1 Tumors of Urinary Tract

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

3 Renal Tumors Tumors of kidney

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

5 Renal cell carcinoma Male > Female :: age years. Risk : –Smoking, cadmium ( food, battery or plastic factory, Cigarettes) –Acquired cystic disease, von- hippel Lindau syndrome ( Ch 3).

6 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

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

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

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

10 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).

11 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 ( Ch11p13) and WT 2 (11p15). (tumor suppressor gene)

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

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

14 Morphology Small blue blastemal cells

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

16 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.

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

18 Types Transitional cell carcinoma Squamous cell carcinoma

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

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

21 Superficial Papillary tumor Cauliflower like mass

22 Genes Superficial neoplasm (tumors): –deletion of Ch 9 Invasive bladder neoplasm : –Mutation of Rb and TP53 gene.

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

24 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

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

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