Phenacetin, Smoking, Aniline/Azo dyes, naphthylamine, Cyclophosphamide, rubber, plastics, textiles, leather and aromatic amine containing dyes
- Benzidine - another possible causative agent
- "Field defect" are often multifocal and recur
- Pleomorphic, hyperchromatic nuclei, disrupted orientation
- Staging is most important prognostic factor and is based off of invasion
- Flat
- High grade flat tumor that invades, p53 mutation association
- Papillary
- Low grade papillary growth, progresses to high grade and then invades
- May form papillary tumors
Squamous Cell Carcinoma of the Bladder and Adenocarcinoma
- Squamous Cell Carcinoma
- Chronic irritation of urinary bladder causes squamous metaplasia leading to dysplasia and squamous cell carcinoma
- Risk factors include Schistosoma haematobium infection (Middle East), chronic cystitis (older women), smoking, chronic nephrolithiasis
- Presents with painless hematuria
- Adenocarcinoma
- Malignant gland proliferation usually within the bladder
- Can arise from urachal remnant (at the dome of the bladder), cystitis glandularis or exstrophy of the bladder
