Genitourinary

Question 1

2004 WHO classification
The most frequent histological subtypes are?

Answer 1

Clear cell RCC
Papillary RCC
Chromophobe RCC
together represent more than 90% of all RCCs

Question 2

Aggressive RCCs?

Answer 2

Clear cell 75%
Papillary 10%
Collecting ducts (Bellini) 1%
Medullary 1%

Question 3

Non Aggressive RCCs?

Answer 3

Chromophobe 5%
Cystic-solid 1–4%
Xp11 translocation (rare)
Other rare ones

Question 4

Chromophobe RCC association? hypovascular

Answer 4

Birt-Hogg-Dubé syndrome

Question 5

Clear cell RCC association?
hypervascular

Answer 5

Von Hippel-Lindau (25– 45%)
tuberous sclerosis (2%)

Question 6

Medullary RCC association?

Answer 6

Sickle cell disease

Question 7

Aggressive RCCs? Do not miss this one…

Answer 7

Collecting ducts (Bellini) 1%

Question 8

Enhancement Pattern can help in differentiating various types of renal masses.
Clear cell?
Papillary?
Oncocytomas?

Answer 8

Clear cell renal: hypervascular - early and intense enhancement
Papillary: hypovascular - minimal progressive to no enhancement; but, more more homogeneous than clear cell and *** marked T2 hypointensity.
Oncocytomas: hypovascular - more delayed and less intense enhancement

Question 9

Papillary: hyper or hypovascular | hyper or hypo T2?

Answer 9

Minimal progressive to no enhancement; but, more homogeneous than clear cell, and
marked T2 hypointensity.

Question 10

Renal lesions > 4.0 cm characteristics?

Answer 10

May be heterogeneous due to the presence of necrosis, hemorrhage and calcification.

Question 11

Macroscopic fat?

Answer 11

Interstitial macrophages with cholesterol

Question 12

Intracytoplasmic fat?

Question 13

Papillary RCC type 1 and type 2?

Answer 13

Type 1 (basophilic): detected at earlier stages and lower grades - better prognosis
Type 2 (eosinophilic): high-grade tumor, frequently associated with ganglial metastasis and, in some cases, with venous invasion.

Question 14

Papillary RCCs single, multifocal or bilateral?

Answer 14

Papillary RCC:
Solid, well defined, slow-growing lesions.
Two subtypes 1 - basophilic | 2 - eosinophilic
Bilateral (4%)
Multifocal (22.5%)

Question 15

Papillary RCC association?

Answer 15

Acquired chronic renal disease

Question 16

Bosniak 1

Answer 16

Simple fluid
Thin < 2 mm smooth wall
No septa or calcification

Question 17

Bosniak 2 fluid | septa | wall

Answer 17

Simple T2 hyper or hemorrhagic T1 hyper fluid
Thin < 2 mm smooth wall.
NO enhancing septa (may have calcification)
1 to 3 septa (few)
UP to 2 mm thick

Question 18

Bosniak 2F fluid | septa | wall

Answer 18

1 to 3 Enhancing septa UP to 3 mm.
If more than 4 (many) enhancing septa should be UP to 2 mm

*Bosniak 2 cannot enhance

Question 19

Enhancing septa or calcification?
Bosniak 2
Bosniak 2F

Answer 19

Bosniak 2 - NO enhancing septa. May have calcification
Bosniak 2F - ANY enhancing septa BUT UP to 3 mm.

Question 20

Bosniak 2F septa enhancement

Answer 20

ANY enhancing septa BUT UP to 3 mm.

Question 21

Bosniak 2F T1 signal?

Answer 21

Bosniak 2F: Heterogeneous T1 signal

Bosniak 2: Homogenous T1 > hemorrhagic/proteinaceous cyst

Question 22

Bosniak 1 to 3 septa (EPOS)

Answer 22

No septa: Bosniak 1

UP to 2 mm: Bosniak 2

UP to 3 mm (but few/less than 4 septa): Bosniak IIF

4 mm or more: Bosniak 3

Question 23

Bosniak 3

Answer 23

4 mm or more Enhancing septa, or

UP to 3 mm obtuse, convex protrusion, or

Any irregular Enhancing walls or septa

Question 24

Bosniak 4

Answer 24

Any size convex protrusion with acute margin, or
4 mm or more enhancing nodule = convex protrusion

Question 25

Bosniak 2F% of malignancy and follow-up for how many years

Answer 25

10.9% (17 of 156) Bosniak category 2F cystic lesions progressed to malignancy;
therefore, the recommended length of follow-up for the majority of Bosniak category 2F lesions is 4 years.