diseases of urinary system zhang hongying how to learn systemic pathology (pathology of urinary...

Diseases of urinary Diseases of urinary systemsystem

Zhang HongyingZhang Hongying

How to learn systemic How to learn systemic pathology (pathology of pathology (pathology of urinary system) ?urinary system) ?

basic science (anatomy, histology,basic science (anatomy, histology, physiology, immunology…)physiology, immunology…)

general pathologygeneral pathology systemic pathologysystemic pathology clinic practiceclinic practice*correlations between structural and functi*correlations between structural and functi

onal changes (clinicopathologic correlatioonal changes (clinicopathologic correlations) ns)

Functions of the kidneysFunctions of the kidneys

Eliminating metabolic waste producEliminating metabolic waste productsts

Regulating fluid and electrolyte balaRegulating fluid and electrolyte balancence

Influencing acid-base balanceInfluencing acid-base balance Secreting hormones (prostaglandins, Secreting hormones (prostaglandins,

erythropoietin, 1,25-dihydroxycholeerythropoietin, 1,25-dihydroxycholecalciferol, renin)calciferol, renin)

The nephron

The main functional unit of the kidney

Normal glomerulus

OutlineOutline GlomerulonephritisGlomerulonephritis Tubulointerstitial nephritisTubulointerstitial nephritis Diseases of the lower urinary Diseases of the lower urinary

tracttract Tumors of urinary systemTumors of urinary system

Etiology of glomerular diseaEtiology of glomerular diseasesses

Primary(majority):disease process aPrimary(majority):disease process appears to start within the glomerulusppears to start within the glomerulus

Secondary:disease process is secondSecondary:disease process is secondary to systemic disease (SLE, vasculaary to systemic disease (SLE, vascular diseases, diabetes mellitus)r diseases, diabetes mellitus)

Hereditary:congenital diseases ( FabHereditary:congenital diseases ( Fabry’s disease)ry’s disease)

Primary glomerulonephritiPrimary glomerulonephritiss

kidney is the kidney is the onlyonly or or predominantpredominant organ organ

Mechanism of glomerular iMechanism of glomerular injurynjury

Circulating immune complex Circulating immune complex nephritisnephritis

immune complex nephritis in immune complex nephritis in situsitu

Cell-mediated immunityCell-mediated immunity Other mechanismsOther mechanisms

Granular pattern

Immunofluorescence microscopy

Linear pattern

Immunofluorescence microscopy

Mechanism of glomerular iMechanism of glomerular injurynjury

Circulating immune complex Circulating immune complex nephritisnephritis

immune complex nephritis in immune complex nephritis in situsitu

Cell-mediated immunityCell-mediated immunity Other mechanismsOther mechanisms

Steps in diagnoses of glomeSteps in diagnoses of glomerular lesionsrular lesions

Clinical presentationClinical presentation Renal biopsyRenal biopsy

Clinical manifestationsClinical manifestations Hematuria (red blood cells in urine)Hematuria (red blood cells in urine) Proteinuria (protein lost in urine) Proteinuria (protein lost in urine) Oliguria or anuria (no urine flow)Oliguria or anuria (no urine flow) Edema Edema Hypertension Hypertension Urinary casts (cell casts, granular casts, hUrinary casts (cell casts, granular casts, h

yaline casts)yaline casts) Azotemia (waste products accumulation)Azotemia (waste products accumulation) Uremia (with autotoxication symptom)Uremia (with autotoxication symptom)

Clinical presentationsClinical presentations

Acute nephritic syndrome: acute oAcute nephritic syndrome: acute onset, blood pressurenset, blood pressure ，， hematuria,hematuria, proteinuria, edema, azotemia proteinuria, edema, azotemia

Rapidly progressive nephritic syndRapidly progressive nephritic syndrome: abrupt or insidious onset of rome: abrupt or insidious onset of hematuria, proteinuria, anemia anhematuria, proteinuria, anemia andd rapidly progressing renal failurerapidly progressing renal failure

Glomerulonephritis

Clinical presentationsClinical presentations Nephrotic syndrome: heavy protNephrotic syndrome: heavy prot

einuria, hypoalbuminemia, seveeinuria, hypoalbuminemia, sever edema, hyperlipidemia and lipir edema, hyperlipidemia and lipiduriaduria

Chronic nephritic syndrome: sloChronic nephritic syndrome: slowly developing renal failure accwly developing renal failure accompanied by proteinuria, hematompanied by proteinuria, hematuria hypertension and uremiauria hypertension and uremia

Key factsKey factsrenal failurerenal failure

Two renal syndromes of Two renal syndromes of total total renal failurenal failure ( acute and chronic renal failure)re ( acute and chronic renal failure)

Two main syndromes of Two main syndromes of partial partial renal failrenal failure (nephritic syndrome and nephrotic sure (nephritic syndrome and nephrotic syndrome)yndrome)

Chronic renal failure is Chronic renal failure is irreversibleirreversible, as it , as it is caused by permanent destruction of neis caused by permanent destruction of nephronsphrons

Acute renal failure sometimes recovers Acute renal failure sometimes recovers when the damaging stimulus resolveswhen the damaging stimulus resolves

The renal biopsyThe renal biopsy

Histological examinationHistological examination Immunofluorescence examinationImmunofluorescence examination Electron microscopic examinationElectron microscopic examination

Primary glomerulonephritPrimary glomerulonephritisis

Acute diffuse proliferative glomerulonephritAcute diffuse proliferative glomerulonephritisis

Crescentic glomerulonephritisCrescentic glomerulonephritis Membranous glomerulonephritisMembranous glomerulonephritis Lipoid nephrosisLipoid nephrosis Focal segmental glomerulosclerosisFocal segmental glomerulosclerosis Membranoproliferative glomerulonephritisMembranoproliferative glomerulonephritis IgA nephropathyIgA nephropathy Chronic glomerulonephritisChronic glomerulonephritis

Diffuse proliferative glomDiffuse proliferative glomerulonephritiserulonephritis

Diffuse, global, acute inflammation Diffuse, global, acute inflammation of glomeruli is caused by the deposiof glomeruli is caused by the deposition of immune complexes in glometion of immune complexes in glomeruli, stimulated by a preceding inferuli, stimulated by a preceding infectionction

Children are more commonly affectChildren are more commonly affecteded

EtiologyEtiology

Poststreptococcal (most common): oPoststreptococcal (most common): onset is 1-2 weeks after a primary infenset is 1-2 weeks after a primary infection with ction with -hemolytic streptococci o-hemolytic streptococci of group Af group A

Non-streptococcal(less common): a rNon-streptococcal(less common): a range of bacterial, viral and protozoal ange of bacterial, viral and protozoal infectionsinfections

Morphology

Gross examination

Swollen with scattered petechia

Histologic featuresHistologic features

Endothelial cells proliferatiEndothelial cells proliferationon

Mesangial cells proliferatioMesangial cells proliferationn

Neutrophils infiltrationNeutrophils infiltration

Normal glomerulus

Post-streptococcal glomerulonephritis

ImmunofluorescenceGranular deposits

Subepithelial “lumps” immune complexes deposition

Electron microscopy

Clinical featuresClinical features Systemic symptomsSystemic symptoms Acute nephritic syndromeAcute nephritic syndrome

Acute onset

Oliguria

Edema

Hypertension

Hematuria

Azotemia

Injures of the capillary wall

GFR decrease

Fluid retention

Fluid retention, renin increase

waste products increase

KEY FACTS:KEY FACTS:Diffuse proliferative glomerulonephritDiffuse proliferative glomerulonephrit

isis Caused by immune complexes in glomeCaused by immune complexes in glome

rulus, often after streptococcal infectiorulus, often after streptococcal infectionn

Causes nephritic syndrome, with prolifCauses nephritic syndrome, with proliferation of endothelium and mesangium eration of endothelium and mesangium and recruitment of neutrophilisand recruitment of neutrophilis

Most cases recover, but a minority may Most cases recover, but a minority may rapidly progress to renal failure or slowrapidly progress to renal failure or slowly develop chronic renal failurely develop chronic renal failure

Main types of glomerulonephritisMain types of glomerulonephritis

Acute proliferative(poststreptococcaAcute proliferative(poststreptococcal, postinfectious)glomerulonephritisl, postinfectious)glomerulonephritis

Rapidly progressive (cresentic) glomRapidly progressive (cresentic) glomerulonephritiserulonephritis

Chronic glomerulonephritisChronic glomerulonephritis

Rapidly progressive glomerulonephrits Rapidly progressive glomerulonephrits (RPGN; crescentic glomerulonephritis)(RPGN; crescentic glomerulonephritis)

RPGN is a manifestation of severe glomeruRPGN is a manifestation of severe glomerular injury characterized by the formation lar injury characterized by the formation of of crescent-shaped massescrescent-shaped masses within the Bow within the Bowman’s spaceman’s space

RPGN occurs in a small percentage of patiRPGN occurs in a small percentage of patients with poststreptococcal glomerulonepents with poststreptococcal glomerulonephritis, but can also be associated with manhritis, but can also be associated with many other forms of glomerular damage y other forms of glomerular damage

PathogenesisPathogenesis

Type Type I RPGN (12%): anti-GBM antibodies ( I RPGN (12%): anti-GBM antibodies ( special type: Goodpasture syndrome) special type: Goodpasture syndrome)

Type Type II RPGN (44%): immune complex-meII RPGN (44%): immune complex-mediated disorderdiated disorder

Type Type III RPGN (44%): pauci-immune compIII RPGN (44%): pauci-immune complexeslexes

Crescentic glomerulonephritis

Histological featuresHistological features

The characteristic is the presense The characteristic is the presense of of crescentscrescents in in most of the glomermost of the glomeruli (>50%)uli (>50%)

The crescents lining Bowman’s cThe crescents lining Bowman’s capsule are composed of a mixture apsule are composed of a mixture of epithelial cells and macrophageof epithelial cells and macrophages proliferatings proliferating

Basement membrane destruction

Cresentic glomerulonephritis

Crescentic glomerulonephritisCrescent

Goodpasture syndrome

Clinical featuresClinical features

RPGN is characterized by rapid anRPGN is characterized by rapid and progressive loss of renal functiod progressive loss of renal function associated with sever n associated with sever oliguriaoliguria ev even en anuriaanuria

Prognosis is poor Prognosis is poor

Main patterns of glomerulonephritisMain patterns of glomerulonephritis

Acute proliferative(poststreptococcaAcute proliferative(poststreptococcal, postinfectious)glomerulonephritisl, postinfectious)glomerulonephritis

Rapidly progressive (cresentic) glomRapidly progressive (cresentic) glomerulonephritis erulonephritis

Chronic glomerulonephritisChronic glomerulonephritis

Chronic glomerulonephrChronic glomerulonephritisitis

end stage kidneyend stage kidney It may be caused by many It may be caused by many

diseasesdiseases

MorphologyMorphology

Macroscopically, affected kidneys arMacroscopically, affected kidneys are small and there is graularity of extee small and there is graularity of external surface (symmetrically contractrnal surface (symmetrically contracted)ed)

Microscopically, there is fibrosis, hyMicroscopically, there is fibrosis, hyalinization of glomeruli, tubular atroalinization of glomeruli, tubular atrophy and interstitial fibrosisphy and interstitial fibrosis

Chronic glomerulonephritis

Chronic renal failure

End stage kidney

Clinical featuresClinical features Chronic glomerulonephritis develops iChronic glomerulonephritis develops i

nsidiouslynsidiously Chronic glomerulonephritis is charactChronic glomerulonephritis is charact

erized by chronic nephritic syndromeerized by chronic nephritic syndrome

Hypertension

Proteinuria

Anemia

Azotemia

Uremia

Edema

Uremic fibrinous pericarditis

Required reading Suggested reading

Case studyCase study

A 13-year-old girl who is brought by A 13-year-old girl who is brought by her parents because she had become her parents because she had become lethargic and her face appeared lethargic and her face appeared swollen, particularly around her swollen, particularly around her eyes. On enquiry, she had recently eyes. On enquiry, she had recently recovered from a flu-like illness. As recovered from a flu-like illness. As part of routine examination her part of routine examination her urine is tested with a dip-stick and is urine is tested with a dip-stick and is found that to contain both protein found that to contain both protein and blood. and blood.


She is also noted to have a mildly raisShe is also noted to have a mildly raised blood pressure. The patient is refeed blood pressure. The patient is referred to hospital where she is found trred to hospital where she is found to have urea and creatinine together o have urea and creatinine together with a reduced urine output. Renal bwith a reduced urine output. Renal biopsy is performed.iopsy is performed.

Histology Histology

The histology report reveals hyperceThe histology report reveals hypercellularity of glomeruli with neutrophilllularity of glomeruli with neutrophils in capillary lumina. Granular deposs in capillary lumina. Granular deposition of IgG, C1q and C3 are seen in tition of IgG, C1q and C3 are seen in the glomerular basement membrane he glomerular basement membrane and mesangium. Electron microscopand mesangium. Electron microscopy confirms the presence of electron dy confirms the presence of electron dense deposits in the basement membense deposits in the basement membrane, predominantly in a subepithelirane, predominantly in a subepithelial location.al location.

Diseases of urinary Diseases of urinary systemsystem

GlomerulonephritisGlomerulonephritis Tubulointerstitial nephritisTubulointerstitial nephritis Diseases of the lower urinary Diseases of the lower urinary


Tubulointerstitial nepTubulointerstitial nephritishritis

Tubulointerstitial nephritis Tubulointerstitial nephritis refers to a group of inflamrefers to a group of inflammatory diseases of the kidnmatory diseases of the kidneys that primarily involve teys that primarily involve the he interstituminterstitum and and tubulestubules

Tubulointerstitial nepTubulointerstitial nephritishritis

Pyelonephritis Pyelonephritis Acute tubular necrosisAcute tubular necrosis Interstitial nephritisInterstitial nephritis

PyelonephritisPyelonephritis Affecting tubulesAffecting tubules Affecting interstitumAffecting interstitum Affecting renal pelvisAffecting renal pelvis One of the most common diseOne of the most common dise

ases of the kidneyases of the kidney

PyelonephritisPyelonephritis

Acute pyelonephritisAcute pyelonephritis Chronic pyelonephritisChronic pyelonephritis

Acute pyelonephritisAcute pyelonephritis Incidence parallels that of obIncidence parallels that of ob

structive uropathystructive uropathy Caused by bacterial infectionCaused by bacterial infection Common suppurative inflamCommon suppurative inflam

mation of the kidney and the rmation of the kidney and the renal pelvisenal pelvis

Acute pyelonephritisAcute pyelonephritis

Childhood Childhood Pregnancy Pregnancy Elderly Elderly

Infancy: Infancy: malesmales>females>females

Puberty to Puberty to middle age: middle age: females>malesfemales>males

Post-40 years: Post-40 years: malesmales>females>females

Three age Three age peakspeaks

Gender Gender differencesdifferences

Routes of bacterial Routes of bacterial infectioninfection

Ascending infection from thAscending infection from the lower urinary tract(most ce lower urinary tract(most common): ommon): enteric gram-negaenteric gram-negative rods ( Escherichia coli)tive rods ( Escherichia coli)

Bloodstream spread in bactBloodstream spread in bacteremic or septicemic states: eremic or septicemic states: staphylococcistaphylococci

Route of infection

Gross featureGross feature

Suppurative inflammationSuppurative inflammation Cortical abscessesCortical abscesses Medullary abscessesMedullary abscesses

Acute pyelonephriAcute pyelonephritistis

Acute pyelonephritisAcute pyelonephritis

Histological featureHistological feature

Infiltration of tubules by neutrInfiltration of tubules by neutrophilsophils

Abscess formationAbscess formation Interestitial edemaInterestitial edema

Acute pyelonephritis

Clinical featureClinical feature Sudden onsetSudden onset Pain in the backPain in the back Evidence of systemic infection( Evidence of systemic infection(

chills, fever, malaise)chills, fever, malaise) Indications of bladder and uretIndications of bladder and uret

hral irritation( dysuria, urgenchral irritation( dysuria, urgency, frequency of micturition)y, frequency of micturition)

Urinary findingsUrinary findings

Pyuria ( white blood cells Pyuria ( white blood cells and pus cells in urine)and pus cells in urine)

Bacteriuria (bacteria in uBacteriuria (bacteria in urine)rine)

Complications and sequComplications and sequelaeelae

ResolutionResolution Healing with scarringHealing with scarring ChronicityChronicity PyonephrosisPyonephrosis Renal papillary necrosisRenal papillary necrosis Perinephric abscessPerinephric abscess Death in uremiaDeath in uremia

Papillary necrosis

PyelonephritisPyelonephritis

Acute pyelonephritisAcute pyelonephritisChronic pyelonephritisChronic pyelonephritis

Chronic pyelonephritiChronic pyelonephritiss

Chronic pyelonephritis is defineChronic pyelonephritis is defined as a morphologic entity in whicd as a morphologic entity in which prodominantly interstitial inflah prodominantly interstitial inflammation and mmation and scarringscarring of the renof the renal parenchyma is associated with al parenchyma is associated with grossly grossly visible scarringvisible scarring and and defordeformitymity of the pelvicalyceal systemof the pelvicalyceal system

Chronic pyelonephritiChronic pyelonephritiss

Obstructive chronic pyeloneObstructive chronic pyelonephritisphritis

Reflux-associated Reflux-associated chronic pchronic pyelonephritis (vesicoureterayelonephritis (vesicoureteral reflux)l reflux)

Gross featureGross feature

Kidneys are not equally damaKidneys are not equally damagedged

Irregular areas of scarringIrregular areas of scarring Marked calyceal deformitiesMarked calyceal deformities

Gross feature

• not equally damaged• Irregular areas of scarring• Marked calyceal deformities

Chronic pyelonephritis

Histological featureHistological feature Chronic inflammatory cells infChronic inflammatory cells inf

iltration, occasionally neutropiltration, occasionally neutrophilshils

Uneven interstitial fibrosisUneven interstitial fibrosis Dilation or contraction of tubuDilation or contraction of tubu

lesles Glomeruli show periglomerulaGlomeruli show periglomerula

r fibrosisr fibrosis

“Thyroidization” Dilation of tubules

Clinical featureClinical feature

Gradual onset of renal insufGradual onset of renal insufficiencyficiency

Tubular dysfunction (polyuTubular dysfunction (polyuria)ria)

Urinary tract infectionUrinary tract infection Uremia Uremia

DiagnosisDiagnosis

Intravenous pyelogramIntravenous pyelogram Urine cultureUrine culture

RequirementRequirement

List the complications of acute pList the complications of acute pyelonephritisyelonephritis

Name the two types of pathogenName the two types of pathogenesis for chronic pyelonephritisesis for chronic pyelonephritis

OutlineOutline GlomerulonephritisGlomerulonephritis Tubulointerstitial nephritisTubulointerstitial nephritis Diseases of the lower urinary Diseases of the lower urinary


Infection Infection ObstructionObstruction Stone Stone

formationformation Tumor Tumor

formationformation Developmental Developmental

abnormalitiesabnormalities

Diseases of the lower urinary tract

Urinary outflow Urinary outflow obstructionobstruction

Renal stonesRenal stones HydronephrosisHydronephrosis

Renal stonesRenal stones

Urolithiasis is calculus forUrolithiasis is calculus formation at any level in the urmation at any level in the urinary collecting systeminary collecting system

most common sites: pelvicmost common sites: pelvicalyceal system and bladder.alyceal system and bladder.

Main predisposing Main predisposing factorsfactors

Increased concentration Increased concentration of solute in urine of solute in urine

Reduced solubility of Reduced solubility of solute in urine solute in urine

EtiologyEtiology

Acquired Acquired InheritedInherited

Renal calculus

Renal staghorn calculus

S

Staghorn calculus

Hydronephrosis

Abscess

Fluoroscopy

Ureteral calculus


Without symptomsWithout symptoms Renal colic with nausea , vomRenal colic with nausea , vom

iting and hematuriaiting and hematuria Dual ache in the loinsDual ache in the loins Recurrent urinary tract infectRecurrent urinary tract infect

ionion

Urinary outflow Urinary outflow obstructionobstruction

Renal stonesRenal stones HydronephrosisHydronephrosis

Hydronephrosis Hydronephrosis

Hydronephrosis refers to Hydronephrosis refers to didilation of the renal pelvis anlation of the renal pelvis and calycesd calyces, with accompanyi, with accompanying ng atrophy of the parenchyatrophy of the parenchymama, caused by obstruction t, caused by obstruction to the outflow of urine o the outflow of urine

Renal pelvisRenal pelvis Pelviureteric juncPelviureteric junc

tiontion UreterUreter BladderBladder UrethraUrethra

HydronephrosisHydronephrosisObstruction of the levelsObstruction of the levels

MorphologyMorphology Unilateral :caused by obstructiUnilateral :caused by obstructi

on at the level of the ureter, pelon at the level of the ureter, pelviureteric junction or renal pelviureteric junction or renal pelvis vis

Bilateral: caused by obstruction Bilateral: caused by obstruction of the level of the bladder or urof the level of the bladder or urethra ethra

Hydronephrosis

Normal urinary tract

Intravenous pyelogram (IVP)

Hydronephrosis Intravenous pyelogram (IVP)

Hydronephrosis ( cut surface)


Clinical features depend Clinical features depend on the cause and site of on the cause and site of the lesionthe lesion

Effects of hydronephrEffects of hydronephrosisosis

Obstruction is removed: renaObstruction is removed: renal function returns to normall function returns to normal

Persistence of obstruction: atPersistence of obstruction: atrophy of renal tubules with grophy of renal tubules with glomerular hyalinization and flomerular hyalinization and fibrosisibrosis

OutlineOutline GlomerulonephritisGlomerulonephritis Tubulointerstitial nephritiTubulointerstitial nephriti

ss Diseases of the lower urinaDiseases of the lower urina

ry tract ry tract Tumors of urinary systemTumors of urinary system

Tumors of urinary Tumors of urinary systemsystem

Tumors of the kidneyTumors of the kidney Tumors of the bladderTumors of the bladder Tumors of the ureterTumors of the ureter Tumors of the urethraTumors of the urethra

Angiomyolipoma

AngiomyolipomaMRI

Angiomyolipoma

Renal cell carcinoma

Renal cell carcinoma invade into the renal vein

MRIRenal cell carcinoma

Renal cell carcinoma (clear cell type)

Key factsKey factsrenal cell carcinomarenal cell carcinoma

Male: female incidence is 3:1Male: female incidence is 3:1 Incidence is greatest in those over 5Incidence is greatest in those over 5

0 years, and increases with age0 years, and increases with age Common presenting symptoms inclCommon presenting symptoms incl

ude ude painless hematuriapainless hematuria, loin pain, l, loin pain, loin massoin mass

Occasional presenting symptoms inOccasional presenting symptoms include bone metastasis,brain metastclude bone metastasis,brain metastasis, polycythemia asis, polycythemia

Key factsKey factsrenal cell carcinomarenal cell carcinoma

Local spread through renal capsulLocal spread through renal capsule into perinephritic fate into perinephritic fat

Lymphatic spread to para-aortic aLymphatic spread to para-aortic and other nodesnd other nodes

Blood stream spread to lungs, bonBlood stream spread to lungs, bone, brain, livere, brain, liver

Prognosis depends on stage at presPrognosis depends on stage at presentationentation

Wilm’s tumor (Nephroblastoma)

Common malignant

tumors of childhood

Abdominal enlargement

Genetic defects on chromosome 11

Wilm’s tumor

Metastatic carcinoma of the kidney

QuestionsQuestions

List five kinds of diseases List five kinds of diseases of unilateral enlargement of unilateral enlargement of the kidney.of the kidney.

What are the causes of What are the causes of urinary tract obstruction?urinary tract obstruction?

Tumors of the lower Tumors of the lower urinary tracturinary tract

Most tumors of the lower Most tumors of the lower urinary tract arise from urinary tract arise from transitional-cell transitional-cell epitheliumepithelium

Transitional cell carcinoma of the bladder

Intravenous pyelogram (IVP)

Carcinoma of the bladder

Carcinoma of renal pelvis

Transitional cell carcinoma


A 57-year-old draughtsman who presenA 57-year-old draughtsman who presents to his family practitioner complainints to his family practitioner complaining of a dragging sensation in his left loin.g of a dragging sensation in his left loin. On questioning, he admits to having h On questioning, he admits to having had intermittent painless hematuria for ad intermittent painless hematuria for three weeks. Following referral to a urthree weeks. Following referral to a urological surgeon, investigation reveals ological surgeon, investigation reveals a large mass replacing the left kidney. a large mass replacing the left kidney. He undergoes a left nephrectomy from He undergoes a left nephrectomy from which he makes a good recovery. which he makes a good recovery.

QuestionsQuestions

What is the most likely What is the most likely diagnosis?diagnosis?

The most likely diagnosis is renal cell carcinoma

QuestionsQuestions

What is the most common histological What is the most common histological pattern of this lesion and what causes this pattern of this lesion and what causes this appearance?appearance?

Carcinomas of the kidney are adenocarcinomas. The most common histological pattern is of lipid and glycogen within the cytoplasm of neoplastic cells

QuestionsQuestions What factors in the histopathologists report What factors in the histopathologists report

would have a particular bearing on the progwould have a particular bearing on the prognosis for this patient?nosis for this patient?

If carcinoma is present within blood vessels (particularly the renal veins) at the hilum, then there is a greater likelihood that metastasis spread will ensue. If tumor is confined within the renal capsule there is a 70% 10-year survival

diseases of urinary system zhang hongying how to learn systemic pathology (pathology of urinary...

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