The document reviews the pathology of kidney tumors, detailing both benign tumors like angiomyolipoma and oncocytoma, as well as malignant tumors such as renal cell carcinoma and Wilms tumor. It discusses the characteristics, genetic factors, and risk factors associated with renal tumors, highlighting the clinical features and morphology of each type. Additionally, it poses a clinical case and related questions to test understanding of the content.

1. KIDNEY
TUMORS
Pathology

2. RENAL TUMORS
Benign tumour
•1.Angiomyolipoma
•2.Oncocytoma
•3.Renal papillary
adenoma
Malignant tumour
•1. Renal cell
carcinoma
•2. Wilms tumour

3. BENIGN TUMORS
qNon-cancerous growths of the kidney that do
not metastasize to other sides of the body.
qNot life threatening but can cause complaints if
they exert pressure

4. ANGIOMYOLIPOMA
q Consists of vessels , smooth muscles and fat
q Originates from perivascular epithelioid cells
q Present in 25-50% of patients with tuberous sclerosis
q Caused by loss of function mutation in TSC1 or TSC2 (TSG)

5. q Tuberous sclerosis is characterised by -
q Lesions of cerebral cortex that produce epilepsy and mental
retardation
q Skin abnormalities
q Clinical importance = Susceptibility to spontaneous
haemorrhage.

7. ONCOCYTOMA
q Epithelial neoplasm
q Composed of large eosinophilic cells having
q Small
q Round
q benign
appearing nuclei that have large nucleoli.
q Arises from intercalated cells of collecting ducts.

8. GROSS APPEARANCE:
q Tumors are tan or
Mahogany Brown.
q Relatively homogenous
q Usually well encapsulated
with central scar
H/E
q Polygonal cells with
abundant eosinophilic
granular cytoplasm
q Excess of mitochondria

9. RENAL
PAPILLARY
ADENOMA
qVery rare
qPresents as a
yellow plaque
qPapillary
configuration on
microscopy

10. MALIGNANT TUMORS

11. RENAL CELL
CARCINOMA
INTRODUCTION
•More often in older
individuals (6th and 7th
decades of life)
•2:1 male
preponderance
•a/k/a
•Grawitz tumor
•Adenocarcinoma
•Hypernephroma

12. RISK FACTORS
Tobacco Obesity Hypertension
Asbestos,
petroleum
products,
heavy metals
End stage
renal disease
Chronic
kidney
disease
Acquired
cystic disease
Tuberous
sclerosis

14. GENETICS OF RCC
1. VHL gene on chr 3p
•Autosomal dominant
•Risk of clear cell cancer
2. HLRCC
•Hereditary
leiomyomatosis
•Mutation in fumarate
hydratase gene
•Risk of papillary cell
carcinoma

15. 3. HPRCC
•Hereditary
papillary RCC
•Mutation in
MET gene
•Hepatocyte
growth factor
increased
expression
4. Birt Hogg
Dube syndrome
•Due to
mutation in
BHD gene
•Encodes for
folliculin
•Increase risk
of
chromophobe
cancer
5. Other
•Hypodiploidy
•Loss of y-
chromosome
•Trisomy 7, 17

16. PARANEOPLASTIC SYNDROME
Increase
ESR
Anemia
Polycythaemia Leukemoid
reaction
Non
metastatic
hepatic
dysfunction
Amyloido
sis
Increase in
calcium ions
feminisation/
masculanizati
on
Cushing
syndrome

17. TYPES OF RCC
BASED ON- CORRELATIVE CYTOGENETIC, GENETIC AND HISTOLOGIC STUDIES-
q Clear cell RCC
q Papillary RCC
q Chromophobe RCC
q Collecting duct
q XP 11 translocation carcinoma

21. COLLECTING DUCT CARCINOMA

22. WILMS
TUMOR
q Age - 2-5 years
q a/k/a Neuroblastoma
q Genetic-
q Loss of function mutation in-
§ WT1 on ch. 11p13
§ WT2 on ch. 11p15
q Presence of anaplasia - mutation of
tp53 mutation
q emergence of risk to chemotherapy
(unresponsiveness of anaplastic cells
to cytotoxic chemotherapy)

23. MORPHOLOGY
q Large solitary well
circumscribed mass
q Soft homogenous tan to grey
with occasional foci of
hemorrhage cyst formation
and necrosis

24. TRIPHASIC
COMBINATION-
MICROSCOPY
Blastemal cells
Stromal cells
Epithelial cells

25. CLINICAL
FEATURES
qLarge abdominal mass
qHaematuria
qPain in abdomen after traumatic
incidence
qIntestinal obstruction
qAppearance of hypertension

30. CASE: A 15 YEAR OLD GIRL
WITH SICKLE CELL TRAIT
PRESENTED WITH GROSS
HEMATURIA, FLANK PAIN
AND LYMPHADENOPATHY.
SHE IS DIAGNOSED AS A
CASE OF RCC. NAME THE
TYPE OF RCC SHE IS LIKELY
TO HAVE?
A. Medullary
B. Papillary
C. Chromophobe
D. Colloid

31. Q. ACQUIRED CYSTIC DISEASE OF
KIDNEY ASSOCIATED WITH
A. Xantho-granulomatous
Pyelonephritis
B. Dialysis
C. Renal Stones
D. Renal Dysplasia

32. Q. TRUE STATEMENT ABOUT
RCC
A. ASBESTOS, SICKLE CELL
ANEMIA & PETROLEUM
PRODUCTS ARE RISK
FACTORS
B. CLEAR CELL CANCER ARISE
FROM PCT
C. CANNON BALL METASTASIS
D. BELLINI DUCT ARISE FROM
FROM LOOP OF HENLE
1. A,B,D are true
2. A,C,D are true
3. Only A & D are true
4. A,B,C are true

33. Q. IN WHICH OF THE
FOLLOWING
CONDITION
,ANIRIDIA AND
HEMI-
HYPERTROPHY ARE
MOST LIKELY TO
PRESENT ?
A. Neuroblastoma
B. Wilm’s Tumor
C. Non- Hogkin Lymphoma
D. Germ Cell Tumor

34. THANK YOU