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Flashcards in Renal Tumours Deck (47):
1

What are the benign renal tumours?

Angiomyolipoma
Oncocytoma

2

What are malignancies associated with the kidney?

RCC
TCC
Lymphoma and other mets

3

What is the pathological appearance of oncocytoma?

It is a spherical, capsulated, brown/tan coloured mass which has a star-shaped or spoke wheel patterned central scar.

Aggregates of Eosinophils
Mitosis is Rare
Mitochondria packed (similar to Chromophobe RCC)


4

What are symptoms of oncocytoma?

Loin Pain
Haematuria
Often an Incidental Finding

5

What are investigations for oncocytoma

Radiologically, these are very difficult to differentiate from Chromophobe RCC.

Classic Sign is the Spoke Wheel Central Scar in a mass.

Follow radiology with biopsy to confirm Oncocytoma with certainty.

6

What is treatment for oncocytoma?


Same treatment as Chromophobe RCC
Partial Nephrectomy for Small Masses Radical Nephrectomy for Large Masses

7

What is the major risk factor for angiomyolipoma?

Tubular Sclerosis

8

What is the pathology for angiomyolipoma?

Blood vessels (angio), immature smooth muscle (myo) and fat (lipoma) are seen, hence the name.

9

What are symptoms of angiomyolipoma?

Loin Pain
Mass
Haematuria
Wunderlich's Syndrome i.e. A Massive Retroperitoneal Bleed with Sudden Pain

10

What are investigations for angiomyolipoma?

USS
CT (Surrounding black shadowing represents fat)

11

What is the treatment for angiomyolipoma?

If 1-3cm, observe once diagnosed and discharge men.
If 1-3cm, pre-menopausal women should be monitored as they exert hormonal influence with oestrogens

4cm is the Cut-Off i.e. Elective Embolization OR Partial/Radical Nephrectomy otherwise risk of spontaneous bleeding increases markedly Emergency Embolization to stop bleeding OR Nephrectomy if the tumour is Large

12

What is RCC?

Adenocarcinoma of the renal cortex and is often noted to arise from the Proximal Convoluted Tubule origin

13

What are risk factors of RCC?

Renal failure and dialysis
Smoking
Obesity
Hypertension
Asbestos
Cadmium
Phenacetin
VHL Syndrome (50% of patients develop RCC)
Sickle Cell Disease
Male

14

What is the pathology of RCC?

Tan coloured, lobulated, solid mass.
10-25% contains cysts and generally, it is predominantly cystic

15

What are the types of RCC?

Clear Cell
Papillary
Chromophobe
Collecting Duct
Medullary

16

What are symptoms of RCC?

Loin pain
Haematuria
Mass
All 3 of the above i.e. Israel Triad which is a less common presentation
Pyrexia of unknown origin
Variocoele, often on the left side, as the left testicular vein drains directly into the renal vein on the left hand side
Paraneoplastic Syndrome e.g. ACTH, Insulin, Renin, EPO etc.
Stauffer's Syndrome i.e. Abnormal Liver Function NOT due to Metastases along with Fever and Anorexia

17

How is RCC staged?

T1; up to 7cm
T2 >7cm; confined to kidney
T3; invasion beyond kidney into renal vein, perinephric fat, renal sinus and IVC which is more common in right side due to anatomy
T4; beyond gerotas fascia into surrounding structure

18

What are investigations for RCC?

USS
CT Chest, Abdomen and Pelvis for staging
FBC; RFTs and LFTs

19

What is the treatment for RCC <3cm?

Surveillance in elderly unfit patients
Ablation techniques in fit, elderly and selected young patients
Partial nephrectomy for fit young patients

20

What is the treatment of RCC >3cm?

Partial nephrectomy (for patients with long life expectancy) via the robotic technique but there is risk of haematuria and bleeding afterwards.
Radical nephrectomy

21

What is the gold standard treatment for extremely large RCC?

Laparoscopic radical nephrectomy

22

What does RCC follow-up consist of?

FBC; in particular LFTs as deranged LFTs can indicate Liver Metastases
Imaging i.e. CT or USS + CXR, depending on how bad the cancer was (minimise radiation in younger population so mix and match)

Duration 5-10 years

23

What are the types of Testicular Cancer (TC)?

Seminomatous, common in men aged 35-45 years (Sergeant's Disease)
Non-Seminomatous, common in men aged <35 (Troop's Disease)

Based on involvement of seminal vesicles

24

What are risk factors of TC?

Being White
Previous TC which causes increased risk in contralateral testicle
HIV
Family history of TC
Cryptorchidism (failure of testicle descending) is found in 5-10% of TC Patients Orchidopexy done before 13 years causes a 2 fold risk while orchidopexy done after 13 years causes a 5 fold risk - essentially it should be done as soon as Cryptorchordism is detected

25

What is the presentation of TC?

Scrotal lump i.e. A hard, non-tender, irregular, intratesticular mass
Discolouration of affected teste
Asymmetry of testes
Delayed presentation occasionally seen
Acute pain due to bleeding in 5% of presentations
Weight loss, neck lumps, chest symptoms or bone pain suggest widespread disease

26

What is involved in examination for TC?

Examine normal side first
Assess for epididymis involvement
Examine spermatic cord and scrotal skin
Look for abdominal mass as this is an indication of advanced disease
Secondary Hydrocoele

27

What are investigations for TC?

USS and once confirmed, CT Chest and Abdomen for staging
Tumour Markers should be raised: Alpha Foeto Protein (AFP), B-HCG, LDH
FBC, in particular LFTs and RFTs

28

What is management of TC?

Gold Standard is Radical Inguinal Orchidectomy

Re-check Tumour Markers 1 Week post-surgery and if they remain elevated, do a CT scan to check for metastases
Further follow up by Oncology with Chemotherapy as an adjuvant (even in non-metastatic disease) as it has been shown to improve outcome significantly

29

What if a mass if found on examination of TC elsewhere?

Urgent CT scan to confirm metastases, followed by oncology chemotherapy referral

30

List common penile cancers

SSC, often on Glans which invades into the tissue
Kaposi's Carcinoma, which is linked to HIV
BCC
Malignant Melanoma
Sarcomas

31

What are symptoms of penile cancer?

Hard, painless groin mass/lump
Urinary Retention
Inguinal Lymphadenopathy

32

What are investigations for penile cancer?

MRI to assess tumour depth
CT Abdomen, Pelvis and Chest

33

What is treatment for penile cancer?

For Preputial Lesions, circumcision
For Superficial Glans Lesions, resurfacing
For Deep Glans Lesions, glansectomy
For Advanced Disease, total penile amputation with formation of perineal urethrostomy
For Inguinal Lymphadenopathy, lymphadectomy but note that there is a high risk even if not involved

34

An African man is most likely to get testicular cancer?

No.
African, Asian and South American men are more likely to have penile cancer while white men are more likely to get testicular cancer.

35

What are the types of non-seminomatous TC?

Yolk Sac
Choriocarcinoma
Embryonal
Trophoblast
Teratoma (most common)

36

Which non-seminomatous TC produces Alpha Foeto Protein?

Yolk Sac

37

Which non-seminomatous TC makes men pregnancy test positive?

Trophoblast, through B-HCG secretion

38

What do Seminomatous TC produce?

LDH

39

What do non-seminomatous TC produce?

Alpha Foeto Protein
B-HCG

40

What is Hydrocoele?

The accumulation of fluid around the testes, between the two layers of the tunica vaginalis and therefore, the fluid is walled off by a mesothelial lining

41

What is Spermatocoele?

A cyst that develops within the vas of epididymis due to an unknown cause and is usually, ASYMPTOMATIC.

42

How do spermatocoele patients present?

Sensation of fullness
Lump, often present after self examination
Feelings of heaviness down there

43

What is Variocoele?

Distension of the venous plexus that drains the testis.

44

How does Variocoele present?

It is usually asymptomatic but patients describe their balls having an inside feeling of a 'bag of worms' and often, may present after having felt a lump.

45

What is the epithelium of the foreskin?

Squamous, hence why it is susceptible to SSC

46

What is penile papilloma associated with?

HPV

47

What are the types of Penile Intraepithelial Neoplasia?

Differentiated (i.e. NOT related to HPV)
Dedifferentiated (i.e. Related to HPV) otherwise known as Non-Differentiated