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
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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
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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
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Squamous Cell Carcinoma of the Bladder and Adenocarcinoma
Squamous Cell Carcinoma
Chronic irritation of urinary bladder causesŽ squamous metaplasia leading toŽ 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
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