UG renal pathophysiology summary
Small cortical papillary adenoma
Less than 0.5 cm in diameter
Found in up to 40% of adults in autopsies ✔✔Name an example of a benign renal
neoplasm, its size and how common is it?
Most common malignant neoplasm: renal cell carcinoma
The second most common type of tumor: nephroblastoma (wilms tumor) ✔✔What are
the most common and second most common renal tumors?
The intercalated cells of the collecting ducts ✔✔Oncocytoma is a benign neoplasm that
arises from:
10% ✔✔Oncocytoma represents ___% of renal neoplasms
Loss of chromosome 1 and Y ✔✔Oncocytoma is associated with which chromosomal
abnormalities?
Oncocytomas are characterized by a plethora of mitochondria causing tan color, and
finely granular eosinophilic cytoplasm seen histologically
A central stellate scar is also a characteristic feature. ✔✔Describe the morphology of
oncocytomas?
Renal cell carcinomas are located predominantly in the cortex ✔✔Moving to renal cell
carcinomas
Are they more common in the cortex or medulla?
Renal cell carcinomas represent 80-85% of all primary malignant neoplasms of the
kidney and 2-3% of all cancers in adults.
Renal cell carcinomas present most commonly in the 6th to 7th decade, and it's more
common in males. ✔✔Describe the incidence of renall cell carcinoma and in which
demographics is it more prevalent?
Smoking
HTN
Obesity
Occupational exposure to cadmium
Acquired polycystic renal disease (30x) (remember what we said about cysts due to
dialysis)
Genetic ✔✔What are the risk factors of renal cell carcinoma?
, Clear cell carcinoma, representing 65% of renal cell canrcinomas ✔✔The most common
type of renal cell carcinomas is:
Usually solitary and large
May arise anywhere in the cortex
The cut surface is yellow to orange to gray-white, with prominent areas of cystic
softening or hemorrhage
The margins of the tumor are initally well defined, but local invasion happens with tumor
progression
Depending on the amount of lipid and glycogen, the neoplastic cells may appear almost
vacoulated (demaracted only by their cell membranes) or may be solid
The nuclei are usually small and round ✔✔Describe the morphology of clear cell
carcinoma. (Part1)
The tumor cells can be granular resembling tubular epithelium with small, round, regular
nuclei and granular pink cytoplasm
The stroma is usually scant but highly vascularize
Highly anaplastic tumors show numerous mitotic figures and enlarged, hyperchromatic,
pleomorphic nuclei
Usually solitary, spherical masses 3-15 cm in diameter, anywhere in the cortex
(dont look at me i didnt come up with this) ✔✔Describe the morphology of clear cell
carcinoma (part2)
Yes, the tumor invades the renal vein and grows as a solid column within the vessel,
extending in a serpentine fashion as far as the IVC and even into the right side of the
heart.
Clear cell carcinoma can invade the perinephric fat and adrenal gland too ✔✔Can clear
cell carcinoma invade the venous system?
von Hippel-Lindau disease ✔✔Most clear cell carcinomas are sporadic, but some occur
in familial forms or in association with:
Autosomal dominant ✔✔What is the mode of VHL inheritance?
1- predisposition to hemangioblastomas of the cerebellum and retina
2- bilateral renal cysts and bilateral multiple clear cell carcinomas (in 40-60% of affected
individuals) ✔✔What is VHL characterized by?
Mutation in the chromosomal band 3p25
The second allele is lost by somatic mutation or hypermethylation in 60% of sporadic
cases ✔✔Name the germline mutation inherited in VHL disease?
Causes degradation of hypoxia induced factors (HIF) ✔✔What does the VHL protein
normally do?
Small cortical papillary adenoma
Less than 0.5 cm in diameter
Found in up to 40% of adults in autopsies ✔✔Name an example of a benign renal
neoplasm, its size and how common is it?
Most common malignant neoplasm: renal cell carcinoma
The second most common type of tumor: nephroblastoma (wilms tumor) ✔✔What are
the most common and second most common renal tumors?
The intercalated cells of the collecting ducts ✔✔Oncocytoma is a benign neoplasm that
arises from:
10% ✔✔Oncocytoma represents ___% of renal neoplasms
Loss of chromosome 1 and Y ✔✔Oncocytoma is associated with which chromosomal
abnormalities?
Oncocytomas are characterized by a plethora of mitochondria causing tan color, and
finely granular eosinophilic cytoplasm seen histologically
A central stellate scar is also a characteristic feature. ✔✔Describe the morphology of
oncocytomas?
Renal cell carcinomas are located predominantly in the cortex ✔✔Moving to renal cell
carcinomas
Are they more common in the cortex or medulla?
Renal cell carcinomas represent 80-85% of all primary malignant neoplasms of the
kidney and 2-3% of all cancers in adults.
Renal cell carcinomas present most commonly in the 6th to 7th decade, and it's more
common in males. ✔✔Describe the incidence of renall cell carcinoma and in which
demographics is it more prevalent?
Smoking
HTN
Obesity
Occupational exposure to cadmium
Acquired polycystic renal disease (30x) (remember what we said about cysts due to
dialysis)
Genetic ✔✔What are the risk factors of renal cell carcinoma?
, Clear cell carcinoma, representing 65% of renal cell canrcinomas ✔✔The most common
type of renal cell carcinomas is:
Usually solitary and large
May arise anywhere in the cortex
The cut surface is yellow to orange to gray-white, with prominent areas of cystic
softening or hemorrhage
The margins of the tumor are initally well defined, but local invasion happens with tumor
progression
Depending on the amount of lipid and glycogen, the neoplastic cells may appear almost
vacoulated (demaracted only by their cell membranes) or may be solid
The nuclei are usually small and round ✔✔Describe the morphology of clear cell
carcinoma. (Part1)
The tumor cells can be granular resembling tubular epithelium with small, round, regular
nuclei and granular pink cytoplasm
The stroma is usually scant but highly vascularize
Highly anaplastic tumors show numerous mitotic figures and enlarged, hyperchromatic,
pleomorphic nuclei
Usually solitary, spherical masses 3-15 cm in diameter, anywhere in the cortex
(dont look at me i didnt come up with this) ✔✔Describe the morphology of clear cell
carcinoma (part2)
Yes, the tumor invades the renal vein and grows as a solid column within the vessel,
extending in a serpentine fashion as far as the IVC and even into the right side of the
heart.
Clear cell carcinoma can invade the perinephric fat and adrenal gland too ✔✔Can clear
cell carcinoma invade the venous system?
von Hippel-Lindau disease ✔✔Most clear cell carcinomas are sporadic, but some occur
in familial forms or in association with:
Autosomal dominant ✔✔What is the mode of VHL inheritance?
1- predisposition to hemangioblastomas of the cerebellum and retina
2- bilateral renal cysts and bilateral multiple clear cell carcinomas (in 40-60% of affected
individuals) ✔✔What is VHL characterized by?
Mutation in the chromosomal band 3p25
The second allele is lost by somatic mutation or hypermethylation in 60% of sporadic
cases ✔✔Name the germline mutation inherited in VHL disease?
Causes degradation of hypoxia induced factors (HIF) ✔✔What does the VHL protein
normally do?
