Category Archives: Kidney

Xanthogranulomatous Pyelonephritis

Posted on July 25, 2011 by admin

Xanthogranulomatous Pyelonephritis

- rare form of  acute pyleonephritis, associated with urinary obstruction

Gross Appearance: large yellow masses replace kidney

Histology

- foamy macrophages, lymphocytes, neutrophils, giant cells
- associated with E. coli and Proteus infections

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Angiomyolipoma

Posted on July 25, 2011 by admin

Angiomyolipoma

Clinical:
- often associated with tuberous sclerosis
- arises from perivascular endothelial cell
- women (2:1)
- most behave in a benign fashion – excision is curative

Gross Appearnace: hemorragic, yellow (fat) – may look like a Renal cell carcinoma, XGP , malakoplakia
Histology:

1. tortuous thickened blood vessels
2. mature fat
3. smooth muscle cells which seem to eminate from blood vessel
- epithelioid cells centred around the blood vessels
if prominent may give rise to “epithelioid angiomyolipoma”
Immunohistochemistry

- muscle markers (desmin, MSA, SMA)
- melanocytic markers (HMB-45, MelanA: especially in the epithelioid cells)
- c-kit

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Hereditary Kidney Cancer

Posted on July 25, 2011 by admin

Hereditary Kidney Cancer

Hereditary renal cell tumors

VON HIPPEL-LINDAU

·    multifocal and bilateral
·    VHL tumour suppresor gene is hypermethylated or mutated
·    maps to 3p25

Features of von Hippel Lindau syndrome

- pheochromocytomas
- Hippel
- multicystic kidneys
- retinal hemangiomas, cerebellar hemangioblastomas

HEREDITARY PAPILLARY RENAL CELL CARCINOMA

·    activating mutations in the proto-oncogene c-MET
·    causes activation of a tyrosine kinase receptor involved in cellular differentiation and proliferation

BIRT-HOGG-DUBE

·    multifocal and bilateral
·    associated cutaenous lesions
·    associated chromophobe renal cell carcinoma or oncocytomas
·    BHD gene maps to 17p12 , function unknown

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Pediatric Kidney Tumors

Posted on July 25, 2011 by admin

Pediatric Kidney Tumors

Wilms tumour
- with favorable histology
- with anaplasia

Nephrogenic rests

Mesoblastic nephroma
- classic
- epithelial
- mixed

Clear cell sarcoma

Rhabdoid tumor

Papillary Renal Cell Carcinoma
Medullary Renal Cell Carcinoma

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Adult Kidney Tumors

Posted on July 25, 2011 by admin

Adult Kidney Tumors

EPITHELIAL

BENIGN:
papillary adenoma
metanephric adenoma
oncocytoma

MALIGNANT (renal cell carcinoma):
- clear cell
-multilocular cystic renal cell carcinoma
- papillary renal cell carcinoma,
- chromophobe
- collecting duct
- medullary
- mucinous tubular and spindle cell carcinoma
- X:1 translocation carcinomas
- carcinoma associated with neuroblastoma
- unclassified

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Furhman Nuclear Grading

Posted on July 25, 2011 by admin

Furhman Nuclear Grading System for Renal Cell Carcinoma

Grade    Nuclear Diameter (um)     Nuclear Outline    Nucleoli
1    10    Round, regular and uniform    absent or inconspicuous
2    15    Slightly irregular    visible at 40x
3    20    Moderate to markedly irregular    prominent, easily seen at 10x
4    20    Similar to grade 3,    bizarre, multilobated, chromatin clumps shapes     prominent easily seen at low power

***sarcomatoid pattern has a poor prognosis and are Grade 4***

***The grade assigned is that of the highest grade found, regardless of extent***

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Renal Cell Carcinoma Staging

Posted on July 25, 2011 by admin

Renal Cell Carcinoma Staging

STAGE:
1.   Tumor size < 7 cm
a.    < 4 cm
b.    4-7 cm
2.    Tumor size > 7cm
3.
a.  Tumor invades  into perinephric fat (contained by Gerota’s fascia) (may include adrenal)
b.  invades into renal vein or into inferior vena cava IVC below diaphragm
c.    into IVC wall or into IVC above diaphragm
4.    beyond Gerota’s fascia

Renal Cell Carcinoma Prognosis

Important prognostic features in renal neoplasia

- stage (are there metastases?)
- invasion histologic type
- nuclear grade (is there sarcomatoid differention?)

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Renal Cell Carcinoma Risk Factors

Posted on July 25, 2011 by admin

Renal Cell Carcinoma Risk Factors

Clinical features
·    adults, men >women
·    classic triad for presentation(10%): abdominal mass and pain, hematuria

Risk Factors:

Smoking    Male
Hypertension   Abestos
Obesity    Metals
Petrol

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Tubulo-Papillary Adenoma

Posted on July 25, 2011 by admin

Tubulo-Papillary Adenoma

·    small (1-3mm)
·    tubules/ papillary
·    benign

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Renal Tumor Differential Diagnosis

Posted on July 25, 2011 by admin

Renal Tumor Differential Diagnosis

Papillary Renal Cell Carcinoma

- these papillae have foamy macrophages
- pseudopapillae of clear cell are fibrotic secondary to ischemia
- PRCC: CK7 + (unlike clear cell)
- PRCC: no desmoplastic repsonse, unlike Collecting duct carcinoma

Chromophobe Renal Cell Carcinoma

Electron microscopy: microvesicles in chromophobe // mitochondria in oncocytoma
Hale’s Colloidal Iron: diffuse in chromophobe // negative in oncocytoma

Differential Diagnosis of clear cells in the kidney (Renal Cell Carcinoma is negative in these immunohistochemistry):

Adrenal cortical carcinoma: inhibin and Melan-A +
Clear cell carcinoma of the ovary: CA-125 and 34BE12 +
Clear cell carcinoma of the thyroid: TTF-1 and thyroglobulin +

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