Renal, testicular and penile cancer

Question 1

What are the common benign renal cancers?

Answer 1

Simple cyst
Angiomyolipoma
Oncocytoma

Question 2

What are the common malignant renal cancers?

Answer 2

Renal cell carcinoma
Transitional cell
Lymphoma

Question 3

Describe the macroscopic appearance of an oncocytoma?

Answer 3

Spherical
Capsulated
Brown/tan coloured
Central scar

Question 4

Will oncocytomas metastasize?

Answer 4

No

Question 5

Describe the histological appearance of oncocytomas?

Answer 5

Aggregates of eosinophilic cells, mitosis rare

Cells packed with mitochondria

Question 6

How will an oncocytoma and angiomyolipoma present?

Answer 6

Majority are incidental findings

Can present with loin pain, haematuria and a mass

Question 7

What will an oncocytoma look like on CT scan?

Answer 7

Spoke wheel pattern

Question 8

What genetic condition is angiomyolipoma associated with?

Answer 8

Tuberous sclerosis

Question 9

What inheritance is tuberous sclerosis?

Answer 9

Autosomal dominant

Question 10

What is tuberous sclerosis associated with?

Answer 10

Mental retardation
Epilepsy
Adenoma sebaceum 
Hamartoma 
Angiomyolipoma

Question 11

What is wunderlich’s syndrome?

Answer 11

Massive retroperitoneal bleed associated with angiomyolipoma

Question 12

What investigations should be done for an angiomyolipoma?

Answer 12

USS: bright echo
CT: fatty tumour of low density

Question 13

What is the treatment for an angiomyolipoma?

Answer 13

4cm is cut off
Partial nephrectomy
Emergency radical nephrectomy

Question 14

What is renal cell carcinoma?

Answer 14

Adenocarcinoma of renal cortex

Arises from proximal convoluted tubules

Question 15

Describe the macroscopic appearance of a renal cell carcinoma

Answer 15

Yellow
Lobulated
Solid
1/4 contain cysts

Question 16

What are the different histological classifications of renal cell carcinoma?

Answer 16

Clear cell 
Papillary 
Chromophobe
Collecting duct
Medullary cells

Question 17

What genetic condition is clear cell carcinoma associated with?

Answer 17

Loss of VHL gene on chromosome 3

Question 18

What is the staging system for renal call carcinoma?

Answer 18

T1: up to 7cm
T2: >7cm confined to the kidney
T3: extends into the renal vein, perinephric fat, renal sinus and IVC

Question 19

Which kidney is more likely to spread to the IVC?

Answer 19

Right kidney - renal vein is shorter and lies closer to the IVC

Question 20

What is the aetiology of renal cell carcinoma?

Answer 20

Smoking
Renal failure and dialysis 
Obesity
Hypertension 
Low socioeconomic class, asbestos, cadmium exposure, phenacetin 
Genetic: VHL

Question 21

What is the classical presentation of renal cell carcinoma?

Answer 21

Haematuria
Loin pain 
Mass 
Pyrexia of unknown origin
Variocele (left sided)

Question 22

Why is a variocele commonly left sided in renal cell carcinoma?

Answer 22

Dilated veins around testis, the left testicular vein drains directly to the left renal vein

Question 23

What paraneoplastic syndrome are associated with renal cell carcinoma?

Answer 23

Anaemia: haematuria or chronic disease
Polycythaemia: erythropoietin
Hypertension: renin, renal artery compression
Hypoglycaemia: insulin
Cushings syndrome: ACTH
Hypercalcaemia: PTHrP
Gynaecomastia, amenorrhoea, reduced lipido, baldness: gonadotropohins
Stauffer syndrome: fever, anorexia, abnormal LFTs

Question 24

What is the treatment of renal cell carcinoma?

Answer 24

Small tumours less than 3cm: surveillance or ablation
More than 3cm: partial nephrectomy or radial nephrectomy
Large tumours: laparoscopic radial nephrectomy is gold standard

Question 25

What is the follow up for RCC?

Answer 25

FBC/ renal and liver function CT/ USS + CXR Duration for 5-10 years

Question 26

What are the different types of testicular cancer?

Answer 26

Seminoma of the seminiferous tubules (35-45) | Teratoma (<35)

Question 27

What are risk factors for testicular cancer?

Answer 27

Previous TC of contralateral testicle Cryptorchidism HIV FMHx

Question 28

What do leydig cells do?

Answer 28

Secrete testosterone via LH

Question 29

What do sertoli cells do?

Answer 29

Spermatogenesis via FSH

Question 30

What is the clinical presentation of testicular cancer?

Answer 30

Scrotal lump Acute pain due to haemorrhage Advanced disease: wt loss, neck lumps, chest symptoms or bone pain

Question 31

What can be seen on clinical examination of testicular cancer?

Answer 31

Asymmetry or slight scrotal discoloration Examine normal side first Hard, non tender, irregular mass mostly intratesticular Assess involvement of epididymis, spermatic cord and scrotal skin Secondary hydrocele Abdo exam: advanced disease (para-aortic lymph nodes) Do chest exam as testicular cancer commonly metastasizes to there

Question 32

What imaging should be done in suspicion of testicular cancer?

Answer 32

USS of testicle | CT chest and abdo for staging

Question 33

What blood tests should be done in a testicular cancer workup?

Answer 33

``` Alpha feto protein Beta-HCG LDH FBC LFTs U&Es ```

Question 34

What is the treatment of testicular cancer?

Answer 34

Radical inguinal orchiectomy through the deep inguinal ring

Question 35

What can cause penile cancer?

Answer 35

``` Squamous cell carcinoma Kaposi sarcoma BCC Malignant melanoma Sarcoma ```

Question 36

What causes kaposi sarcoma?

Answer 36

HHV 8 in HIV

Question 37

What are risk factors for penile cancer?

Answer 37

``` 5-6th decade Phimosis HPV 16 and 18 Smoking Immunocompromised patients ```

Question 38

What are the common sites for penile cancer?

Answer 38

Gland Prepuce Shaft

Question 39

What is the presentation of penile cancer?

Answer 39

Hard painless lump | Urinary retention or groin mass (inguinal lymphadenopathy)

Question 40

What should be examined in penile cancer?

Answer 40

Abdomen Inguinal region External genitalia

Question 41

What imaging should be done in suspicion of penile cancer?

Answer 41

MRI to assess tumour depth | CT scan abdo, pelvis, chest

Question 42

Are the stats for penile cancer good?

Answer 42

NO | If patient presents with metastasis the 5-year survival is 0%

Question 43

What is the treatment for penile cancer?

Answer 43

Prepucial lesion: circumcision Glans lesion: glans resurfacing or glansectomy Advanced: total penile amputation Inguinal lymphadenopathy

Question 44

What is balanits xerotical obliterans/

Answer 44

Chronic inflammation of the penis | Phimosis causing dysuria

Question 45

What increases the risk of papilloma?

Answer 45

HPV 16 and 18 | Benign = 6 and 11

Question 46

What is the functional unit of the testis?

Answer 46

``` Seminiferous tubules Sertoli cells (FSH) = spermatogenesis Leydig cells (LH) = converts testosterone to DHEA ```

Question 47

What is a hydrocele?

Answer 47

Accumulation of fluid around the testis between the 2 layers of the tunica vaginalis - unicystic, smooth and fluid filled Transilluminates

Question 48

What is a spermatocele?

Answer 48

Cystic change within the vas of the epididymis Unknown cause Feel fullness Presents after self examination

Question 49

What is the varicocele?

Answer 49

Varicosities of venous plexus that drains the testis Asymptomatic Present as a lump

Question 50

What can predispose to a testicular torsion?

Answer 50

Bell clapper deformity

Question 51

What is a testicular torsion?

Answer 51

Urlologcial emergency | Testis and cord rotate around the arterial blood supply causing ischaemia and cell death

Question 52

What is a risk factor for a seminoma?

Answer 52

Undescended testes

Question 53

What testicular tumour is associated with aFP?

Answer 53

Yolk sac

Question 54

What testicular tumour is associated with raised beta hCG?

Answer 54

Trophoblastic choriocarcinoma

Question 55

What testicular tumour is associated with raised LDH?

Answer 55

Seminoma

Question 56

Which is the most aggressive form of testicular tumour?

Answer 56

Embryonal

Question 57

Which is more malignant, seminoma or non seminoma?

Answer 57

Non seminoma`