GU Flashcards
“Molar tooth” extrav from the bladder
extraperitoneal
Name a syndrome with increased risk of RCC.
VHL
How is prostate cancer staged?
- Not detectable on imaging.
- Confine to the prostate
- Extends outside capusle and may involve seminal vesicals.
- Invasion of rectum, levator, or pelvic wall
Solid adnexal mass + abnormal endometrium
endometrial hyperplasia 2/2 granulosa cell tumor
egg shell like calcs in the bladder wall?
Schistosomiasis infxn
(developing countries middle east and africa)
How to remember the difference between Bartholin and Gartner duct cysts?
One doesn’t let Bart in (Bartholin) because it is at the posterior introitus.
The other is Gartner. Garden along the front and sides of the house.
MC epidydimal tumor?
Adenomatoid tumor
-30% of extratesticular masses
Struma ovarii
mature cystic teratoma composed entirely or predominantly of thyroid tissue. The presence of fat in an ovarian lesion does not preclude the diagnosis of struma ovarii.
Potter sequence
if kidneys don’t form, yhou don’t make pee
if you don’t make pee, you don’t develop lungs
Mayer-Rokitansky-Kuster-Hauser
unilateral renal agenesis with mullerian duct anomalies including absence/atresia of the uterus
What are some risks associated with Horseshoe kidney?
IMA gets hung up
8x increased risk of Wilm’s Tumor
TCC (from more frequent infections)
Rare: renal carcinoid
Turner’s syndrome more likely to have horesehoe
Which kidney is inferior in crossed fused renal ectopia?
ectopic
calcs in a fatty renal mass
always RCC
enhancing renal mass
always RCC
RCC bony mets- lytic or blastic?
always lytic
Most common subtype RCC?
clear cell.
assoc w/ VHL
more aggro than papillary
enhances equal to cortex
Renal tumor that enhances less than cortex and is less aggro than clear cell
Papillary RCC
2nd most common RCC subtype
RCC Subtype assoc with Sickle Cell Trait
Medullary
aggro
large
happens in younger patients
RCC subtype associ with Birt Hogg Dube
Chromophobe
Birt Hogg Dube
lung cysts (w/ spont ptx)
mult bilat renal tumors (including oncocytomas)
cutaneous stuff
RCC Staging
- kidney, <7cm
- kidney, >7cm
- inside gerota’s fascia
a. renal vein
b. ivc below diaphragm
c. ivc above diaphram - beyond gerota’s, adrenal
Renal lesion associated with tuburous sclerosis
AML
bening renal tumor that looks like rcc, but has central scar?
oncocytoma
could show spoke wheel vascular pattern on u/s
hot on PET
renal lesion: non-communicating fluid-filled locules surrounded by thick fibrous capsule
Multilocular cystic nephroma
zzz: protrudes into the renal pelivs
4 yo boys and 40yo women
homogenous renal lesion with greater than 70 HU
benign proteinaceous or hemorrhagic hyperdense cyst
genetic renal disease with liver cysts, berry aneurysms, kidneys get larger and lose function, dialysis in 5th decade
ADPKD
genetic renal disease with HTN, associated biliary ductal abnormalities and fibrosis. kidneys are enlarged and diffusely echogenic with loss of corticomedullary differenctiation.
ARPKD
increased risk of malignancy with dialysis?
3-6x
25-50% of people with this disorder end up with RCC (clear cell)
VHL
Auto Dominant
panc serous microcystic adenomas, islet cell tumor
pheo, multiple
hemangioblastomas of cerebellum, brain stem and spinal chord
VHL
hamartoma party with renal AMLs
+LAM in chest
Rhabdomyosarc in heart
giant cell astrocytoma in brain
tuberous sclerosis
you are shown MRI of kidneys in patient with bipolar disorder with mult microcysts
lithium nephropathy
no functioning renal tissue and multiple small cysts in utero, contralateral renal tract abnormalities 50% of the time
Multicystic dysplastic kidney
Difference between peri and para pelvic cysts?
Peri orifinates from renal sinus, mimics hydro
Para originates from parenchyma, compresses collecting system.
Para and Parenchyma
staghorn calc, psoas abscess, bear paw on CT
xanthogranulomatous pyelonephritis
filling defect in renal calyx.. papillary necrosis. What causes it?
DM, peylo, sicke cell, TB, analgesics, cirrhosis
shrunken clacificed kidney
TB. MC extrapulmonary site of infxn
big kidney that is echogenis and renal sinus fat disappears (2/2 edema)
HIV nephropathy
most common composition of renal stone
calcium oxalate
renal calc that can’t be seen on CT
idinavir (HIV rx)
patient with history of shok develops thin renal calcs
cortical nephrocalcinosis
hyperechoic renal papilla/pyramids
Medullary nephrocalcinosis
hyperPTH or medullary sponge kidney
lasix in a kid
renal tubular acidosis (type 1)
Congenital cause of medullary nephrocalcinosis.
Medullary sponge kidney.
THis is related to Ehler Danlos, Carolis, and Beckwith-Weidman
Fluid collections that occus 2 weeks post op vs. 1-2 months post op from renal transplant
urinoma short term, lymphocele longer out
How do you tell the difference between acute rejection and ATN?
best distinguished on MAG-3 where ATN has normal perfusion and rejection does not
Both will have delayed excretion
both occur about 1st week after surgery
transplant RAS criteria
PSV >200-300cm/sec
PSC ration >3.0 (external iliac artery/RA)
Tarus parvus at hilum
reversal fo diastolic renal artery flow =?
reval vein thrombosis. look for this in transplants. they won’t show the vein.
cancer caused by immunosuppresion after transplant (usually at 1 year)
PTLD
which immunosuppressant is associated with increased risk of urothelial cancer?
cyclophosphamide
dilated ureter without obstuction, possibl from adynamic segment, UVJ reflux, or idiopathic
Congenital (primary) megaureter
Weigert meyer rule
in a duplicated system, the upper pole moiety inserts inferior and medial
upper pole prone to ereterocele and obstruction
lower pole prone to reflux
difference between psuedoureterocele and ureterocele?
pseudo is acquired possibly to impacted uereteral stone, recetly passed stone, or bladder malignancy
ectopic ureter
ureter inserts distal to external sphincter
women
incontinence
Congenital UPJ obstruction
MC congen GU anomaly
bilat 20% of the time
look for crossing vessels
assoc with mcdk on other side
genetic prob with aortic co-arc, horseshoe kidney, and preburtal appearing uterus and streaky ovaries
Turner’s syndrome (XO)
salpingitis isthmica nodosa
nodular scarring of the faloopian tubes
likely post-inflamm/infxn
high velocity flow in serpiginous/tubular anechoic uterine structures in patient with previous D&C
Uterine AVM
can kill you
non filling of uterus on HSG or multiple irregular linear filling defects
T2 dark bands on MRI
infertility
Ashermans
Intrauterine adhesions
Hyaline degeneration of fibroid
MC
fibroid outgrows blood supply
do not enhance
T2 dark
Carneous/Red fibroid degeneration
occurs during pregnancy
2/2 venous thrombosis
peripheral rim of T1 high signal
thickening of the junctional zon of the uterus to >12mm
adenomyosis
will have T2 bright cystic changes too
HNPCC
Hereditary Non-Polyposis Colon Cancer has what increased risk of endometrial cancer?
30-50x
How thick can the endometrium get on Tamoxifin (SERM) without getting a bx?
8 mm
When staging cervical cancer, which finding pushes you from surgery to chemo/radiation?
parametrial invasion or involvement of the lower 1/3 of the vagina bumps you up from IIA to IIB
Parametrium= fibrous band that separates the supravaginal cervix from the bladder… T2 dark ring around the cervic
“t-shaped uterus”
DES- drug thought to prevent miscarraige back in the day
Zebra cancer: clear cell adenocarcinoma
vaginal tumor in a child
vaginal rhabdomyosarc
skene glad cysts
periurethral, can cause recurrent UTIs and urethral obstruction
ÐIt would probably hurt to have one of these “skiing”
theca lutein cyst
multilocular cystic looking ovary (spoke wheel)
- multifetal preg
- moles
- ovarian hyperstimulation syndrom
theca lutein cysts, ascites, pleural effusions, +/- pericardial effusions
ovarian hyperstimulation syndrome
maximal ovarian volume in a post-menopausal woman
6mL
rounded mass with homogenous low level internal echoes and increased through transmission
(gyn)
endometrioma
What are risky things with endometriomas-> malignancy?
older than 45
bigger than 6-9cm
enhancing mural nodule
blood flow (unless pregnancy- then its “decidualized” and will get f/u
MRI of endometrioma looks…?
T1 bright (blood)
No fat
T2 dark (iron)
pelvic lesion female:
“fishnet appearance”
lacy
enhanced through transmission
disappears after 1-2 menstrual cycles
henorrhagic cyst
MC ovarian neoplasm younger than 20
dermoid
cystic ovarian mass with hyperechoid solid mural nodule
fat sats
dermoid
ureteral wall calcifications (2 things)
TB
schistosomiasis
medial deviation of the ureters
retroperitoneal fibrosis (B)
retrocaval ureter (R)
pelvic lipomatosis
psoas hypertrophy (lower)
- in contrast, if you see widening, think RP adenopathy, AAA, and psoas hypertrophy (proximal)
Difference between serous ovarian and mucinous ovarian carcinoma?
Serous unilocular, papillary projections
mucinous multi-locular, pseudomyxoma peritonei and scalloping
Differential for a BFM in an adult
- Ovarian masses- mucinous and serous
- desmoids- Gardener syndrome
- Sarcoma
What is Meigs syndrome?
triad of ascites, pleural effusion, and benign ovarian tumor (MC fibroma)
black garland sign?
dark T1 and T2 signaal with ovarian fibromatosis
B9
Brenner tumor
epithelial tumor of the ovary
women in 50-70s
fibrous
calcs common
struma ovarii
subtype of ovarian teratoma- contains thyroid tissue
possible question would be related to hyperthyroid or thyroid storm
what defines stage 3 prostate cancer?
bulging or frank extension through the capsule
MC testicular tumor?
Seminoma
best prognosis- radiosensitive
age usually 25
homogenous hypoechoic round mass
T2 dark (in contrast to non-seminomatous GCTs which are higher)
