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Renal Patho lab 2 PART 1 colored

Renal Patho lab 2 PART 1 colored

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Renal Pathology LAB 2 trans PART 1 - colored version
Renal Pathology LAB 2 trans PART 1 - colored version

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Pathology Lab 2 Part 1
OS 214: Excretory Module
Pathology Dept.LecturersExam 2
March 11, 2009 | WEDNESDAY
Page 1 of 8ADI - LEXI - GILLIAN - BUTCH
A
OUTLINE
I.
Urology LCD module
a.
Chronic Pyelonephritis
b.
Clear Cell Renal Carcinomac.Angiomyolipomad.Wilms Tumo
e.
Prostate Adenocarcinoma
f.
Chronic Cystitis
g.
Invasive Urothelial Carcinoma
II.
Case Discussiona.Rapidly Progressive GN Type 1b.IgA Nephropathyc.Focal Segmental GNd.Membranous GNe.Acute Tubular Necrosisf.Hyperplastic Arteriolitis
III.
Gross Specimen
IV.
MicroscopyUROLOGY LCD MODULE
Surgical Pathologist
The one who studies specimens, usually from asurgeon, and makes a diagnosis depending onwhat they see from the specimen. They are also theones who specify if the lesion is benign or malignant.
They rely on what they observe directly from thespecimen itself and the clinical input coming fromthe clinician or surgeon
Specimen – may be a whole organ or a piece of tissue
Tissues are “fixed” by immersing them in formalin.This prepares the tissue for slide processing.Changes that may occur because of formalin include:
o
Areas of the tissue with increased number of cells per unit volume tend to become more whitecompared to less cellular areas of the tissues
o
Color of the tissues usually become lighter 
I.Renal Cell Carcinoma
Kidney: Organ is 5-6 inches in length, andcovered with fat
When assessing the gross anatomy:
o
Calyx and Ureter:Is there anything blocking it? NO
o
ParenchymaCan you delineate the cortex from themedulla (normal ratio of 1:3 or 1:4)? NO
o
Light tan color of lesion - the lighter the color of the lesion, the more packed it is with cells
o
Presence of ulceration? YES (encircled)
Light Microscope:
o
Glomerulus: bowman’s space is enlarged (A)
o
Tubules: normally found in spaces betweenthe glomeruli. In this picture, you see afibrous area which is almost devoid of tubules
o
Blood Vessels – wall is thickened (B)ON High Power 
o
Inflammatory cells found on the slide (do yousee the lymphocytes below the glomerolus?)
o
Thyroidization is present (boxed)
o
Casts (Tamm-Horsefall protein) insidetubules signify a long standing renal problemwith decreased urine flow.
o
When the tubules are dilated, they usuallyform broad casts and the kidney damage isirreversible.ON Oil Immersion
 
Pathology Lab 2 Part 1
OS 214: Excretory Module
Pathology Dept.LecturersExam 2
March 11, 2009 | WEDNESDAY
Page 2 of 8ADI - LEXI - GILLIAN - BUTCH
A
o
Numerous lymphocytes and inflammatorycells
NtK from Robbins:
Renal cell carcinomas represent about1% to 3% of all visceral cancers and account for 85% of renal cancers in adults. The tumors occur most often in older individuals, usually in the sixth and seventh decades of life,showing a male preponderance in the ratio of 2 to 3 : 1. Theyusually have a gross yellow color and tumor cells resembleclear cells of the adrenal cortex but in truth, these tumorsarise from the tubular epithelium and are therefore renaladenocarcinomas
II.Clear Cell Renal Carcinoma
Kidney: presence of hemorrhage (A) andnecrosis (B).
Normal kidney upper portion (circled)
Most of the kidney is occupied with large mass(lower portion) (boxed)
Light Microscope:
o
Clear cell Renal Carcinoma with large nuclei(Fuhrman grade 4)
o
Pathologists are responsible for the T part of grading
o
Makes use of Fuhrman Grading system
The Fuhrman grade is based on nuclear size and shape andthe prominence of nucleoliGrade 1: tumors have round, uniform nuclei withinconspicuous or absent nucleoli.Grade 2: Nuclear contours are more irregular than Grade 1;nuclei are about 15 microns in diameter. Nucleoli may bevisible at high magnification.Grade 3: Nuclear contours are even more irregular. Nuclear diameters can approach 20 microns. Nucleoli are readilyseenGrade 4: Looks quite different from normal kidney cells andhas the worst prognosis.
** visithttp://webpathology.com/case.asp?case=66for nice pictures of renal cell cancer 
 
o
Grade of the tumor is directly proportional tosize of the nucleus and the aggression of thetumor.
NtK from Robbins:
Renal cell carcinomas represent about 1% to3% of all visceral cancers and account for 85% of renal cancers inadults. The tumors occur most often in older individuals, usually inthe sixth and seventh decades of life, showing a malepreponderance in the ratio of 2 to 3 : 1. They usually have a grossyellow color and tumor cells resemble clear cells of the adrenalcortex but in truth, these tumors arise from the tubular epitheliumand are therefore renal adenocarcinomas
Clear cell carcinoma.
This is the most common type of renal cellca, accounting for 70% to 80% of renal cell cancers. On histologicexamination, the tumors are made up of cells with clear or granular cytoplasm and are
nonpapillary 
. They can be familial,associated with VHL disease, or in most cases (95%) sporadic.
III.Angiomyolipoma
Kidney: lower part is made of normal renal tissue
Tumor is cleaner (less hemorrhage and necrosiscompared to clear cell carcinoma) – a probablesign that the lesion is benign
Light Microscope:
o
Angiomyolipomas are made up of matureadipose, smooth muscle and blood vessels.
NtK from Robbins:
Angiomyolipoma.
This is a benign tumor consisting of vessels, smooth muscle, and fat.
 Angiomyolipomas are present in 25% to 50% of patientswith tuberous sclerosis,
a disease characterized by lesionsof the cerebral cortex that produce epilepsy and mentalretardation as well as a variety of skin abnormalities
IV.
Wilms Tumor / Nephroblastoma
 
Pathology Lab 2 Part 1
OS 214: Excretory Module
Pathology Dept.LecturersExam 2
March 11, 2009 | WEDNESDAY
Page 3 of 8ADI - LEXI - GILLIAN - BUTCH
A
Light Microscope:
o
Highly cellular tissue with no tubules
o
Notice the stroma (A), some gland likestructures made by primitive cuboidalepithelial elements (B), and blastema (C -dark staining cells)** checkhttp://webpathology.com/case.asp?case=73for more histological pictures of wilm’s tumor 
 
NtK from Robbins
: Wilms tumor 
is the most common primaryrenal tumor of childhood and the fourth most common pediatricmalignancy in the United States. Approximately 5% to 10% of Wilms tumors involve both kidneys, either simultaneously
(synchronous)
or one after the other 
(metachronous).
BilateralWilms tumors have a median age of onset approximately 10months earlier than tumors restricted to one kidney. It is usuallyfound in 3 syndromes:
WAGR syndrome
(characterized byaniridia, genital anomalies, and mental retardation),
Denys-Drash syndrome
(which is characterized by gonadal dysgenesis(male pseudohermaphroditism) and early-onset nephropathyleading to renal failure. The characteristic glomerular lesion inthese patients is a diffuse mesangial sclerosis), and
Beckwith-Wiedemann syndrome
(characterized by enlargement of bodyorgans (organomegaly), macroglossia, hemihypertrophy,omphalocele, and abnormal large cells in adrenal cortex (adrenalcytomegaly))
V.Nodular Hyperplasia of the Prostate andAdenocarcinoma of the prostate
Prostate is normally symmetrical
Prostate on this picture is not symmetrical. Youcan also notice multilobular structuresCUT section
o
Multiple cysts on cut section
o
May be due to proliferation of stromalelements OR both stromal and glandular elements (when glandular elementsproliferate, they manifest as cystic spaces)
Light Microscope:
o
Presence of Adenocarcinoma of the Prostate
o
You see the tumor cells trying to form glands
o
Gleason Grading systemgrades 1-3 = distinct glandsgrade 4 = fused glandsgrade 5 = no glands visibleGleason score = predominating grade +second most predominant grade
GLEASON GRADIG SYSTEMThe pathologist assigns a
grade
to the most common tumor pattern, and a second
grade
to the next most common tumor pattern. The two
grades
are added together to get a Gleason
score
. For example, if the most common tumor pattern wasgrade 3, and the next most common tumor pattern wasgrade 4, the Gleason
score
would be 3+4 = 7. A lower Gleason indicates a well differentiated, or a lower potential tospread. A higher Gleason grade indicates a poorlydifferentiated cancer, or more likely to spread.Gleason scores are associated with the following features:
Grade 1 - The cancerous prostate closely resemblesnormal prostate tissue. The glands are small, well-formed, and closely packed

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