GU Flashcards
DDx for medullary nephrocalcinosis
“HAM HOP”
H: hyperparathyroidism
A: (renal tubular) acidosis (type 1)
M: medullary sponge kidney, milk alkali syndrome
H: hypercalcemia/hypercalciuria, hypervitaminosis D
O: oxalosis
P: papillary necrosis
DDx for cortical nephrocalcinosis
"COAG" C: cortical necrosis O: oxalosis A: Alport syndrome G: (chronic) glomerulonephritis
What are the 4 histologic types of RCC?
- Clear cell (most common)
- Papillary
- Chromophobe
- Sarcomatoid
What are serum tumor markers for testicular neoplasms?
- Beta hCG- seminomas and choriocarcinomas
- Alpha fetoprotein- yolk sac tumors
What are the typical MR features of uterine leiomyomata?
- T1: Isointense to myometrium
- T2: loss of signal
- May be hyperintense on T1 and T2 if undergoing degen.
- Calcs may appear as areas of signal drop
How do you calculate absolute adrenal washout? What is considered an adenoma?
(PVP - Delayed) / (PVP - Unenhanced) x 100%
Absolute washout >60% = adenoma
How do you calculate relative adrenal washout? What is considered an adenoma?
(PVP - Delayed) / PVP x 100%
Relative enhancement washout >40% = adenoma
What is the timing for the enhanced and delayed phases for adrenal washout?
Radiology Assistant and Radiopaedia state, “1 min (PVP) for enhanced and 15 min for delayed”
A spoke wheel pattern of enhancement is characteristic of what renal tumor?
Oncocytoma; however, b/c it cannot be reliably distinguished from RCC and is much less common than RCC, oncocytoma should not be diagnosed prospectively.
What are the diagnostic criteria for Polycystic Ovarian Syndrome?
The revised Rotterdam consensus criteria devised in 2003 require 2 of 3 criteria for the dx:
1) oligo- or anovulation
2) hyperandrogenism (clinical or biochemical) and
3) polycystic ovaries: on imaging
- As well as the exclusion of other etiologies, such as congenital adrenal hyperplasia, Cushing syndrome and/or an androgen secreting tumour.
True or False: The frequency of malignant renal neoplasms in patients with adult PKD is the same as that in the general population.
True (Radcases)
What are imaging findings of PCOS?
- ≥ 12 follicles per ovary
- ≥ 10 mL ovarian volume
- Fulfillment of 1 criterion by 1 ovary is sufficient
- Usually bilateral, may be unilateral
- Peripheral follicles, “string of pearls”
- T2: Multiple small, subcapsular ↑ SI follicles, thick ↓ SI ovarian cortex, ↑ volume central ovarian stroma
- T1 C+: Rim enhancement of follicles
- Endometrial changes in 30-40%
- Endometrial thickening ± cystic change
- Cannot exclude atypia or endometrial carcinoma
What are indications for treatment of renal artery aneurysm?
- Size > 2 cm
- pregnancy
- expansion
- presence of other complications
What is the most common site for transitional cell carcinoma (TCC)?
Bladder, followed by the upper urinary tract
What is the rate of synchronous and metachronous TCC?
- 12% of upper urinary tract cases;
- 4% of bladder TCC will have synchronous or metachronous lesions
What is malakoplakia?
Flat areas of wall thickening, granulomatous inflammation, of the renal pelvis, ureter and bladder (most common site) are usually multiple and a/w UTI.
What is the mgmt of malakoplakia?
Although malakoplakia may be extremely aggressive, invading the perivesical space, and it can even cause bone destruction, non-surgical medical management is the mainstay of treatment, and as such biopsy for accurate diagnosis is essential.
What is the measurement cutoff for adenomyosis?
Thickening of the juntional zone of >12 mm is considered specific.
What is the typical appearance of multilocular cystic nephroma?
A cystic mass with multiple thin septa and herniation into the renal pelvis is characteristic.
What is the typical age distribution of multilocular cystic nephroma?
Bimodal: MLCN occurs most commonly in boys younger than 4 years of age or women older than 30 years.
What is the most common neoplastic lesion of the ovary?
dermoid cyst
What percentage of bladder ruptures are intraperitoneal?
20%
What is the typical MR appearance for uterine leiomyoma?
- isointense to myometrium on T1
- hypointense to myometrium on T2. A whorled pattern is characteristic.
- Hyperintensity on T1- or T2-WI may be seen in leiomyomata undergoing degeneration.
What are the 4 most common sources of adrenal metastases?
melanoma and cancers of the lung, breast, kidney
What are features of DES exposure to the uterus?
-T-shaped uterus, a wide lower uterine segment, small hypoplastic uterus, narrow fundal endometrial canal, irregular endometrial margins, and intraluminal uterine filling defects
DDx bilateral renal lesions
- RCC
- AML
- renal abscesses
- lymphoma
- metastases
- extramedullary hematopoiesis
- Erdheim Chester disease
DDx enhancing adnexal mass
- ovarian malignancy
- germ cell tumor
- sex cord stromal tumor
- pedunculated fibroid
- uterine sarcoma
- smooth muscle tumor of unknown malignant potential (STUMP) (rare)
What conditions are associated with pheochromocytoma?
- MEN II: both MEN IIa and MEN IIb (account for 3% of all pheochromocytoma)
- -almost never extra-adrenal
- -almost always bilateral
- von Hippel-Lindau disease
- von Recklinghausen disease (NF I)
- Sturge-Weber syndrome
- Carney triad: for extra-adrenal pheochromocytoma
- tuberous sclerosis
- familial pheochomocytoma
What biochemical markers are there for pheochromocytoma?
- 24-hour urine collection for creatinine, total catecholamines, vanillylmandelic acid, and metanephrines
- plasma free metanephrines
- serum chromogranin A (83% sensitive and 96% specific for identifying a pheochromocytoma. Chromogranin A levels are sometimes used to detect recurrent pheochromocytoma.)
What is the treatment of pheochromocytoma?
Definitive treatment is surgical, and if complete resection is achieved, without metastases, then surgery is curative, and hypertension usually resolves.
What nuclear medicine test can be used for detection of pheochromocytoma?
- I-123 MIBG (sensitivity 81%)
- Indium 111-DTPA Octreotide scan
