1 Tumors of Urinary Tract. 2 Urinary Tract Neoplasm KidneyRenal Cell Carcinoma [ adult],...
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Transcript of 1 Tumors of Urinary Tract. 2 Urinary Tract Neoplasm KidneyRenal Cell Carcinoma [ adult],...
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Urinary Tract Neoplasm
Kidney Renal Cell Carcinoma [ adult],
Transitional cell carcinoma [ adult],
Wilms Tumor [children]
Ureter /
Urethra
Transitional Cell Carcinoma
Urinary Bladder
Transitional Cell Carcinoma (common)
Uncommon is Squamous cell Carcinoma
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Renal TumorsBenign
[Usually small]
Malignant
Cortical Papillary Adenoma
[< .5 cm]
Common finding at autopsy.
Renal Cell Carcinoma
[ RCC ]
Angiomyolipoma. Nephroblastoma (Wilms Tumor)
Primary tumor of calyces and Pelvis
(TCC)
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Renal cell carcinoma
• Male > Female :: age 50-70 years.
• Risk : – Smoking, cadmium ( food, battery or
plastic factory, Cigarettes)– Acquired cystic disease, von- hippel
Lindau syndrome ( Ch 3) .
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Morphology • Gross:
– Yellow, circumscribed mass in upper pole– Invade renal vein→ vena cave and reach
right heart ( metastasis).– Invade adrenal → Addison disease.
• Microscopic types: – Clear cell carcinoma= MOST COMMON– Papillary carcinoma– Chromophobe carcinoma
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Key words ; Renal cell carcinoma
Clear Cell Carcinoma
Associated with Von Hippel- Lindau (VHL) disease.
Most common
Papillary Renal Cell Carcinoma
Associated with MET proto-oncogene mutation
Bilateral and Multifocal
Chromophobe Renal Carcinoma
Multiple loss of various chromosome
Good Prognosis
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RCC
• Metastasis: Lung and bone• Bone: produce osteolytic lesion and cause
pathological fracture.• Marker of bone mets.: ↑alkaline phosphatase
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Clinical for all RCC
• Silent• Classic triad: Hematuria, mass, pain or fever.• Paraneoplastic syndromes:
– Polycythemia ( erythropoietin):: Hct > 60%– Hypercalcemia ( PTH like hormone)– Cushing syndrome ( ACTH)– Feminization / Musculinization (↑
gonadotrophin).
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Wilms tumor ( nephroblastoma)
Age: 2-5 y, present as abdominal mass extended into the pelvis.
Syndromes:
WAGR syndrome
Denys-Drash Syndrome
Beckwith-widemann Syndrome
Genes:
WT 1 ( Ch11p13) and WT 2 (11p15).
(tumor suppressor gene)
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WAGR syndrome
A = aniridia, G = genital abnormality, R = mental retardation
Denys-Drash Syndrome
Gonadal Dysgenesis and renal abnormality.
Beckwith-widemann Syndrome
Enlargement of Individual organ (macroglossia).
Enlargement of entire body segment (hemihypertrophy).
Enlargement of adrenal cortical gland.
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Morphology and prognosis
• Gross: lobulated, tan mass
• Micro: – Blastemal cells– Epithelial elements– Stroma
• Prognosis:– Excellent, long term survival 90%
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Transitional cell carcinoma in renal pelvis.
Note: Papillary growth; irregular cauliflower like surface.
May follow acetaminophen poisoning.
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TUMORS OF THE URINARY BLADER
AND
COLLECTING SYSTEM
Usual Type -Transitional Cell Carcinoma (TCC)
(Urothelial Neoplasm)
Tumors of the Lower urinary tract are about twice as common as renal Cell
carcinomas.
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It frequently produces obstructive It frequently produces obstructive features (common than metastasis).features (common than metastasis).
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Transitional cell carcinoma
• Male > female :: Age: 40-60 years• Risk (carcinogens)
– Smoking– beta naphthylamine,– Chronic cystitis– Aniline dye.
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Types: superficial (non invasive) and deep.
Most TCC are Papillary tumor,
Produce cauliflower like mass
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Genes
• Superficial neoplasm (tumors): – deletion of Ch 9
• Invasive bladder neoplasm : – Mutation of Rb and TP53 gene.
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Squamous cell carcinoma
Common in Middle east
Risk:
Schistosoma hematobium
(host is snail).
Micro: squamous cell carcinoma
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Clinical of all bladder tumor
1. Pain less hematuria
2. Urine: atypical cells
3. Prognosis:
1. High incidence of recurrence.
2. Depends upon grade and stage
4. Bad prognosis
1. High pleomorphism ( anaplasia) of the cells.
2. Invasion
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Angiomyolipoma.
• A hamartoma
• Micro: Blood vessels, fat, smooth muscle
• Associated with: tuberous sclerosis