Tumours of Kidney & Urothelial Tract

What is Intermittent frank haematuria

Occasional, visible presence of blood in the urine

Name 3 Malignant neoplasms of the kidney

– Renal cell carcinoma (RCC)

– Metastasis to kidney

– Urothelial cell carcinoma (UCC) of renal pelvis

Name 3 benign neoplasms of the kidney

– Papillary adenoma

– Oncocytoma

– Angiomyolipoma

Name 2 other ddx for mass in kidney

Abscess

Xanthgranulomatous pyelonephritis

What imaging can be used for RCC

– Ultrasound

– CT

What happens between imaging & surgery for RCC

Generally nothing - biopsy generally not done so diagnosis is confirmed after surgery

Classic triad for RCC

Frank haematuria, ± flank pain, mass

Where would RCC metastasise to generally

Mets to lung, bone, mediastinum, CNS, thyroid…

What % of RCC present as each of these

Name some other Sx of RCC

Polycythaemia, hypertension, hypercalcaemia, cushings, anaemia

Name 7 Risk Factors for RCC

• Smoking

• Obesity

• Dialysis

• Hypertension

• Arsenic and inorganic compound, cadmium exposure

• Ionizing radiation

• Family history

Name main 2 RCCs

Clear Cell RCC (CC-RCC)

Papillary RCC (P-RCC)

What % of RCCs are Clear Cell RCC (CC-RCC)

80%

What % of RCCs are Papillary RCC (P-RCC)

10-15%

Name some other RCCs

chromophobe 6%

collecting duct <1%

Tubulo cystic

Acquired Cystic

Disease Associated RCC

Xp11

Macro features of Clear Cell– RCC (CC-RCC)

Clear Cell RCCs arise from what

PCT (proximal convoluted tubule)

Describe histology of Clear Cell RCC

Nests of clear cells (containing lipid and glycogen) (PAX8 positive)

Clear Cell RCCs are graded based on what system & with how many grades

Fuhrman system; Grade 1-4

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Von Hippel Lindau Syndrome has germ line mutations in VHL gene and has what inheritance pattern

autosomal inheritance

Name 4 tumours associated with Von Hippel Lindau Syndrome

– Angiomas of retina

– Renal CCC

– Haemangioblastomas of CNS

– Pheochromocytoma

Give a feature of Von Hippel Lindau Syndrome

Café au lait spots

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What is Angiomyolipoma

Benign neoplasm

Composition of Angiomyolipoma

Contains blood vessels (angio) smooth muscle (myo) & fat (lipoma)

2 causes of Angiomyolipoma

Sporadic or in tuberous sclerosis

What could a Angiomyolipoma do that could make the patient unstable

Tendency to bleed

6 common causes of frank haematuria

• Neoplasia (benign, malignant)

• Inflammatory (& reparative) (Stones, infection, iatrogenic)

• Hyperplasia (e.g. prostate)

• Trauma

• Medical renal

• Medication

4 investigations for frank haematuria

• Urine for cytology and c/s

• Cystoscopy ± ureteroscopy ± biopsy

• IVP

• CT abdomen

Give 1 Ddx for this presentation:

• Male 60 yrs

• Smoker

• Frank haematuria

• Dysuria

• Urgency

Urothelial Cell Carcinoma (UCC)

Where can Urothelial Cell Carcinoma arise & where is most common

– Renal pelvis

– Ureter

– Bladder (commonest site)

– Urethra

What type of lesions are present in 40% of bladder tumours

Metachronous lesions

Presentation of UCC in the bladder

– Frank, painless haematuria (75%)

– Dysuria, frequency or urgency (25%)

Presentation of UCC in the Ureter

+/- Colicky pain

Presentation of UCC in the Renal pelvis

Haematuria

UCC makes up what % of all adult cancers

3%

Risk factors for UCC

• Male > Female

• Median age: 65-69 years

• Main risk factors

– Smoking

– Occupation: Exposure to aromatic amines, polycyclic hydrocarbons

– Ionising radiation

– Arsenic exposure

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