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Common tumours of urinary tract

Wilms’ Tumor (Nephroblastoma)
1. Paediatric tumour
2. derived from nephrogenic blastemal cells
3. Pathogenesis
  1. WAGR complex (syndrome)
    1. Loss of one WT-1 gene (11p13)
      1. abnormal kidney development
  2. Denys-Drash syndrome
    1. WT1 gene
      1. Nephrotic syndrome, gonadal dysgenesis, genital dysgenesis
  3. Beckwith-Wiedemann syndrome
    1. gene WT2
      1. Organomegaly, exomphalos, hemihypertrophy
4. Clinical
  1. Palpable mass
  2. Mild hypertension
  3. excellent prognosis
5. Macroscopic
  1. large single well-circumscribed ,solid white
  2. Necrosis & cysts
6. Microscopic
  1. Blastema
  2. loose myxoid, skeletal muscle, cartilage , smooth muscle
  3. epithelial -- small tubules or cysts
    1. Primitive rosette- like structures
  4. Biphasic and monophasic patterns
Renal cell carcinoma
1. adults
  1. Old age
  2. Male
2. Clinical
  1. Hematuria Costovertebral pain Palpable mass
  2. Polycythemia, hypercalcemia, hypertension, hepatic dysfunction
  3. Risk Factors
    1. Smoking
    2. Von Hippel-Lindau Syndrome
    3. Hereditary (familial) clear cell carcinoma
    4. Hereditary papillary carcinoma
  4. Macroscopic
    1. yellow/white with areas of haemorrhage
    2. necrosis with fibrosis or cyst formation
    3. invade renal vein
3. Types
  1. Clear cell carcinoma (80%)
    1. Loss of one VHL gene
    2. mutation of VHL
    3. cells are polygonal and large with clear cytoplasm due to accumulation of lipid and glycogen
  2. Papillary carcinoma
    1. MET mutation
    2. psammoma bodies
    3. papillae likes
  3. Chromophobe renal cell carcinoma
    1. Multiple chromosome losses (not 3p)
    2. Arises from intercalated cells of collecting ducts
    3. Good prognosis
    4. eosinophilic cells with perinuclear halos
  4. Collecting duct carcinoma (Bellini duct carcinoma)
    1. Aggressive
    2. younger adults
4. Blood spread most often to lungs (50%)
5. staging
Tumours of urinary bladder
1. epithelial origin
2. Urothelial carcinoma
  1. Second most common
  2. old male
3. Risk Factor
  1. Smoking
    1. Carcinogens in tobacco become concentrated in the urine and eventually damage the bladder lining
  2. Chronic inflammation
    1. Schistosoma haematobium
      1. squamous cell carcinoma of bladder
  3. Medicine
    1. cyclophosphamide
    2. Phenacetin
4. Clinical Features
  1. Painless haematuria
  2. Increased frequency
  3. Diagnosis
    1. urinary cytology
    2. CT or MRI
      1. lymph node
    3. Cystoscopy
5. Macroscopic
6. Inverted urothelial papilloma
7. Urothelial papilloma
8. Invasive urothelial carcinoma
9. Cytology

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Common tumours of urinary tract

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	Created by Zulhilmi Zainal about 10 years ago