Tumors of Renal Pelvis and Ureters
Nephrolithiasis
A. Urothelial Carcinoma
a) Adults, High Grade (can invade renal
parenchyma)
b) Nephrouterectomy (kidney, ureter)
c) 5YRSR >50%
d) Gray-Red, Glistening surface
e) Diffuse renal pelvis and ureter
Tumor of Bladder
A. Diverticulosis
a) Due to Prostatic nodular hyperplasia
b) Posterior wall (above trigone)
c) Can become lithiasis, perforation and
tumor development
B. Lithiasis
a) Elderly men, Solitary stones
b) Phosphate salts
c) Treatment (Cystostomy, Lithotripsy
and Shock Wave Therapy)
C. Endometriosis (in bladder)
a) History of surgery
b) Hematuria along with menses
c) Tx Hormonal manipulation and
resection
D. Malakoplakia
a) Rare lesion in mucosa of bladder
b) More frequent in women
c) Nodular thickening(mucosa and
stroma)
d) Yellow gray plaques
e) Macrophages + Calcospherites
(Michaelis-Guttman bodies) around
bacteria
f) Histiocytes with Granular acidophilic
cytoplasm
g) Mistaken as carcinoma
E. Urothelial Carcinoma
a) 90% of all tumors
b) Petrochemical and Cigarette
c) Schistosoma haematobium
d) HPV is controversial
e) Elders >50 years old
f) More in men and whites
g) Hematuria (gross of microscopic)
h) Dysuria (advance disease with
bladder wall involvement)
i) Has prominent nuclei
j) In situ lesion: Total cystectomy
k) Localized lesion: Intravesical chemo
l) Low grade (-) Invasion: transurethral
resection with IVChemo
m) High grade (+) invasion: radical
cystectomy +- adjuvant
n) Immunotherapy is via BCG
F.
a) Common, Collecting system
b) Men 4x (30-50)
c) Symptoms: Pain and Hematuria
d) Pain: Severe, Abrupt, Flank pain
(Colic)
e) Hematuria (gross or microscopic)
f) 75% Caox or Caox+CaPO3
g) 15% Struvite (Mg Ammonium PO3)
h) 10% Uric acid
i) 1% Cystine
j) Proximal to stones= Dilation
G. Hydronephrosis
a) Swell due to failure of normal
drainage of urine from kidney to
bladder
CYSTIC DISEASE OF KIDNEY
A. MRD (Multicystic renal dysplasia)
a) Most common of cystic in children
b) Unilateral (usually) can be bilateral
c) Heart Malformations
d) Sporadically (few Familial)
e) Reniform mass of cysts
f) Cuboidal epithelial cells (immature
stromal elements)
g) Primitive tubules and glomerular
B. ADPKD (autosomal dominant polycystic
kidney disease)
a) Progressive destroy parenchyma
b) Can cause renal failure
c) One of the MC hereditary
d) AD with complete penetrance
e) PKD1 gene (16p13.3)
f) PKD2 gene (4q13-23)
g) Mass, Pain, Hematuria, Hypertension,
Renal Failure
h) 20% Uric acid kidney stones
i) Bilateral (kidneys enlarged)
j) Cysts in all segments of renal tubule
and glomerular capsule
C. ARPKD (autosomal recessive polocystic
kidney disease)
a) Rare
b) PKDH1 (6p21.1 and p12)
c) Polycystic kidney hepatic disease
d) Large abdominal masses at birth
D. Medullary Sponge Kidney
a) Ectasia of collecting ducts
b) Cystic formation of M. Pyramids
c) Asymptomatic
d) Sporadic
e) Sl. Enlarged kidney
f) Multiple and small cyst (like sponge)
E.