Renal Tumors And Congenital Anomalies Flashcards
(27 cards)
Renal Tumors
- Malignant:
• 85% Adenocarcinoma.
• 15% Wilms, TCC, sarcomas.
Renal Tumors Benign
Oncocytoma, angiomyolipoma.
Renal Cell Carcinoma “RCC”
- Most lethal urological cancer.
- 5th most lethal cancer.
- Adenocarcinoma from the renal cortex.
- Arises mostly from proximal tubule.
- More common in males.
- In 50-60s.
- Unilateral, solitary, solid.
Renal Cell Carcinoma “RCC” RFs
• Smoking: ×2.3.
• Renal failure with cysts: ×30.
• Obesity, HTN.
• Polycystic kidney disease.
• Sickle cell.
RCC Histological types:
• Clear cell: MC.
→ Proximal tubule, very vascular, VHL gene on Ch 3.
• Papillary: bilateral, Ch 7, 17.
• Chromophobe: cortical part of collecting, least aggressive.
• Collecting duct: young, poor prognosis, rare.
• Medullary: sickle cell, young and aggressive
RCC genetics
VHL syndrome:
Sporadic RCC associated in 80% with VHL mutation.
Papillary RCC: AD, CH 7 C-met activation.
VHL syndrome:
→ Autosomal Dominant.
→ Mutation in VHL gene in chromosome 3.
→ Associated with: bilateral RCC, hemangioblastoma,
polycythemia.
RCC Presentation:
• Mostly incidental.
• Painless hematuria: 60%, MC.
• Loin pain: 40%.
• Mets symptoms: 30%.
• Para-neoplastic syndrome: 30%.
→ Hypercalcemia, polycythemia, fever, hypertension, hepatic dysfunction, hypoglycemia.
RCC Investigations:
• Labs:
→ CBC, ESR.
→ KFT.
→ LFT.
→ Urine analysis & culture.
RCC Images:
→ Renal protocol enhanced CT: GOLD STANDARD.
→ Chest CT for staging.
→ Bone scan: if symptomatic.
RCC Spread:
• Renal Vein 44%.
• Bone 25%.
• Hematogenous: lung (MC). bone, liver, brain.
→ Paired organs metastasize to lung more.
→ Single organs metastasize to liver more.
• Lymphatic.
RCC Treatment:
• Radical nephrectomy or partial nephrectomy (nephron
sparing surgery).
• Chemotherapy usually has no role.
• Radiotherapy: palliation in metastatic patients.
Wilms Tumor “Nephroblastoma”
- The MC renal cancer in childhood.
- Usually bilateral.
Wilms Tumor “Nephroblastoma” DDx
Neuroblastoma, Hydronephrosis.
Wilms Tumor “Nephroblastoma” Investigations
• Tests:
→ Bone marrow biopsy.
→ Urine collection for VMA & metanephrines.
• Images:
→ IVU, MRI.
Wilms Tumor “Nephroblastoma” Tx:
nephrectomy -/+ chemoradioimmunotherapy.
Oncocytoma
- Central scar: spoke wheel appearance.
- Looks like chromophobe RCC in histology.
- Biopsy is not diagnostic in most cases
- Tx: Nephrectomy.
Angiomyolipoma
- Females more than males.
- Associated with tuberous sclerosis(AD).
- Histology: very vascular and contains fat.
- Presentation: incidental vs bleeding.
- Tx: if symptomatic→ surgery, angioembolization.
- Can be differentiated from renal cell carcinoma by contrast CT.
Hypospadias
• Urethra opens in an abnormal position on the ventral
aspect of the penis.
• Associated with chordee and hooded prepuce
Vesico-ureteral reflux (VUR):
• Child with HTN and recurrent UTI.
• Urographic demonstration of longitudinal folds in renal
pelvis and ureter in children.
MC cancer in renal transplant patients:
skin cancer (BCC).
Renal transplantation is usually defined as a
heterotopic graft.
MC site of ureteral urothelial tumor:
bladder and pelviuretric
Horseshoe kidneys:
• The MC fusion anomaly.
• More in males.
• True fusion of the lower poles at the level of L4 or L5
→ Which forms an isthmus and becomes medially directed.
• High incidence of neoplasia.
