#10 Zaman - Urolithiasis, Vascular Disease and Tumors

Question 1

Identify the disease if any.

Answer 1

HUS/TTP

Hemolytic Uremic Syndrome

Throbotic Thrombocytopenic Purpura

Caused by E. coli OH157:H7 and shigella

Ischemic damage to tubules

*Fibrinoid necrosis of arterial wall, thrombi, fragmented RBCs in lumen

Question 2

What are the manifestations of Hemolytic Uremic Syndrome?

Answer 2

(HUTS for MILEs)

Hemolytic Uremia

Thrombocytopenia

Schistocytes

Microvascular thrombosis

Infection by E. coli OH157:H7 and shigella

LDH elevated

Question 3

A child comes in with hemolysis and uremic signs what would you suspect?

Answer 3

Hemolytic Uremic Syndrome / TTP

Uremic Signs:

gastritis, nausea, vomiting, anorexia, salty layer on skin, muscle twitching, seizures, coma, anemia

Lab changes: metabolic acidosis, hyperkalemia, hyperphosphatemia, hypocalcemia

Question 4

Identify the disease if any.

Answer 4

Renal Cell Carcinoma

Clear Cell Type (most common type 70-80%)

Basal nucleus with clear space

Yellow cell surface with some grey foci

*invade renal vein

Question 5

Patient comes in fever, weight loss and fatigue. You order a CT and discover an invasion of the renal vein. What do you suspect?

Answer 5

Renal Cell Carcinoma, Clear Cell Type

Only 10% have flank pain.

Also can present with polycythemia, Cushing’s, hypercalcemia, gonadotrophins

Question 6

Identify the disease if any.

Answer 6

Chromophil RCC

Color is dark

Papillary structure

Question 7

Identify the disease if any.

Answer 7

Wilm’s Tumor - grey white mass

primitive mesoblastic and nephroblastic

Anaplasia is prognosticating factor

Triphasic

Question 8

Toddler enters and you see aniridia. What is a likely diagnosis?

Answer 8

Wilm’s Tumor

Pediatric tumor (2-4 Y)

Black, male

(WAGR: Wilm’s tumor, Aniridia (no iris), GU malformations, Retardation)

11p13 Wilm’s Tumor 1 - unlucky #

11p15 Wilm’s Tumor 2 - Beckwith-Wiedeman syndrome