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Tumorsof

Urinary Tract

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Urinary Tract Neoplasm

Kidney Renal 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

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Renal Tumors

Tumors of kidney

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Renal TumorsBenign

[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)

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Renal cell carcinoma

• Male > 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 > 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 It frequently produces obstructive features (common than metastasis).features (common than metastasis).

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Types

• Transitional cell carcinoma

• Squamous cell carcinoma

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Transitional cell carcinoma

• Male > 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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Superficial Papillary tumor

Cauliflower like mass

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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:

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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Angiomyolipoma.

• A hamartoma

• Micro: Blood vessels, fat, smooth muscle

• Associated with: tuberous sclerosis

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