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Urology > B/2. Renal tumors > Flashcards

B/2. Renal tumors Flashcards

1
Q

BENIGN Renal tumors

A
  • Angiomyolipoma
  • Oncocytoma
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2
Q

Angiomyolipoma def

A

benign renal tumors that arise from perivascular epithelioid cells
and consist of:
* blood vessels,
* smooth muscle, and
* mature fat cells

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3
Q

most common benign renal tumor

A

angiomyolipoma

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4
Q

Epidemiology Angiomyolipoma

A

most common benign renal tumor,
F > M(4:1)

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5
Q

angiomyolipoma etiology

A

: sporadic

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6
Q

Angiomyolipoma symptoms

A

mostly asymptomatic;
large tumors can present with
* hematuria,
* retroperitoneal hemorrhage,
* impaired renal function

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7
Q

Angiomyolipoma Pathology, hows growth rate?

A

slow-growing;
epithelioid angiomyolipoma have a greater number of epithelioid
cells, acidophilic and granular cytoplasm, less fat than classic type

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8
Q

Angiomyolipoma diagnostics

A
  • US
  • CT
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9
Q

Angiomyolipoma treatment

A

Treatment: surgical resection if >4 cm

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10
Q

Oncocytoma def

A

benign epithelial tumor arising in the collecting duct from the intercalated tubular cells

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11
Q

Oncocytoma symptoms

A
  • painless hematuria,
  • abdominal mass,
  • flank pain
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12
Q

Oncocytoma gross pathology

A

smooth, clearly defined brown tumor
with central radial scar;
large acidophilic cells,
excessive amount of mitochondria resulting in granular cytoplasm
without perinuclear clearing (unlike chromophobe RCC)

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13
Q

Oncocytoma diagnostics

A
  • US
  • CT
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14
Q

Oncocytoma treatment

A

often resected in order to exclude RCC

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15
Q

Oncocytoma prognosis

A

may transform into malignant oncocytic RCC

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15
Q

Oncocytoma prognosis

A

may transform into malignant oncocytic RCC

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16
Q

painless hematuria can be symptom of ?

A

Oncocytoma

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17
Q

MALIGNANT renal tumor

A

RENAL CELL CARCINOMA

18
Q

RENAL CELL CARCINOMA epidemiology
gender
age
%

A
  • Incidence increases continuously during the last years
  • RCC accounts for >90% of malignant kidney neoplasms
  • More common in males
  • 50-70 years but can present at any age
19
Q

what tumor accounts for >90% of malignant kidney neoplasms

20
Q

RENAL CELL CARCINOMA more common in which sex

A

males (2:1)

21
Q

peak age incidence of RCC

A

ages 50-70
but can present at any age

22
Q

RENAL CELL CARCINOMA risk factors

A
  • Smoking
  • Renal cystic diseases
  • end-stage kidney disease
  • Von-Hippel-Lindau syndrome (AD mutation, tumor suppressor gene, located on chromosome 3);
    bilateral RCC, hemangioblastoma, angiomatosis, pheochromocytoma
23
Q

Von-Hippel-Lindau syndrome

A
  • (AD mutation, tumor suppressor gene, located on chromosome 3);
    bilateral RCC, hemangioblastoma, angiomatosis, pheochromocytoma

Von HIPPEL-Lindau syndrome:
Hemangioblastoma, Increased risk of renal cell carcinoma, Pheochromocytoma, Pancreatic lesions (cysts, cystadenomas, and neuroendocrine tumors), Eye Lesions (retinal angiomas or hemangioblastomas)

24
VHL normally inhibits
VHL normally inhibits HIF-1 alpha (Hypoxia Inducible Factor alpha ) > mutation results in increased activity of VEGF and PDGF pathways
25
RENAL CELL CARCINOMA clinical findings
* Up to 70% of cases are asymptomatic * Classic triad: hematuria, abdominal mass, flank pain * Constitutional: fever, weight loss, anemia * Paraneoplastic syndromes: *PTHrP > hypercalcemia *EPO > erythrocytosis *ACTH> cushing syndrome *Renin > hypertension
26
How is RCC usually discovered?
* Up to 70% of cases are asymptomatic; most commonly detected as an incidental finding on radiograph or other abdominal imaging
27
List Paraneoplastic syndromes in RCC
* PTHrP > hypercalcemia * EPO > erythrocytosis * ACTH> cushing syndrome * Renin > hypertension
28
classic triad in RCC
* hematuria, * abdominal mass, * flank pain
29
histopathological classification of RCC
* Clear cell RCC 60% Arises from PCT cells * Papillary (chromophilic) RCC 5-15% Arises from PCT cells * Chromophobe RCC 5-10% Indolent clinical course * Oncocytic RCC 5-10% Considered benign neoplasm * Collecting duct (Bellini) RCC < 1% Arises from medullary collecting ducts; aggressive
30
RCC Diagnostics
* The standard evaluation of patients with suspected renal cell tumor includes: 1. Renal US 2. CT scan of the abdomen and pelvis 3. CXR 4. Urinalysis 5. Urine cytology * If metastatic disease is suspected from the chest radiograph, a CT of the chest is warranted * MRI is useful in evaluating the IVC in cases of suspected tumor involvement or invasion by thrombus.
31
when is MRI useful in RCC
MRI is useful in evaluating the IVC in cases of suspected tumor involvement or invasion by thrombus.
32
In clinical practice, any solid renal mass should be considered
malignant until proven otherwise
33
staging of RCC T1a, T1b
T1a Tumor < 4 cm in largest diameter, confined to the kidney T1b Tumor 4-7 cm in largest diameter, confined to the kidney
34
staging of RCC T2
T2 Tumor > 7 cm in largest, confined to the kidney
35
staging of RCC T3a, T3b, T3c
* T3a Tumor invades adrenal gland or perinephric tissue, but not beyond Gerota's fascia * T3b Tumor invades renal vein or IVC below diaphragm * T3c Tumor invades IVC above diaphragm
36
staging of RCC T4
T4 Tumor invades beyond Gerota's fascia
37
metastasis of RCC
lymphatics, lung, bone, brain, liver
38
which LN get involved in RCC
renal hilar lymph nodes
39
Treatment of RCC T1, T2
* Radical nephrectomy en-bloc removal: *of Gerota's fascia including kidney, *adrenal gland, and *hilar lymph nodes * Nephron-sparing approach/Partial nephrectomy (laparoscopic or open surgery): *appropriate choice if T1a *or for patients who have only one functional kidney (depending on the size and location of the lesion)
40
when is nephron sparing approach/partial nephrectomy used in RCC
(laparoscopic or open surgery) 1. appropriate choice if T1a or 2. for patients who have only one functional kidney (depending on the size and location of the lesion)
41
Advanced/ metastatic RCC treatment
* Consider surgery to alleviate hematuria/pain from primary tumor, or cytoreductive nephrectomy before systemic treatment is initiated * Targeted therapy -Sunitinib, sorafenib, pazopanib, axitinib (oral TKI targetting VEGF and PDGF) -Bevacizumab Anti-VEGF monoclonal Ab -Everolimus, temserolimus (mTOR inhibitors, used if patient fails to respond to TKI therapy * Immunotherapy -Pembrolizumab, nivolumab (anti-PD1 monoclonal Ab) -Ipilimumab (anti-CTLA4 monoclonal Ab) -Cytokines : IL-2 (Aldesleukin), IFN-alpha; not commonly used nowadays
42
when to consider surgery in advanced metastatic RCC
Consider surgery to alleviate hematuria/pain from primary tumor, or cytoreductive nephrectomy before systemic treatment is initiated

Urology (30 decks)

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