FN: Renal Tumours

Question 1

Renal cell carcinoma/Hypernephroma epi

Answer 1

90$ of renal cancers
Age: 55 yrs
Sex: M>F =2:1

Question 2

Renal cell carcinoma/Hypernephroma RF

Answer 2

Obesity
Smoking
HTN
Dialysis (15% of pts. develop RCC)
4% heritable e.g. VHL syndrome

Question 3

Renal cell carcinoma/Hypernephroma pathology

Answer 3

Adenocarcinoma from proximal renal tubular epithelium

Question 4

Renal cell carcinoma/Hypernephroma subtypes

Answer 4

Clear cell (glycogen):70-80%
Papillary: 15%
Chromophobe:5%
Collecting duct:1%

Question 5

Renal cell carcinoma/Hypernephroma PResentation

Answer 5

50% incidental finding
Systemic: anorexia, malaise, wt. loss, PUO
Clot retention
Invasion of L renal vein - varicocel (1%)
Cannonball mets - SOB

Question 6

Renal cell carcinoma/Hypernephroma Triad

Answer 6

HAematuria
Loin pain
loin mass

Question 7

Renal cell carcinoma/Hypernephroma Paraneoplastic features

Answer 7

EPO - polycythaemia
PTHrP - raised Calcium
Renin - HTN
ACTH - Cushings syn
Amyoidosis

Question 8

Renal cell carcinoma/Hypernephroma spread

Answer 8

Direct: renal vein
Lymph
Haematogenous: bone, liver and lung

Question 9

Renal cell carcinoma/Hypernephroma Investigations blood shows

Answer 9

Polycythaemia, ESRm U+E, ALP, Ca

Question 10

Renal cell carcinoma/Hypernephroma Urine

Answer 10

Dip

Cytology

Question 11

Renal cell carcinoma/Hypernephroma Imaging

Answer 11

CXR: cannonballmets
US: mass
IVU: filling defect
CT/MRI

Question 12

Renal cell carcinoma/Hypernephroma Robson staging

Answer 12

1. Confined to kidney
2. Involves perinephric fat, but not Garotas fascia
3. Involves perinephric fat, but not Garotas fascia
4. Spread into renal vein
5. Spread to adjacent/distant organs

Question 13

Renal cell carcinoma/Hypernephroma Medical Mx

Answer 13

REserved for pts. with poor prognosis

Temsirolimus (mTOP inhibitor)

Question 14

Renal cell carcinoma/Hypernephroma Mx surgical

Answer 14

Radical nephrectomy

Consider partial if small tumour of 1 kidney

Question 15

Transitional cell Carcinoma Epi

Answer 15

2nd commonest renal cancer
Age: 50-55yrs
Sex: M>F=4:1

Question 16

Transitional cell Carcinoma RF

Answer 16

Smoking
Amine exposure (rubber industry)
Cyclophosphamide

Question 17

Transitional cell Carcinoma Pathology

Answer 17

Hihgly malignant
Locations
-bladder 50%
Ureter
REnal pelvis

Question 18

Transitional cell Carcinoma Presentation

Answer 18

Painless haematuria
Freqeuncy, urgency, dysuria
Urinary tract obstruction

Question 19

Transitional cell Carcinoma Investigations

Answer 19

Urine cytology
CT/MRI
IVU: pelvicael filing defect

Question 20

Transitional cell Carcinoma MA

Answer 20

Nephrouretctomy

REgular f/up: 50% develop bladder tumours

Question 21

Nephroblastoma: Wilms tumour

Answer 21

Childhood tuour of primitve renal tubules and mesenchymal cells
May be association with Chr 11 mutation
May be association with WAGR syndrome - wilms, aniridia, GU abnormalities, REtardation

Question 22

Nephroblastoma: Wilms tumour Presentation

Answer 22

2-5 yrs
5-10% bilateral
Abdo mass (doesnt cross the midline)
Haematuria
Abdo pain
GTN

Question 23

Benign neoplasms

Answer 23

Cysts: very common
Renal papillary adenomas
Oncocytoma: eosinophilic cells with numerous mitochondria
Angiomyolipoma: seen in tuberous sclerosis

Question 24

Malignant neoplasms

Answer 24

SCC: associations with chronic infected staghom calculi

Question 25

Benign tumours note

Answer 25

Commonly require nephrectomy to exclude malignancy