Tumors of Urinary Tract 1 Urinary Tract Neoplasm

Tumors of Urinary Tract 1

Urinary Tract Neoplasm Kidney Renal Cell Carcinoma [ adult], Transitional cell carcinoma [ adult], Wilms Tumor [children] Ureter / Urethra Urinary Bladder Transitional Cell Carcinoma (common) Uncommon is Squamous cell Carcinoma 2

Renal Tumors of kidney 3

Renal Tumors Benign [Usually small] Cortical Papillary Adenoma [<. 5 cm] Common finding at autopsy. Angiomyolipoma. Malignant Renal Cell Carcinoma [ RCC ] Nephroblastoma (Wilms Tumor) Primary tumor of calyces and Pelvis (TCC) 4

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). 5

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 6

Key words ; Renal cell carcinoma Clear Cell Carcinoma Associated with Most common Von Hippel- Lindau (VHL) disease. Papillary Renal Cell Carcinoma Associated with Bilateral and MET proto. Multifocal oncogene mutation Chromophobe Multiple loss of Renal Carcinoma various chromosome Good Prognosis 7

RCC ( clear cell carcinoma) Cancer cells with clear cytoplasm. It contain glycogen. PAS +ve. 8

RCC • Metastasis: Lung and bone • Bone: produce osteolytic lesion and cause pathological fracture. • Marker of bone mets. : ↑alkaline phosphatase 9

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). 10

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 ( Ch 11 p 13) and WT 2 (11 p 15). (tumor suppressor gene) 11

WAGR syndrome Denys-Drash Syndrome Beckwithwidemann Syndrome A = aniridia, G = genital abnormality, R = mental retardation Gonadal Dysgenesis and renal abnormality. Enlargement of Individual organ (macroglossia). Enlargement of entire body segment (hemihypertrophy). Enlargement of adrenal cortical gland. 12

Morphology and prognosis • Gross: lobulated, tan mass • Micro: – Blastemal cells – Epithelial elements – Stroma • Prognosis: – Excellent, long term survival 90% 13

Morphology Small blue blastemal cells 14

Transitional cell carcinoma in renal pelvis. Note: Papillary growth; irregular cauliflower like surface. May follow acetaminophen poisoning. 15

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. 16

It frequently produces obstructive features (common than metastasis). 17

Types • Transitional cell carcinoma • Squamous cell carcinoma 18

Transitional cell carcinoma • Male > female : : Age: 40 -60 years • Risk (carcinogens) – Smoking – beta naphthylamine, – Chronic cystitis – Aniline dye. 19

Types: superficial (non invasive) and deep. Most TCC are Papillary tumor, Produce cauliflower like mass 20

Cauliflower like mass Superficial Papillary tumor 21

Genes • Superficial neoplasm (tumors): – deletion of Ch 9 • Invasive bladder neoplasm : – Mutation of Rb and TP 53 gene. 22

Squamous cell carcinoma Common in Middle east Risk: Schistosoma hematobium (host is snail). Micro: squamous cell carcinoma 23

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 24

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Angiomyolipoma. • A hamartoma • Micro: Blood vessels, fat, smooth muscle • Associated with: tuberous sclerosis 26

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