HRP - Urinary

Question 1

Differential diagnoses of:

Haematuria (few days), dull aching pain lower left flank, last few months felt generally unwell and lost weight
(mass in left flank on palpation)

Answer 1

Nephrolithiasis
UTI
Renal carcinoma
Renal Abscess
Renal cyst

Question 2

Lab tests normal - what investigations do you do next?

Answer 2

CT

Also US and biopsy

Question 3

What % of people >50 have at least 1 renal mass?

What type of neoplasms are the most common (%)?

Answer 3

50%

renal cell carcinoma, 95%.

Question 4

Differences between malignant and benign tumours?

Answer 4

Malignant: poorly differentiated; fast rate of growth; invasion, infiltration and destruction of surrounding tissues; metastases.
Benign: well differentiated; slow rate of growth; localised to site of invasion do not invade; do not metastasise

Question 5

What part of the uriniferous tubule are in the cortex?

Answer 5

Glomeruli, proximal convoluted tubule and distal convoluted tubule

Question 6

What part of the uriniferous tubule are in the medulla?

Answer 6

Loop of henle, collecting duct

Question 7

What type of epithelium lines the renal pelvis, ureters and bladder?

Answer 7

Transitional

Question 8

What info is in a histopathology report?

Answer 8

Tumour type, grade, stage and whether it is completely excised

Question 9

What is the most common carcinoma of the kidneys? What does it look like histologically?

Answer 9

Clear cell renal cell carcinoma
rows of uniform cells with a clear empty looking cytoplasm (normally filled with lipid and glycogen but this doesn’t show up well) rows of clear cells interspersed with a rich vascular network.

Question 10

Types of Kidney cancer?

Answer 10

Renal cell carcinoma, urothelial carcinoma, sarcoma (CT around kidney), Wilms tumor (kids), Lymphoma

Question 11

Types of Kidney cancer cells?

Answer 11

Clear cell, Papillary, Sarcomatoid Features, Medullary/ Collecting duct, chromophobe, oncocytoma, angiomyolipoma

Question 12

Two years later, patient suffers severe back pain at night, not relieved by analgesics. What do you suspect?

Answer 12

Metastatic disease to vertebrae (33% of patients with renal cell carcinoma develop mets; often involves >1 organ and found at time of diagnosis)

Question 13

Most common sites for renal cell carcinoma mets?

Answer 13

Lung, bone, liver (up to half of patients develop mets after nephrectomy)