Renal Pathology Practice Questions

Q: What is the commonest site of metastasis for Wilms' tumour?

Lungs. **Explanation:** Wilms’ tumour (Nephroblastoma) is the most common primary renal malignancy in children. The correct answer is **Lungs** because Wilms’ tumour typically spreads via the **hematogenous route**. Once the tumour cells enter the renal vein and inferior vena cava, the first major capillary bed they encounter is in the pulmonary circulation, making the lungs the most frequent site of distant spread [1]. **Analysis of Options:** * **B. Lungs (Correct):** Approximately 80% of patients with metastatic disease at diagnosis will have pulmonary involvement. These often appear as "cannonball" metastases on a chest X-ray. * **A. Bones:** Unlike Neuroblastoma (the main differential diagnosis), Wilms’ tumour rarely metastasizes to the bones. Bone pain or lesions should prompt a clinician to consider Clear Cell Sarcoma of the Kidney (CCSK) instead. * **C. Liver:** The liver is the second most common site of distant metastasis, but it occurs less frequently than pulmonary spread. * **D. Brain:** Brain metastasis is extremely rare in Wilms’ tumour and usually only occurs in the very late stages of aggressive or relapsed disease. **High-Yield Clinical Pearls for NEET-PG:** * **Triphasic Morphology:** On histology, Wilms’ tumour classically shows three components: Blastemal, Stromal, and Epithelial cells. * **WAGR Syndrome:** Associated with *WT1* gene deletion (Wilms’ tumour, Aniridia, Genitourinary anomalies, and intellectual disability/Retardation). * **Beckwith-Wiedemann Syndrome:** Associated with *WT2* gene (imprinting defect), characterized by macroglossia, organomegaly, and hemihypertrophy. * **Staging:** Unlike many other tumours, the presence of lung metastasis in Wilms' tumour classifies it as **Stage IV**. **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Diseases Of The Urinary And Male Genital Tracts, pp. 492-493.

Q: A 70-year-old male, a known case of a certain malignancy, presents with elevated erythropoietin levels and a packed cell volume (PCV) of 52%. Which tumor is most likely responsible?

Renal Cell Carcinoma. ### **Explanation** **1. Why Renal Cell Carcinoma (RCC) is Correct:** The clinical presentation of elevated erythropoietin (EPO) and a high packed cell volume (PCV) in the presence of a malignancy points toward a **Paraneoplastic Syndrome**. RCC is the most common cause of **paraneoplastic erythrocytosis** [1], [3]. The tumor cells ectopically produce erythropoietin, which stimulates the bone marrow to increase red blood cell production, leading to secondary polycythemia (erythrocytosis) [3]. **2. Why the Other Options are Incorrect:** * **Medullary Thyroid Carcinoma:** Typically associated with the secretion of Calcitonin, CEA, or ACTH (leading to Cushing syndrome), but not EPO [2]. * **Gastric Carcinoma:** Often presents with iron deficiency anemia due to chronic occult blood loss, rather than erythrocytosis. * **Colorectal Carcinoma:** Similar to gastric cancer, it is a common cause of microcytic hypochromic anemia due to chronic GI bleeding. **3. High-Yield Clinical Pearls for NEET-PG:** * **Differential Diagnosis for Ectopic EPO Production:** Remember the mnemonic **"Potentially Really High Hematocrit"**: * **P**heochromocytoma * **R**enal Cell Carcinoma (Most common) [1] * **H**epatocellular Carcinoma (HCC) * **H**emangioblastoma (Cerebellar) * **U**terine Leiomyoma (Fibroids) * **Stauffer Syndrome:** A unique paraneoplastic syndrome in RCC characterized by reversible hepatic dysfunction (elevated ALP) without liver metastases. * **Classic Triad of RCC:** Hematuria, flank pain, and a palpable abdominal mass (seen in only 10% of cases). * **Investigation of Choice:** Contrast-Enhanced CT (CECT) of the abdomen [1].

Question 1

Which of the following statements is not true regarding IgA nephropathy (Berger's disease)?

Accepted Answer

Absence of associated proteinuria is pathognomonic.

Answer

The pathological changes are proliferative and usually confined to mesangial cells; usually focal and segmental.

Answer

Hematuria may be gross or microscopic.

Answer

On immunofluorescence, deposits contain both IgA and IgG.

Question 2

A 35-year-old man with AML and WBC of 100,000 cells/µL is treated with chemotherapy and develops oliguric renal failure. His urine is acidic and numerous crystals are noted in the urine. What is the most likely diagnosis?

Accepted Answer

Urate nephropathy

Answer

Nephrocalcinosis

Answer

Leukemic infiltration of the kidneys

Answer

Acute tubular necrosis secondary to a nephrotoxic effect of his chemotherapy

Question 3

Polycythemia is seen with which tumor?

Accepted Answer

Renal cell carcinoma

Answer

Endometrial carcinoma

Answer

Lung carcinoma

Answer

Fibrosarcoma

Question 4

What is the most common kidney disease associated with chronic heroin use?

Accepted Answer

Focal segmental glomerulosclerosis

Answer

IgA nephropathy

Answer

Lipoid nephrosis

Answer

Mesangioproliferative GN

Question 5

What is the commonest site of metastasis for Wilms' tumour?

Accepted Answer

Lungs

Answer

Bones

Answer

Liver

Answer

Brain

Question 6

Which of the following is seen in nephrotic syndrome?

Accepted Answer

Low serum calcium

Answer

Raised antithrombin III

Answer

Low lipids

Answer

Platelet activation

Question 7

Which chromosomal mutation is characteristic of low-grade transitional cell carcinoma of the bladder?

Accepted Answer

FGFR3

Answer

p53

Answer

Rb gene

Answer

HRAS

Question 8

Squamous cell carcinoma of the bladder is predisposed by which of the following factors?

Accepted Answer

Persistent urachus

Answer

Urolithiasis

Answer

Schistosomiasis

Answer

Smoking

Question 9

Papillary necrosis is most commonly seen in?

Accepted Answer

Analgesic nephropathy

Answer

Diabetes Mellitus

Answer

Sickle cell anemia

Answer

Acute pyelonephritis

Question 10

A 70-year-old male, a known case of a certain malignancy, presents with elevated erythropoietin levels and a packed cell volume (PCV) of 52%. Which tumor is most likely responsible?

Accepted Answer

Renal Cell Carcinoma

Answer

Medullary thyroid carcinoma

Answer

Gastric Carcinoma

Answer

Colorectal Carcinoma

Renal Pathology — MCQs

Renal Pathology — MCQs

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