Term
| what is the most common renal tumor? |
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Definition
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Term
| who do renal cell carcinomas affect more commonly? what are risk factors associated with it? |
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Definition
| renal cell carcinomas affect males more commonly, and smoking/HTN are risk factors |
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Term
| how do pts with renal cell carcinoma present? |
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Definition
| *hematuria, *flank pain, *abdominal mass, (classic triad) weight loss, anemia and fever |
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Term
| how can renal cell carcinoma be associated with anemia or polycythemia? |
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Definition
| the cancer itself may cause anemia, but if the cancer affects part of the kidney that produces erythropoietin - then polycythemia may occur |
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Term
| what are endocrine effects of renal cell carcinoma? |
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Definition
| hypercalcemia, HTN, gynecomastia, polycythemia, cushing syndrome |
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Term
| how can a renal cell carcinoma cause hypercalcemia? |
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Definition
| this is due to production of a parathyroid-like hormone, and the resulting hypercalcemia would likely cause metastatic calcification |
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Term
| how can a renal cell carcinoma cause HTN? |
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Definition
| this is due to renin overproduction |
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Term
| how can a renal cell carcinoma cause gynecomastia? |
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Definition
| this is due togonadotropin and placental lactogen production |
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Term
| how can a renal cell carcinoma cause polycythemia? what are possible complications of this? |
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Definition
| this is due to erythropoietic stimulating substance. complications of polycythemia include increased clotting/thrombi, occlusion of microvasculature, predisposure to ischemias, strokes, gangrene, headaches, and eye problems |
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Term
| how can a renal cell carcinoma cause cushing syndrome? |
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Definition
| this is due to production of an ACTH-like substance. cushing = moon face, buffalo hump, truncal obesity, purple striae, and muscle wasting |
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Term
| von hippel-lindau diseases cause renal cell carcinoma, what else can it cause? what causes von hippel-lindau disease? |
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Definition
| yes as well as CNS and retinal hemangioblastomas, cysts of the kidney, liver, pancrease, clear cell tumors, and pheocytomas. von hippel-lindau disease is a result of a mutation of tumor supressor gene 3p25-5 |
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Term
| when is renal cell carcinoma an more of a risk as an aquired disease? |
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Definition
| pts on dialysis, and those with: adult polycystic kidney disease, tuberous sclerosis, neuroblastomas, and lymphoma |
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Term
| what part of the kidney is usually affected by renal cell carcinomas? |
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Definition
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Term
| do pts with renal cell carcinomas still have relatively normal kidney function? |
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Definition
| yes - though there is hematuria |
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Term
| what is a frequent route of dissemination in renal cell carcinoma? |
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Definition
| *if the CA gains access to the renal vein* IVC syndrome may follow. this is an exception to the rule that most CAs metastasize via lymphatics, as this one spreads hematogenously |
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Term
| what are the different subtypes of renal cell carcinoma? |
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Definition
| clear cell carcinoma, papillary carcinoma, chromophobe renal carcinoma, and collecting duct carcinoma |
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Term
| what is the most common subtype of renal cell carcinoma? how is it acquired? |
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Definition
| the clear cell type, which is non papillary and has a clear or granular cytoplasm. it can be acquired familially or sporadically |
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Term
| what is a genetic abnormality common to clear cell renal cell carcinomas? |
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Definition
| most clear cell CA have a *loss of sequences on the short arm of chr 3* |
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Term
| what are the growth patterns seen with clear cell renal cell carcinoma? |
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Definition
| solid to trabecular (bridge-like) to tubular |
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Term
| what do cells look like in clear cell renal cell carcinoma? |
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Definition
| the cells have a rounded or polygonal shape with abundant cytoplasm which contain glycogen and lipids |
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Term
| what does the vasculature look like in clear cell renal cell carcinoma? |
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Definition
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Term
| what is the growth pattern of papillary renal cell carcinoma? what do the cells look like? are there particular bodies present? what is vascularization like? |
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Definition
| there is a papillary growth pattern. cells are cuboidal. psammoma bodies may be present (round collections of calcium). there is a high level of vascularization. |
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Term
| what are the genetics of papillary renal cell carcinoma? |
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Definition
| there are sporadic and family types. papillary renal cell carcinoma is associated with trisomy 7, 16, and 17, loss of Y in males (sporadic form), and a mutated and activated MET a protooncogene on chr 7. |
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Term
| can papillary renal cell carcinomas be multifocal? |
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Definition
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Term
| what are chromophobe renal cell carcinomas associated with? where in the kidney do they grow? how do they appear? |
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Definition
| multiple chromosomal losses. chromophobe renal cell carcinomas grow from the collecting ducts and have prominent nuclear membranes, pale eosinophilic cytoplasms, and a halo around the nucleus. they grow from collecting duct cells and are highly vascularized |
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Term
| what is the most rare of the renal cell carcinomas? how does it appear? from where do they arise? |
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Definition
| the collecting duct renal cell carcinoma which appear as irregular channels lined by atypical cells enmeshed in *fibrotic stroma. these arise from the collecting duct cells in the medulla. |
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Term
| how do collecting duct renal cell carcinomas appear grossly? |
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Definition
| chalky white - an indication of fibrosis |
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Term
| can renal cell carcinomas metastasize before local signs or symptoms? how do they metastasize? where are common sites of spread? |
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Definition
| yes, they can metastasize via lymphatics or directly to the renal vein and process to the vena cava w/a poorer prognosis. the lungs and bone are common sites of spread. renal cell carcinomas may remain silent until they reach a large size. |
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Term
| how does a renal papillary adenoma appear? are they malignant? where are they found in the kidney? |
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Definition
| renal papillary adenomas are small (couple of mm), pale yellowish, well circumscribed, usually in the cortex, consist of polygonal cells w/no atypia and may be multiple. |
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Term
| how do oncocytomas appear? what genetics are involved? do they metastasize? how are they treated? |
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Definition
| oncocytomas tend to have a mahogany brown color w/central stellate scar, they can be large, and have abundant granular cytoplasms with small, round and regular nuclei. they may have deletions in chr 10, can usually be cured by nephrectomy and occasionally have metastasis |
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Term
| what is a angiomyolipoma composed of? who are they found in? what can angiomyolipomas result in? what is the association between angiomyolipomas and tuberous scelerosis? |
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Definition
| angiomyolipomas are composes of adipose, smooth muscle and blood vessels. they are found mostly in adults and may result in massive hemorrhage and possible death. *1/3 of pts with angiomyolipoma have tuberous sclerosis* |
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Term
| how do angiomylipomas appear? how prevalent is capsular invasion? |
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Definition
| angiomyolipomas are usually grossly yellow, multinucleated and have a perivascular epitheloid cell - which has an intimate relationship with blood vessels (and predispose to some hemorrhage). capsular invasion is present in 1/4 of cases. |
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Term
| what is treatment for angiomyolipomas? can angionmylipomas cause death? metastazise? |
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Definition
| sx, which is usually curative. death can occur from massive local recurrence and distant metastasis is possible |
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Term
| what is transitional cell carcinoma associated with? what is the most common cinical feature? how do they appear? |
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Definition
| transitional cell carcinoma (line ureters/bladder) is associated with analgesic abuse and/or renal papillary necrosis in 1/3 of cases. painless hematuria is the most common clinical feature and it can form soft grayish red masses that may diffusely involve the entire renal pelvis and can extend down the entire ureter. |
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Term
| can transitional cell carcinoma lead to bladder infection or pyelonephritis |
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Definition
| yes, they can produce this b/c there is stasis |
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Term
| what can cause acute and chronic cystitis? how do pts w/it present? |
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Definition
| e coli and proteus, cytotoxic antitumor drugs, radiation, and trauma can all lead to acute and chronic cystitis. pts w/this present with lower abdominal pain and dysuria |
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Term
| what makes up 90% of the primary tumors of the bladder? who does this affect? how does it present? what is the prognosis? |
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Definition
| transitional cell carcinoma, which affects mainly males over 50, who present with hematuria. prognosis is based on stage |
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Term
| what are the 4 types of transitional cell CA in the bladder? |
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Definition
| papillary, invasive papillary, flat noninvasive, flat invasive |
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Term
| what is the main danger w/transitional cell carcinoma in the bladder? |
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Definition
| the invasive type can subtly invade the mucosa |
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