Kidney tumors

kidney tumors- benign and malignant
Pathology- epidemiology, risk factors, genetics, morphology, and microscopy.
Angiomyolipoma, oncocytoma, renal papillary adenoma- benign.
Malignant- renal cell carcinoma and its types, Wilms tumor

1. KIDNEY
TUMORS
Pathology

2. RENAL TUMORS
Benign tumour
•1.Angiomyolipoma
•2.Oncocytoma
•3.Renal papillary adenoma
Malignant tumour
•1. Renal cell carcinoma
•2. Wilms tumour

3. BENIGN TUMORS
qNon-cancerous growths of the kidney that do
not metastasize to other sides of the body.
qNot life threatening but can cause complaints if
they exert pressure

4. ANGIOMYOLIPOMA
qConsists of vessels , smooth muscles and fat
qOriginates from perivascular epithelioid cells
qPresent in 25-50% of patients with tuberous sclerosis
qCaused by loss of function mutation in TSC1 or TSC2 (TSG)

5. qTuberous sclerosis is characterised by -
qLesions of cerebral cortex that produce epilepsy and mental
retardation
qSkin abnormalities
qClinical importance = Susceptibility to spontaneous
haemorrhage.

7. ONCOCYTOMA
qEpithelial neoplasm
qComposed of large eosinophilic cells having
qSmall
qRound
qbenign
appearing nuclei that have large nucleoli.
qArises from intercalated cells of collecting ducts.

8. GROSS APPEARANCE:
qTumors are tan or
Mahogany Brown.
qRelatively homogenous
qUsually well encapsulated
with central scar
H/E
qPolygonal cells with
abundant eosinophilic
granular cytoplasm
qExcess of mitochondria

9. RENAL
PAPILLARY
ADENOMA
qVery rare
qPresents as a
yellow plaque
qPapillary
configuration on
microscopy

10. MALIGNANT TUMORS

11. RENAL CELL
CARCINOMA
INTRODUCTION
•More often in older individuals (6thand 7th
decades of life)
•2:1 male preponderance
•a/k/a
•Grawitztumor
•Adenocarcinoma
•Hypernephroma

12. RISK FACTORS
Tobacco ObesityHypertension
Asbestos, petroleum products, heavy metals
End stage renal disease
Chronic kidney disease
Acquired cystic diseaseTuberous sclerosis

14. GENETICS OF RCC
1. VHL gene on chr 3p
•Autosomal dominant
•Risk of clear cell cancer
2. HLRCC
•Hereditary
leiomyomatosis
•Mutation in fumarate
hydratase gene
•Risk of papillary cell
carcinoma

15. 3. HPRCC
•Hereditary papillary RCC
•Mutation in MET gene
•Hepatocyte growth factor increased expression
4.BirtHogg
Dube syndrome
•Due to mutation in BHD gene
•Encodes for folliculin
•Increase risk of chromophobe
cancer
5. Other
•Hypodiploidy
•Loss of y-chromosome
•Trisomy 7, 17

16. PARANEOPLASTIC SYNDROME
IncreaseESRAnemiaPolycythaemiaLeukemoid reaction
Non metastatic hepatic dysfunction
AmyloidosisIncrease in calcium ions
feminisation/ masculanization
Cushing syndrome

17. TYPES OF RCC
BASED ON-CORRELATIVE CYTOGENETIC, GENETIC AND HISTOLOGIC STUDIES-
qClear cell RCC
qPapillary RCC
qChromophobe RCC
qCollecting duct
qXP 11 translocation carcinoma

21. COLLECTING DUCT CARCINOMA

22. WILMS
TUMOR
qAge -2-5 years
qa/k/a Neuroblastoma
qGenetic-
qLoss of function mutation in-
§WT1 on ch.11p13
§WT2 on ch.11p15
qPresence of anaplasia -mutation of
tp53 mutation
qemergence of risk to chemotherapy
(unresponsiveness of anaplastic cells
to cytotoxic chemotherapy)

23. MORPHOLOGY
qLarge solitary well
circumscribed mass
qSoft homogenous tan to grey
with occasional foci of
hemorrhage cyst formation
and necrosis

24. TRIPHASIC
COMBINATION-
MICROSCOPY
Blastemal cells
Stromal cellsEpithelial cells

25. CLINICAL
FEATURES
qLarge abdominal mass
qHaematuria
qPain in abdomen after traumatic
incidence
qIntestinal obstruction
qAppearance of hypertension

30. CASE: A 15 YEAR OLD GIRL
WITH SICKLE CELL TRAIT
PRESENTED WITH GROSS
HEMATURIA, FLANK PAIN
AND LYMPHADENOPATHY.
SHE IS DIAGNOSED AS A
CASE OF RCC. NAME THE
TYPE OF RCC SHE IS LIKELY
TO HAVE?
A. Medullary
B. Papillary
C. Chromophobe
D. Colloid

31. Q. ACQUIRED CYSTIC DISEASE OF
KIDNEY ASSOCIATED WITH
A. Xantho-granulomatous
Pyelonephritis
B. Dialysis
C. Renal Stones
D. Renal Dysplasia

32. Q. TRUE STATEMENT ABOUT
RCC
A. ASBESTOS, SICKLE CELL
ANEMIA& PETROLEUM
PRODUCTS ARE RISK
FACTORS
B. CLEAR CELL CANCER ARISE
FROM PCT
C. CANNON BALL METASTASIS
D. BELLINI DUCT ARISE FROM
FROM LOOP OF HENLE
1. A,B,D are true
2. A,C,D are true
3. Only A & D are true
4. A,B,C are true

33. Q. IN WHICH OF THE
FOLLOWING
CONDITION
,ANIRIDIA AND
HEMI-
HYPERTROPHY ARE
MOST LIKELY TO
PRESENT ?
A. Neuroblastoma
B. Wilm’sTumor
C. Non-Hogkin Lymphoma
D. Germ Cell Tumor

34. THANK YOU