Kidney Urinary Tract Neoplasms u u Jaroslava Dukov
- Slides: 55
Kidney & Urinary Tract Neoplasms u u Jaroslava Dušková Inst. Pathol. , 1 st Med. Faculty, Charles Univ. Prague http: //www 1. lf 1. cuni. cz/~jdusk/
Kidney Cancer u 2% of the total human cancer burden, M: F 2: 1, middle age u preference for developed (industrialized) countries u risk factors: TOBACCO SMOKING, OBESITY
Symptoms u silent for a long time - discovered by chance u hematuria, backache, abdominal mass, metastatic spread u early hematogenic spread possible
WHO classification of tumours of the kidney (2004)
WHO Histogenetic groups (& number of nosology units identified) u. Renal cell (12) u. Metanephric (3) u. Nephroblastic (3) u. Mesenchymal (18) u. Mixed mesenchymal and epithelial (3) u. Neuroendocrine (5) u. Hematopopietic and lymphoid (3) u. Germ cell (2)
Epithelial Neoplasms of the Pelvis u Benign - papillomas u Malignant - carcinomas v papillocarcinomas v squamous cell Urinary ways
Kidney Tumours u Benign u Malignant
Kidney Adenoma Definition: v Formerly - diam. 2 -3 cm v Recently – only diam. less than 5 mm without a clear cell component – – tubulopapillary architecture lack of atypiae & mitoses
Epithelial Kidney Tumours benign v papillary tubulopapillary ADENOMAS (<5 mm!) v oncocytic (oncocytoma) v metanephric
Oncocytoma v Kidney cortex v may be multicentric and bilateral v Macro – tan with a central stellate scar v Micro - eosinophillic granular cytoplasm bizarre nuclei v Elmi – mitochondria filling up the cytoplasm v Biological behaviour benign
Kidney Tumours - mesenchymal Angiolipoleiomyoma – mixed mesenchymal tumour
Metanephric Adenoma u small dark cells u acinar and glomeruloid formations u calkospherites, calcifying non agressive
Benign Kidney Tumours Mimicking Carcinomas and Sarcomas v Metanephric adenoma - large & cellular v Oncocytoma - large with atypiae v Angioleiomyolipoma - large with atypiae
Epithelial Kidney Tumours u Clear Conventional Cell malignant CARCINOMAS u Papillary (chromophillic) v type 1 v type 2 u Chromophobe v classical v eosinophillic u Sarcomatoid u Cystic u Collecting Duct
Clear Cell Ca (Grawitz tumour) (75%) u Solid / cystic u Unilocullar or multilocular u Micro - solid or tubulocystic clear cytoplasm (fat & glycogen) u Immunohistochemistry cytokeratins, vimentin, CD 10, EMA, S-100 u Cytogenetics deletion of the short arm chromosome 3 (3 p) Prognosis: G, p. T dependent Sarcomatoid variant is the most malignant
Papillary (Chromophillic) Ca (10%) u In dialysed more frequent u X-ray hypovascular u Histology – papillary/ tubulopapillary type 1 – cubic cells type 2 - cylindric cells (worse prognosis) u Genetics – trisomy or tetrasomy 7 and 17 in men often Y chromosome missing mutation of c-met oncogen Prognosis : G, p. T dependent slightly better than in conventional ca
Chromophobe Carcinoma (5%) u Macro u Mikro - u Elmi u Genetics brown color solid, cytoplasms clear or eosinophillic, positive in Hale´s colloidal iron staining, raisin-like cell nuclei microvesicles in cytoplasm missing chromosomes 1, 2, 10, 13, 6, 21, 17 Prognosis: G, p. T dependent
Collecting Duct Carcinoma u Starts in the medulla v Micro v adenocarcinoma & urothelial like v hobnail cells v papillary v fibroplasia, mucin production v Imuno cytokeratin 13, vimentin, lectin Prognosis unfavourable
Nephroblastoma (Wilms´tumour) u syn. - embryonal adenosarcoma u Children - preschool age u Macro: gray-white large retroperitoneal mass palpable through abdominal wall u Micro: undifferentiated renal blastema, tubular and glomeruloid formations may be present u Prognosis: curable (stage!) u Follow up: - nephroblastomatosis
Role of the Pathologist in the Kidney Tumour Diagnostics v Typing v Biological Behaviour v Grading v Staging
Grading u Nuclear – Fuhrman et al. 1982 u Nuclear plus architecture u Proliferation factors - PCNA, Ki 67, Bcl 2 u Morphometry v DNA Analysis v Ag. NOR v Angiogenesis u Cytometry Flow cytometry
Staging v Size v Kidney capsule infiltration v Angioinvasion v Metastases in the lymph nodes v Number of lymph nodes involved v Metastases in the surrounding organs
Nuclear Grading in Kidney Cancer (Fuhrman et al. 1982) u Grade I small, uniform, round (10 ) inaparent or missing nucleoli u Grade II larger irregular (15 ) nucleoli small u Grade III large, irregular margins (20 ) nucleoli large u Grade IV large, bizarre, pleomorphic
Factors with an Adverse Prognosis Influence in Kidney Cancer Size diam. more than 12 cm Invasion to venes recidives Grading G III and G IV Staging most important Proliferation Index p 53 Expression
Kidney Cancer – complications 1. u metastatic spread & generalisation u manifestation via solitary bloodborne metastasis possible (pathological fracture, struma neoplastica…) u hematuria – anemia
Kidney Cancer – complications 2. u hormon production – erythropoietin polyglobulia Wood L, Swanepoel C, du Toit A, Jacobs P. Clinically silent renal tumour producing erythropoietin. S Afr Med J. 2003 Feb; 93(2): 128 -9. Shaheen M, Hilgarth KA, Hawes D, Badve S, Antony AC. A Mexican man with "too much blood". Lancet. 2003 Sep 6; 362(9386): 806. u insulin, glukagon, renin, HPL like substances
Urothelial Tumours
Urothelial Cancer u approx. 3% of total human cancer burden uincreasing incidence uindustrialized countries urisk factors: TOBACCO SMOKING aniline dye industry phenacetin schistosomiasis
Symptoms u hematuria (obstruction) (metastases)
Terminology …the term UROTHELIAL be used rather than „transitional“. . .
Normal urothelium multilayered variable number of layers empty bladder 4 -6 full bladder 2 -3
„Variations“ of Urothelium – slight reactive changes von Brunn´s nests mucinous metaplasia squamous metaplasia (nonkeratinising, vagina type)
Metaplasia Def: change of one differentiated structure into another one (e. g. urothelium – squamous epithelium)
Metaplasia Significance: v dif. dg. problem v with atypia precancerosis
The WHO/ISUP Consensus Classification of Urothelial Neoplasms of the Urinary Bladder Epstein JI, Amin MB, Reuter VR, Mostofi FK, & the Bladder Consensus Conference Committee Am. J. Surg. Pathol. , 22, 1998, 1435 -8 WHO 2004
The WHO/ISUP Consensus Classification I. III. IV. Hyperplasia Flat lesions with atypia Papillary neoplasms Invasive neoplasms
The WHO/ISUP Consensus Classification I. Hyperplasia Flat Papillary
Hyperplasia Def: regular increase in number of uroth. layers (min. >7, mostly >10) slight increase in cell nuclei size, preserved architecture
Hyperplasia Significance: precancerosis 70% of patients with urothelial ca identical mutations
The WHO/ISUP Consensus Classification I. III. IV. Hyperplasia Flat lesions with atypia Papillary neoplasms Invasive neoplasms
II. Flat lesions with atypia Reactive (inflammatory) atypia Atypia of unknown significance Dysplasia (LG IUN) CIS (HG IUN)
Dysplasia DEF: disturbance of normal urothelium architecture & cytology
Dysplasia LG IUN – low grade intraurothelial neoplasia HG IUN/ CIS – high grade intraurothelial neoplasia
The WHO/ISUP Consensus Classification I. III. IV. Hyperplasia Flat lesions with atypia Papillary neoplasms Invasive neoplasms
III. Papillary neoplasms v Papilloma v Inverted papilloma v Papillary Urothelial Neoplasm of Low Malignant Potential PUNLMP v Papillary carcinoma, low grade v Papillary carcinoma, high grade
Papilloma WHO 1973 G 0 Def: circumscribed solitary papillary lesion covered with cytologically and architecturally normal urothelium.
Papillary neoplasm of low malignant potential Def. : well stratified urothelium bering features of slight dysplasia and increased number of layers
The WHO/ISUP Consensus Classification I. III. IV. Hyperplasia Flat lesions with atypia Papillary neoplasms Invasive neoplasms
Invasive neoplasms v lamina propria invasion (p. T 1 a, b) v muscularis propria (detrusor muscle) invasion (p. T 2 a, b) v perivesical tissue macro/micro (p. T 3 a, b) v surrounding organs/ abdominal wall (p. T 4 a, b)
Less Common Types of Urinary Bladder Cancer u u u u microcystic carcinoma with pseudosarcomatose stroma with bone or chondroid stromal metaplasia spinocellular adenocarcinoma undifferenciated ca with trophoblastic differentiation neuroendocrine
Non-Epithelial Bladder Tumours - Mesenchymal u u u leiomyomas and leiomyosarcomas rhabdomyosarcoma botryoides rhabdoid fibrohistiocytic vascular (capilllary, cavernous and angiovenous hemangiomas and hemangiosarcomas) malignant lymphomas
Non-Epithelial Bladder Tumours - Neuroectodermal u neurofibromas in Recklinghausen´s disease u melanoma u paraganglioma u composite pigmented paragangliomaganglioneuroma
Urinary Bladder Pseudotumors u u inflammatory malakoplakia amyloid deposits pseudosarcoma
Cystectomy – Biopsy Report MICRO: u type, grade (G) and stage (p. T) of the tumor u further urothelial abnormities u lymphatic and blood vessel invasion u presence / absence of the tumor in the resection margins and neighbouring organs u further abnormities of the neighbouring organs
Urinary Blader Cancer - complications u local recidives u progression u metastases
- Dr kiran bidari
- Urinary tract infection in pregnancy ppt
- Histological structure of kidney
- Urised otc
- Urethra
- Uti causes
- Urinary tract infection
- Tumor in the urinary tract
- Complicated urinary tract infection
- Dorsal reticulospinal tract
- Pyramidal vs extrapyramidal lesions
- Jaroslava koníčková
- Jaroslava healer
- Mudr. jaroslava orosová ml.
- The urinary system is also known as
- Urinary retention
- "urinary reflux"
- Chapter 20 urinary/excretory system
- Inferior vena cava tributaries
- Loop diuretics mechanism of action
- Normal constituents of urine
- Chapter 22 urinary elimination
- Rat urinary system
- Kidneys location and structure figure 15-1
- Micturition
- Anatomical structure of urinary system
- Nephroureterectomy
- Urinary structure
- Urinary bladder
- Chapter 25 urinary catheters
- Urinary system
- Bundle of urinary catheter
- Fundus of bladder
- Frog spinal nerves
- Chapter 25 the urinary system
- Adh function
- Urinary
- Figure 15-3 is a diagram of the nephron
- Physiology of urine formation
- _____ is difficulty in starting a urinary stream.
- Gastric gland
- Chapter 15 the urinary system figure 15-3
- Layers of kidney
- Superior surface of urinary bladder
- Vena cava urinary system
- Bowmans capsule
- Defination of urinary system
- Chapter 9 the urinary system learning exercises answer key
- Branching gills
- Chapter 24 urinary elimination
- Urinary system root words
- Composition of urine slideshare
- Fetal pig urinary system labeled
- Length of male urethra
- Cloacal membrane
- Alteration in urinary elimination