This document provides an overview of tumors of the kidney and urinary tract. It begins by outlining the objectives and key topics to be covered, which include benign kidney tumors, renal cell carcinoma, Wilms tumor, and transitional cell and squamous carcinomas of the bladder. The document then covers these topics in detail over several sections, describing the histology, risk factors, clinical features, and characteristics of each tumor type. The major tumor types discussed are renal oncocytoma, angiomyolipoma, renal cell carcinoma (clear cell and papillary subtypes), Wilms tumor, and transitional cell neoplasms of the bladder.
Vasculitis
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Basavarajeeyam is a Sreshta Sangraha grantha (Compiled book ), written by Neelkanta kotturu Basavaraja Virachita. It contains 25 Prakaranas, First 24 Chapters related to Rogas& 25th to Rasadravyas.
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
The Gram stain is a fundamental technique in microbiology used to classify bacteria based on their cell wall structure. It provides a quick and simple method to distinguish between Gram-positive and Gram-negative bacteria, which have different susceptibilities to antibiotics
Basavarajeeyam is an important text for ayurvedic physician belonging to andhra pradehs. It is a popular compendium in various parts of our country as well as in andhra pradesh. The content of the text was presented in sanskrit and telugu language (Bilingual). One of the most famous book in ayurvedic pharmaceutics and therapeutics. This book contains 25 chapters called as prakaranas. Many rasaoushadis were explained, pioneer of dhatu druti, nadi pareeksha, mutra pareeksha etc. Belongs to the period of 15-16 century. New diseases like upadamsha, phiranga rogas are explained.
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
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Hemodialysis: Chapter 3, Dialysis Water Unit - Dr.Gawad
Renal pathology lecture 4 Tumors of kidney and urinary tract. Sufia Husain 2020
1. PATHOLOGY OF TUMORS OF THE
KIDNEY & URINARY TRACT
April 2020
Reference: Robbins & Cotran Pathology and Rubin’s Pathology
Sufia Husain
Associate Professor
Pathology Department
College of Medicine
KSU, Riyadh
2. OBJECTIVES
At the end of the lecture the students will be able to:
Recognize the benign tumors of the kidney.
Describe renal cell carcinoma and Wilm’s tumor.
Recognize transitional cell and squamous carcinoma of the urinary bladder.
Key Outlines:
Benign tumors of the kidney.
Renal Cell Carcinoma.
Wilm’s tumor (nephroblastoma).
Transitional Cell and Squamous Carcinoma of bladder.
3. LECTURE OUTLINE
Tumors of Kidney
Benign tumors of the kidney
Oncocytoma
Angiomyolipoma
Malignant tumors of the kidney
Renal Cell Carcinoma
Wilm’s tumor (nephroblastoma)
Tumors of urinary tract
Transitional cell neoplasms of urinary bladder
Squamous cell carcinoma of urinary bladder
6. RENAL
ONCOCYTOMA
Benign tumors that arises from the
intercalated cells of the collecting ducts in
the kidney.
Grossly: well circumscribed mahogany-brown
colored tumor with a central stellate scar.
Microscopically: they are composed of
uniform round polygonal cells with abundant,
intensely eosinophilic and granular cytoplasm
with uniform round and central nuclei. These
cells are called as oncocytes or oncocytic
cells.
Electron microscopy: there are numerous
mitochondria in the cytoplasm.
Radiologically: they mimic renal cell
carcinoma.
Complications: spontaneous hemorrhage.
Ali et al. Annals of Saudi Medicine, Vol 4 No. 4; 1984
7. ANGIOMYOLIPOMA
Angiomyolipomas benign neoplasm
composed of admixture of blood
vessels, smooth muscle and adipose
tissue
The amount of each component is
variable
They are usually associated with
tuberous sclerosis syndrome.
http://www.histopathology.guru/wp-content/uploads/2018/05/DSCN3356-p-1024x768.jpg
8.
9. RENAL CELL CARCINOMA
(RCC) Renal cell carcinoma is the most common primary cancer of the kidney. It accounts
for 80% of all renal cancers.
It arises from renal tubular epithelial cells.
Seen in men ranging from 50-60 years of age.
Men affected more than women.
Types of RCC
TYPES OF RCC FREQUENCY (%)
Clear cell type 65%
Papillary type 10-15%
Chromophobe type 5%
Others 15%
10. Risk factors include:
Tobacco (smoked or chewed).
Acquired cystic kidney disease due to end stage renal disease they predispose to
papillary RCC (as a complication of chronic dialysis)
Chronic hypertension
Obesity
Occupational exposure to cadmium
Genetic: about 5% are inherited. Hereditary RCCs tend to be multifocal & bilateral &
appear at a younger age than sporadic RCC.
Hereditary clear cell RCC associated with Von Hippel-Lindau (VHL) Syndrome in
which there is an autosomal dominant germline mutation of VHL gene at chromosome
3 (VHL syndrome is characterized by cerebellar hemangioblastomas, retinal angiomas,
clear cell RCC, pheochromocytoma and cysts in kidney).
Hereditary papillary RCC associated with mutations in the c-MET protooncogene at
chromosome 7. There is no association with the VHL gene.
11. RCC: CLEAR CELL TYPE
These are the most common type and arises from
proximal tubular epithelial cells.
The majority of them are sporadic. Uncommonly
associated with VHL disease.
Gross:
usually solitary and large.
cut surface: well circumscribed solid
heterogenous partly yellow and partly
hemorrhagic mass. May be cystic and necrotic.
Tumor commonly invades the renal vein. There
may be direct invasion into the perinephric fat and
adrenal gland.
http://web2.airmail.net/uthman/specimens/images/renal_cell_ca.ht
ml
12. RCC: CLEAR CELL TYPE
Microscopically:
Tumor is made up of cells with
clear cytoplasm and sharp cell
membrane. The cells are often
arranged in sheets or nests. The
stroma is highly vascularized. The
nuclei can range from no atypia to
marked atypia/pleomorphism.
Some tumors exhibit marked
degrees of anaplasia.
https://upload.wikimedia.org/wikipedia/commons/thumb/6/6d/Renal_clear_cell_ca_%281%29_Nephrecto
my.jpg/1591px-Renal_clear_cell_ca_%281%29_Nephrectomy.jpg
13. RCC: papillary cell type
The tumors have a papillary growth pattern.
They can be sporadic or familial.
The familial forms are uncommon and show mutation in the MET proto-oncogene.
RCC: chromophobe cell type
The tumors are made up of chromophobic cells (they are acidophilic granular cells).
Note: papillary and chromophobe RCCs have a better prognosis than the clear cell
RCC.
14. RCC: CLINICAL
FEATURES
The incidence of RCC peaks in the sixth decade.
RCC is twice as frequent in men as in women.
Hematuria is the single most common presenting sign.
The classic clinical triad hematuria, flank pain and a palpable abdominal mass.
Some patients develop polycythemia.
Uncommonly, these tumors produce paraneoplastic syndromes e.g. [a] secretion
of a parathormone-like substance leads to hyperparathyroidism and
hypercalcemia; [b] production of erythropoietin causes erythrocytosis,
polycythemia; [c] release of renin results in hypertension [d] may present with
Cushing syndrome, masculinization.
These tumor have a high tendency to invade the renal vein and metastasize.
Sometimes RCC is a silent and discovered only after metastasis.
The tumor spreads most frequently to the lungs and bones
15.
16. WILMS TUMOR
(NEPHROBLASTOMA)
It is malignant tumor arising from embryonic nephrogenic elements. It is
composed of mixtures of blastemal, stromal, and epithelial cells.
The precursor lesion for the Wilms tumor is called as nephrogenic rests.
It is the most common primary tumor of the kidney in children
Most cases of Wilms tumor are sporadic and unilateral.
Some cases of Wilms tumor are familial with deletion of WT1 gene on
chromosome 11p13.
Can be associated with WAGR syndrome, Denys Drash syndrome and
Beckwith weidmann syndrome.
17. WILMS TUMOR:
MORPHOLOGY
Gross:
Unilateral (10% bilateral), solitary, well circumscribed
lesion.
By the time Wilms tumor is detected it is large.
Cut section: uniform, pale gray and soft in consistency
(Fish flesh like)
The tumor may show foci of hemorrhage, cystic
degeneration & necrosis
18. WILMS
TUMOR:
Microscopy:
It is composed of the classical triphasic combination of:
1. Blastemal component: composed of densely packed small
round blue cells with scanty cytoplasm and brisk mitosis
2. Epithelial component: composed of immature primitive
tubular structures (rosettes) and immature glomeruli.
3. Stromal component: composed of loose immature stroma
of undifferentiated mesenchymal cells (i.e. immature
spindle cells and myxoid material).
Biphasic and monophasic patterns can also occur.
5% of tumors contain foci of anaplasia. Anaplasia is an
indication of poor prognosis.
http://www.histopathology.guru/wp-content/uploads/2018/06/wilms-tumor-300x207.jpg
19. By Nephron - Own work, CC BY-SA 3.0, https://commons.wikimedia.org/w/index.php?curid=14818887
20. WILMS TUMOR:CLINICAL
FEATURES
Clinical features
Wilms tumor usually presents between 1 and 3 years of age, and 98% occur before
10 years of age.
Abdominal mass (commonest sign)
Hematuria
Pain abdomen
Hypertension
Treatment and prognosis
Chemotherapy and radiation therapy combined with surgical resection, have
dramatically improved the outlook of patients with this tumor.
The prognosis for Wilms' tumor is generally very good
23. TUMORS OF THE LOWER
URINARY TRACT
• Tumors in the collecting system above the bladder are relatively uncommon
• A small lesion in the ureter may cause urinary outflow obstruction and have
greater clinical significance than a much larger mass in the large capacious
bladder.
• The types of urothelial tumors include the following:
Non invasive papillary lesions
Papilloma (benign)
PUNLMP (borderline)
Noninvasive papillary urothelial carcinoma low grade (malignant)
Noninvasive papillary urothelial carcinoma high grade (malignant)
Non invasive flat lesions
Flat urothelial carcinoma in situ
Invasive urothelial carcinoma.
24. PAPILLOMA
are rare and benign.
They are non-invasive papillary tumor lined by
benign transitional epithelium.
Usually solitary
Do not recur once removed.
25. PAPILLARY UROTHELIAL NEOPLASM OF LOW
MALIGNANT POTENTIAL (PUNLMP)
o Uncommon.
o They are non-invasive papillary tumors with nuclear
features intermediate between papilloma and low grade
papillary urothelial carcinomas
o They may recur after removal.
26. Non-invasive papillary tumors made up of papillary projections lined
by malignant urothelial cells with mild atypia/ pleomorphism and mild
mitotic activity.
By CoRus13 - Own work, CC0, https://commons.wikimedia.org/w/index.php?curid=72016202
NONINVASIVE PAPILLARY UROTHELIAL CARCINOMA LOW
GRADE
27. Non-invasive papillary tumor made up of papillary projections lined by poorly differentiated
malignant urothelial cells with marked atypia/ pleomorphism and significant (brisk) mitotic activity.
Majority of high grade papillary urothelial carcinomas progress and they invade into the
underlying lamina propria and the muscularis propria becoming invasive urothelial carcinoma.
NONINVASIVE PAPILLARY UROTHELIAL CARCINOMA
HIGH GRADE
28. UROTHELIAL
CARCINOMA IN SITU
o Non-papillary, non-invasive flat lesions.
o Tend to be multifocal.
o There is the full-thickness dysplasia of
the urothelium (hyperchromatic and
pleomorphic cells with prominent
nucleoli).
o There may be excessive shedding of
malignant cells in urine.
o In about 50% of cases it is associated
with subsequent invasion into the
underlying lamina propria and the
muscularis propria becoming invasive
urothelial carcinoma.
29. INVASIVE UROTHELIAL
CARCINOMA
Invasive urothelial carcinoma usually
progresses from
High grade papillary urothelial
carcinoma
and flat urothelial carcinoma in
situ.
Microscopically, the tumor cells
infiltrate beyond the basement
membrane into the underlying tissue
(the lamina propria and muscularis
propria i.e. the detrusor muscle) in
the form of irregular nests, lobules
and single cells. @andreafelso @ofpathology
https://gramho.com/profile/ffix_it/23398923249
30. UROTHELIAL CARCINOMA
More common in men.
Age: 50 to 70 years.
Predisposing factors:
Bladder tumors are more common in those exposed to chemicals called aromatic amines
(arylamines) such as benzidine and beta-naphthylamine, which are sometimes used in the
dye industry (aniline and Azo dyes).
Cigarette smoking and chronic cystitis
Chronic bladder irritation from stones or long term bladder catheters
Chemotherapy (long-term use of cyclophosphamide) and
Radiotherapy (previous exposure of the bladder to irradiation)
They are not familial.
Clinical Features
Painless hematuria is the dominant clinical presentation of all these tumors and less
frequently as dysuria. Cystoscopy reveals the tumor.
Bladder cancers vary from exophytic, flat, ulcerated to deeply invasive.
Bladder cancer metastasize to regional lymph nodes, liver, lung, and bone.
31. NON-UROTHELIAL
CARCINOMAS OF THE
LOWER URINARY TRACT
are rare and have very poor prognosis.
Squamous cell carcinoma.
Adenocarcinoma.
Small cell neuroendocrine carcinoma.
Sarcomas (leiomyosarcoma, rhabdomyosarcoma)
Metastatic (from cervix, prostate etc).
32. Squamous cell carcinoma of the bladder develops in foci of squamous
metaplasia.
Long standing Schistosoma haematobium infections can predispose to
squamous cell carcinoma of the urinary bladder.