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55 terms

Urolithiasis and Tumors

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What renal stones are vegetarians at risk for?
calcium oxalate
(due to hyperoxaluria)
What is the most common type of renal stones?
calcium oxalate +/- calcium phosphate
What is the 2nd most common renal stone?
magnesium ammonium phosphate
What is the 3rd most common renal stone?
uric acid
What increases the likelihood of uric acid stones?
acidic urine
What is the underlying cause of magnesium ammonium phosphate renal stones?
Proteus infection
(convert urea to ammonia)
What is the only renal stone that appears radiolucent?
uric acid stones
What type of renal stones can be caused by hyperparathyroidism?
calcium oxalate +/- calcium phosphate
What type of renal stones can be cause by sarcoidosis?
calcium oxalate +/- calcium phosphate
What is the cause of staghorn ccalculi?
Proteus infection
Pts with gout or leukemia/lymphoma are at risk for what type of renal stones?
uric acid
What disorder predisposes pts to cystine renal stones?
hereditary cystinuria
Pt presents with flank pain, radiating to groin and gross hematuria with no casts. Possible dx?
urolithiasis
What are potential complications of renal pelvis stones?
pyelonephritis and hydronephrosis
What are 4 benign renal tumors?
Renal adenoma
Angiomyolipoma
Medullary fibroma
Oncocytoma
What are 3 malignant renal tumors?
Wilms' tumor (Nephroblastoma)
Renal cell carcinoma (RCC)
Urothelial (transitional cell) tumors
What is the most common renal tumor?
renal cell carcinoma
Where do renal cell carcinomas arise from?
renal tubules
What is a common mutation involved in renal cell carcinoma?
What chromosome is it found on?
VHL gene
→ chromosome 3
What doubles the risk for renal cell carcinoma? Other risk factors?
smoking!
also obesity, HT, asbestos, petroleum, heavy metals, CRF, tuberous sclerosis
What syndrome is characterized by renal cysts, renal cell carinomas, cerebellar hemangioblastoma, and pheocromocytoma?
von Hippel-Lindau syndrome
What familial renal cell carcinoma disorder has the VHL mutation but lacks the other characteristic s of VHL syndrome?
familial clear cell carcinoma
What autosomal dominant disorder presents with bilateral tumors and has a Met proto-oncogene mutation?
hereditary papillary carcinoma
What is the most common histological type of renal cell carcinoma?
clear cell carcinoma (70-80%)
→ filled with glycogen, lipid
What is the histological pattern of papillary carcinoma?
cuboidal or low columnar cells
w/ interstitial foamy macrophages
What is the histological pattern of chromophobe carcinoma?
Solid sheets of pale eosinophilic cells, perinuclear halos, discrete cell membranes (vegetable like cells)
What type of stain can help differentiate a chromophobe renal cell carcinomas from an oncocytoma?
+ colloidal iron stain
Metastatic clear cell carcinoma is found in the liver, where do you want to look for the primary tumor?
kidneys
What ectopic hormones can be produced by a renal cell carcinoma?
Epo, Renin, PTH-like, ACTH
What is the classic triad of renal cell carcinoma presentation?
hematuria
palpable abdominal mass
dull flank pain
What carcinoma mimics a true renal sarcoma?
Which renal cell carcinoma can change into this?
sarcomastoid renal cell carcinoma
→ any
What small renal tumor arises from renal tubules, usually having a papillary architecture, has no atypia or clear cells and is a common incidental finding at autopsy?
renal adenoma
What is a benign tumor of the renal collecting ducts can sometimes present grossly with a central scar and microscopically is made up of uniform cells with abundant granular eosinophilic cytoplasm?
oncocytoma
What are the cytoplasm of cells in an oncocytoma filled with?
mitochondria
What benign tumor of vessels, smooth muscle and fat is the most common renal tumor in pts with tuberous sclerosis?
angiomyolipoma
What is a benign fibroblastic tumor of the renal medulla?
renal medullary fibroma
What gene is responsible for wilm's tumor? What chromosome is involved?
WT1 and WT2
→ chromosome 11
Pt presents with hemihypertrophy, macroglosia, and wilm's tumor (WT2). What syndrome would this be?
Beckwith Wiedman syndrome
What makes up the triphasic nature of Wilm's tumor?
The epithelial elements (E) surround nodules of blastema (B).
The nodules of blastema are separated by myxoid stroma (S)
Cartilage, bone and muscle tissue can also be seen in what renal tumor?
Wilm's tumor
What cell type do urothelial tumors arise from?
transition cell tumor
What disorder primarily presents as painless hematuria?
urothelial tumor
What percent of urothelial tumors are malignant?
99%
What is the major risk for urothelial tumors?
tobacco smoke (3-7x risk)
(also azo dyes, rubber industry, painters)
What parasitic infection can increase the risk of urothelial tumors?
chronic cystitis cause by organism like Schistosoma hematobium
What cancer drug can increase the risk for urothelial tumors?
cyclophosphamide
Non-invasive urothelial tumors have a deletion of which chromosome, affecting what gene?
chromosome 9
→ p16INK4a
Invasive urothelial tumors have a deletion of which chromosome, affecting what gene?
chromosome 17p
→ p53
What are the two types of papillary urothelial tumors?
exophytic papilloma (left)
inverted papilloma (right)
What tumor is a urothelial neoplasm of low malignant potential similar to?
papilloma
→ slightly thicker epithelium or mild nuclear enlargement
A urothelial carcinoma shows thick papillary urothelium, mild atypia, occasional mitoses. How would you grade this tumor?
low grade papillary carcinoma
A urothelial carcinoma shows you moderate atypia and mitoses, as well as signs of necrosis. Grade this tumor.
high grade urothelial carcinoma
Urothelial biopsy shows full thickness atypia with an intact basement membrane. Likely dx?
What is the likelihood this becomes invasive?
urothelial carcinoma in situ
→ (50-75% chance of becoming invasive)
What increases the risk for squamous cell carcinoma of the bladder?
schistosomiasis
indwelling catheter
What is the intermediate process occurs in the bladder between schistosomiasis and squamous cell carcinoma?
squamous metaplasia