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RB Y2 Renal > Renal Malignancy > Flashcards

Renal Malignancy Flashcards

1
Q

renal fibroma

A
  • benign
  • common
  • present as white nodule in the medullary region
  • no clinical signficance
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2
Q

adenoma

A
  • benign
  • yellowish nodules in the cortical region
  • <2cm
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3
Q

Angiomyolipomas

A
  • benign
  • mixture of fat, muscle and blood vessels
  • can be multiple and bilateral
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4
Q

how are Angiomyolipomas diagnosed on CT

A
  • demonstration of fat on CT is cornerstone of diagnosis
  • the Hounsfield scale is used for describing radiodensity - fat has a value of less than ten (is dark)
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5
Q

what can genetic disorder Angiomyolipomas be assoicated with

A

tuberous sclerosis

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6
Q

tuberous sclerosis

A
  • TSC1 (tuberin) or TSC2 (hamartin) gene
  • Nails: Periungual fibromata and longitudinal ridging
  • Cutaneous: ash-leaf macule (depigmented macule). These can be seen better under a Woods lamp.
  • Facial angiofibromas
  • Bone cyst
  • Cortical tubers/calcification of falx cerebri – seizures, mental impairment
  • Enamel pitting
  • Shagreen patches
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7
Q

how may Angiomyolipomas present

A
  • may embolise
  • suddenly as a haemorrhage - Wunderlich’s syndrome
    • this is a spontaenous, non traumatic haemorrhage that is confined to the subcapsular and peri renal space
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8
Q

what are oncocytes

A

epithelical cells that have an excessive amount of mitochondria

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9
Q

oncocytoma

A
  • benign renal mass - 3-7% of all
  • often asymptomatic
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10
Q

describe the appearance of oncocytomas

A

large cells with eosinophilic granular pink cytoplasm

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11
Q

are oncocytoma benign or malignant

A

benign, mayhave somemalignant potential

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12
Q

diagnosis of oncocytoma

A
  • there is often no definitive diagnosis except at nephrectomy
  • often mistaken for RCC
  • CT: sharp central stellate scar is characteristic
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13
Q

JGCT

A

a rare tumour of the JG cells that produce renin. is a rare cause of 2y hypertension

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14
Q

renal cysts

A
  • comprise 70% o benign asympatomatic renal lesions
  • can be single or multiple
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15
Q

which type of CT is used for imaging

A

triple phase CT contrast enhanced

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16
Q

Nephroblastoma (Wilm’s Tumour)

A
  • embryonic malignant tumour
  • of the primitive renal tubules and mesenchymal cells
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17
Q

how does Nephroblastoma (Wilm’s Tumour) present

A

abodminal mass in children

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18
Q

what is the most common abdominal malignancy in children

A

Nephroblastoma (Wilm’s Tumour)

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19
Q

other names for RCC

A

Aka clear cell carcinoma, Grawtiz tumour, hypernephrom

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20
Q

epidemiology of RCC

A
  • males
  • mean age 55
  • 90% of renal cancer
21
Q

what percentage of dialysis patients develop carcinoma

A

15% - RCC

22
Q

classical triad of RCC presentation

A
  • abdominal mass (may be lumpy), haematuria, flank pain
23
Q

presentation of RCC

A
  • often asymptomatic
  • classic triad of features
  • hypertension
  • systemic features eg anorexia, weight loss, malaise
  • often an incidental finding on imaging
24
Q

how can RCC present in the testes

A

if invaded the left renal vein can compress the left testicular vein causing a varicocele

25
Q

name 3 paraneoplastic manifestations of RCC

A
  • polcythaemia: increased production of erythropoietin from caricnoma cells - high haematocrit
  • anaemia: due to poor nutritional status and CKD causing a fall in erythropoietin (more common than the latter)
  • hypercalcaemia: due to release from bone metastases or increased calcium production
26
Q

how is polycythaemia treated

A

regular venesection

27
Q

describe the pathology of RCC

A
  • large, well circumscribed mass centered on the cortex
  • yellow colour
  • solid cystic, necrotic and haemorrhagic areas
28
Q

what is the most common type of RCC

A

clear cell - tumour cells are rich in glycogen and lipid

29
Q

what genetic mutation occurs in clear cell RCC

A

3p deletion

30
Q

2nd most common type of RCC

A

papillary - elongated papilla with foamy cells

31
Q

chromophobe

A
  • type of RCC
  • large cells with defined cell borders
  • atypical nuclei that resemble raisins - ‘raisinoid’
32
Q

what is the most aggressive type of RCC

A
  • collecting duct
  • high grade carcinoma of mixed cell type
33
Q

which genetic disorder often features multiple and bilateral RCC

A

von hippel-lindau

34
Q

VHL

A
  • genetic AuD disorder characterised by cysts and benign tumours with potential for subsequent malignant transformation
  • caused by mutations in the VHL gene which is involved in hypoxia pathways
35
Q

which type of RCC is seen in VHL

A

clear cell

36
Q

diagnosis of RCC

A
  • USS
  • CT
  • biopsy
37
Q

is biopsy good for RCC diagosis?

A

there is a high false negative rate

38
Q

spread of RCC

A
  • direct renal vein extension, has a poor prognosis
    • can extend all the way from vena cava to RA
  • haematogenous - bone, liver, lung
  • lymphatic spread
39
Q

generally, how are RCC on presentation

A

often have metastases - they present late as they are deep seated in the retroperitoneum

40
Q

what is a classical sign in the lung of metastases from RCC

A

cannon ball metastases - caused by several types of tumour, but RCC is the most common

41
Q

what grading is used for RCC

A

Fuhrman nuclear grading, has less prognostic significance

42
Q

staging of RCC

A

Robson:

43
Q

surgery

A
  • radical/partial nephrectomy
  • radiofrequency ablation, cryoablation
44
Q

radical nephrectomy

A

removes the whole kidney within the renal fascia

45
Q

partial nephrectomy

A
  • nephron sparing - preserves renal function
  • good for low grade tumours
46
Q

what is an ECOG performance status

A

a scale used to assess the progression of disease and effect on patient’s daily living activities

47
Q

when is an ECOG performance status used

A

metastatic kidney cancer will have one

48
Q

adjuvant therapy for RCC

A
  • IL2
  • Interferon alpha
  • Sunitinib
    • Inhibits VEGF/PDGF targeting angiogenesis and reducing neo-vascularization
49
Q

follow up of RCC

A

there is a risk of late recurrences - 10 year follow up

RB Y2 Renal (26 decks)

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