Tumors of Urinary Tract

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Tumorsof Urinary Tract
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Urinary Tract Neoplasm
Kidney Renal Cell Carcinoma adult, Transitional cell carcinoma adult,
Kidney Wilms Tumor children
Ureter / Urethra Transitional Cell Carcinoma
Urinary Bladder Transitional Cell Carcinoma (common)
Urinary Bladder Uncommon is Squamous cell Carcinoma
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• Renal Tumors
• Tumors of kidney

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

• Male gt Female age 50-70 years.
• Risk
• Smoking, cadmium ( food, battery or plastic
  factory, Cigarettes)
• Acquired cystic disease, von- hippel Lindau
  syndrome ( Ch 3) .

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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

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

• Metastasis Lung and bone
• Bone produce osteolytic lesion and cause
  pathological fracture.
• Marker of bone mets. ?alkaline phosphatase

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Clinical for all RCC

• Silent
• Classic triad Hematuria, mass, pain or fever.
• Paraneoplastic syndromes
• Polycythemia ( erythropoietin) Hct gt 60
• Hypercalcemia ( PTH like hormone)
• Cushing syndrome ( ACTH)
• Feminization / Musculinization (? gonadotrophin).

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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)

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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.
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Morphology and prognosis

• Gross lobulated, tan mass
• Micro
• Blastemal cells
• Epithelial elements
• Stroma
• Prognosis
• Excellent, long term survival 90

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Morphology
Small blue blastemal cells
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Transitional cell carcinoma in renal pelvis.
Note Papillary growth irregular cauliflower
like surface. May follow acetaminophen poisoning.
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• 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.

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

• Transitional cell carcinoma
• Squamous cell carcinoma

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Transitional cell carcinoma

• Male gt female Age 40-60 years
• Risk (carcinogens)
• Smoking
• beta naphthylamine,
• Chronic cystitis
• Aniline dye.

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Types superficial (non invasive) and deep. Most
TCC are Papillary tumor, Produce cauliflower like
mass
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Cauliflower like mass
Superficial Papillary tumor
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Genes

• Superficial neoplasm (tumors)
• deletion of Ch 9
• Invasive bladder neoplasm
• Mutation of Rb and TP53 gene.

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Squamous cell carcinoma

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

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Clinical of all bladder tumor

1. Pain less hematuria
2. Urine atypical cells
3. Prognosis
4. High incidence of recurrence.
5. Depends upon grade and stage
6. Bad prognosis
7. High pleomorphism ( anaplasia) of the cells.
8. Invasion

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Angiomyolipoma.

• A hamartoma
• Micro Blood vessels, fat, smooth muscle
• Associated with tuberous sclerosis

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