FN: Renal Tumours Flashcards Preview

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Flashcards in FN: Renal Tumours Deck (25):
1

Renal cell carcinoma/Hypernephroma epi

90$ of renal cancers
Age: 55 yrs
Sex: M>F =2:1

2

Renal cell carcinoma/Hypernephroma RF

Obesity
Smoking
HTN
Dialysis (15% of pts. develop RCC)
4% heritable e.g. VHL syndrome

3

Renal cell carcinoma/Hypernephroma pathology

Adenocarcinoma from proximal renal tubular epithelium

4

Renal cell carcinoma/Hypernephroma subtypes

Clear cell (glycogen):70-80%
Papillary: 15%
Chromophobe:5%
Collecting duct:1%

5

Renal cell carcinoma/Hypernephroma PResentation

50% incidental finding
Systemic: anorexia, malaise, wt. loss, PUO
Clot retention
Invasion of L renal vein - varicocel (1%)
Cannonball mets - SOB

6

Renal cell carcinoma/Hypernephroma Triad

HAematuria
Loin pain
loin mass

7

Renal cell carcinoma/Hypernephroma Paraneoplastic features

EPO - polycythaemia
PTHrP - raised Calcium
Renin - HTN
ACTH - Cushings syn
Amyoidosis

8

Renal cell carcinoma/Hypernephroma spread

Direct: renal vein
Lymph
Haematogenous: bone, liver and lung

9

Renal cell carcinoma/Hypernephroma Investigations blood shows

Polycythaemia, ESRm U+E, ALP, Ca

10

Renal cell carcinoma/Hypernephroma Urine

Dip
Cytology

11

Renal cell carcinoma/Hypernephroma Imaging

CXR: cannonballmets
US: mass
IVU: filling defect
CT/MRI

12

Renal cell carcinoma/Hypernephroma Robson staging

1. Confined to kidney
2. Involves perinephric fat, but not Garotas fascia
2. Involves perinephric fat, but not Garotas fascia
3. Spread into renal vein
4. Spread to adjacent/distant organs

13

Renal cell carcinoma/Hypernephroma Medical Mx

REserved for pts. with poor prognosis
Temsirolimus (mTOP inhibitor)

14

Renal cell carcinoma/Hypernephroma Mx surgical

Radical nephrectomy
Consider partial if small tumour of 1 kidney

15

Transitional cell Carcinoma Epi

2nd commonest renal cancer
Age: 50-55yrs
Sex: M>F=4:1

16

Transitional cell Carcinoma RF

Smoking
Amine exposure (rubber industry)
Cyclophosphamide

17

Transitional cell Carcinoma Pathology

Hihgly malignant
Locations
-bladder 50%
Ureter
REnal pelvis

18

Transitional cell Carcinoma Presentation

Painless haematuria
Freqeuncy, urgency, dysuria
Urinary tract obstruction

19

Transitional cell Carcinoma Investigations

Urine cytology
CT/MRI
IVU: pelvicael filing defect

20

Transitional cell Carcinoma MA

Nephrouretctomy
REgular f/up: 50% develop bladder tumours

21

Nephroblastoma: Wilms tumour

Childhood tuour of primitve renal tubules and mesenchymal cells
May be association with Chr 11 mutation
May be association with WAGR syndrome - wilms, aniridia, GU abnormalities, REtardation

22

Nephroblastoma: Wilms tumour Presentation

2-5 yrs
5-10% bilateral
Abdo mass (doesnt cross the midline)
Haematuria
Abdo pain
GTN

23

Benign neoplasms

Cysts: very common
Renal papillary adenomas
Oncocytoma: eosinophilic cells with numerous mitochondria
Angiomyolipoma: seen in tuberous sclerosis

24

Malignant neoplasms

SCC: associations with chronic infected staghom calculi

25

Benign tumours note

Commonly require nephrectomy to exclude malignancy

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