Cysts and Cancer Flashcards
What is a simple cyst?
A small fluid filled sac, usually asx and found incidentally. Fluid = ultrafiltrate.
How does a simple cyst look on ultrasound?
anechoic (black)
What is a complex cysts?
Cysts that are large, septated, w/ loculations, or have solid components.
Treatment of simple cysts vs. complex cysts?
Simple - nothing.
Complex - resect or drain.
In what age group does autosomal recessive polycystic kidney disease present?
In infancy.
Patient presentation of ARPKD?
Anuric, b/l palpable flank masses.
ARPKD diagnosis?
U/S and biopsy.
What do the cysts in ARPKD look like?
radially oriented.
What is ARPKD associated with?
congenital hepatic fibrosis, potter sequence.
What is potter sequence?
Olighydramnios –> compression of developing fetus –> limb deformities, facial anomalies such as low set ears, retrognathia.
Compression of chest and lack of amniotic aspiration into lungs leads to pulmonary hypoplasia (cause of death).
If patients with ARPKD live, what are some concerns beyond the neonatal period?
systemic HTN, progressive renal insufficiency, and portal hypertension from congenital hepatic fibrosis.
What is autosomal dominant polycystic kidney disease?
Numerous cysts causing b/l enlarged kidneys that ultimately destroy kidney parenchyma.
What is the presentation of ADPKD?
flank pain, hematuria, HTN, UTIs, progressive renal failure.
What is ADPKD associated with?
HTN (increased renin production) Benign hepatic cysts Cysts in the pancreas Mitral Valve Prolapse Berry Aneurysms
What is medullary cystic disease?
Inherited disease causing tubulointerstitial fibrosis and progressive renal insufficiency with inability to concentrate urine.
What does medullary cystic disease look like on ultrasound?
Shrunken kidneys.
In what age range does renal cell carcinoma present?
Men 50-70
Risk factors for renal cell carcinoma?
Smoking, obesity
Clinical sx of renal cell carcinoma?
hematuria, flank mass/pain. 2ndry polycythemia (too much EPO), fever, weight loss.
How does RCC spread and where?
Hematogenously. Invades IVC via renal vein, then spreads to lungs and bone.
What paraneoplastic syndromes is RCC associated with?
EPO, ACTH, PTHrP.
What genetic syndrome is RCC associated with?
von-Hippel Lindau. Cerebellar hemangiomas, clear cell renal, pheos.
Where in the kidney does RCC manifest?
PCT cells - polygonal clear cells.
Treatment for RCC?
resection if local, immunotherapy or targeted therapy for advanced/metastatic disease. Not great for chemo/rads.
What is renal oncocytoma?
Benign epithelial cell tumor. Often resected to r/o RCC.
What is Wilms Tumor?
Nephroblastoma. Most common renal malignancy of early childhood (ages 2-4).
Presentation of wilms tumor?
Large palpable, unilateral flank mass +/- hematuria.
What syndromes may Wilms be a part of?
Beckwidth Wiedmann - Wilms, macroglossia, organomegaly, hemi-hypertrophy.
WAGR complex - Wilms Tumor, Aniridia, Genitourinary malformation, mental Retardation.
