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Oncology - Urology (PAthoma - upper renal CA (Angiomyelolipoma this…

- - - - Left sided varicocele presentation in RCC
        
        note that ONLY the left testes drain into the renal vein
        --> can get blockage of the Renal vein and varicocele
        
        on the right testes drain into the IVC
      - Histology
        
        RCC is most often a CLEAR CELL RCC
        
        have large cytoplasm
      - VHL = VON hippel Lindau and RCC
        
        most common cause
        
        VHL HARP
        --> hemangioma of the cerebellum
        --> ataxia
        --> RCC
        --> pancretic CA
        
        VHL gene causes a double whammy cascade
        --> it is a tumor supressor so requires the 2 hit tumor
        
        IGF-1 = insulin growth factor
        
        VEGF = vascular ndothelial GF
        
        PDGF = platelet derived GF
        --> all these give both angiogenesis and growth of the tumor
      - 2 types and courses of RCC
        
        sporadic type = MEN who SMOKE > 50
        --> always in the UPPER POLES of
        --> ONE kidney
        --> ONE single tumor mass
        
        hereditary RCC
        --> these are usually BILATERAL
        --> multiple smaller tumours
      - METS in RCC
        
        RCC always spreads BACKWARDS to the retro peritoneal lymph nodes
        
        KEY = RCC loves to go through the RENAL VEIN
        --> it uses this to spread to the bone and lungs
- - - - 2 pathways of urothelial bladder CA
        
        papillary pathway
        --> low grade then progresses
        --> note that papules always form epithelial issue over blood vessels as seen here
        
        FLAT
        --> much worse since starts t high grade
        --> has EARLY p53 mutations
        --> field defect = in FLAT BLADDER urothelial cancer expecially smokers have had so much damage to their entire bladder that they constant have mutations
        --> ALWAYS reccurs
  - - - Classic in squamous bladder CA
        
        middle eastern young MALE who has a SHISTOMA infection
        --> high risk of bladder CA
  - - - Classic Urachal Remnant give adenocarcinoma of the bladder
        
        urachus - connected in embryo the DOME of the bladder to the yolk sac to get rid of waste
        
        DOME of the Blader