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Kidney CA Flashcards

1
Q

2 main benign renal lesions

A
  1. renal cyst

2. angiolyolipoma (AML)

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2
Q

what are renal cysts

A

fluid filled sac in renal parenchyma

  • common
  • M>F
  • increase with age
  • most benign, some have malig potential
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3
Q

what is needed to diagnose renal cysts

A

radiological Dx

  • US is good most of the time
  • CT/MR for complex issues
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4
Q

4 features of a simple renal cyst on US

A
  1. anechoiuc- dark
  2. well defined wall
  3. posterior acoustic enhancement
  4. no internal calcification or solid
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5
Q

3 features of simple cyst on CT

A
  1. homogenous
  2. low (water) density
  3. no internal enhancement
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6
Q

3 features of simple cyst on MR

A
  1. homogenous
  2. follows fluid on all sequences (T1 dark, T2 bright)
  3. no internal enhancements
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7
Q

what is classification system for cysts

A 
Bosniak system - radiologic based
1. simple - no malig
2. mild complex - 1-2% malig
2F. complex - 10-15 malig
3. sig. complex - 40-50 malig
4. CA until proven otherwise
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8
Q

what is follow up for classes

A

1 and 2 - no follow-up
2F - imaging surveillace
3 and 4 - surgery

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9
Q

what are features of type 1

A
  • simple benign
  • thin walled
  • water density
  • so septa or calcifications
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10
Q

features of type 2

A
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11
Q

features of type 3

A
  • mural or septal thinkening

- both benign and malig. lesions

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12
Q

featues of type 4

A

fulfills type 3

  • clearly malig
  • enhancing soft tissue component indep. of cyst wall or septa
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13
Q

features of 2F

A
  • F for follow-up
  • well marginated
  • may contain multiple thin walled septa
  • minimal mural or septal thinkening
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14
Q

what is AML

A
  • benign tumor with variable amounts of blood vessels, muscle, or fat
  • f>M, rare before puberty
  • most sporadic
  • usually asymptomatic
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15
Q

what is path of AML

A
  • see all three elements

- + HMB stain, - cytokeratin stain

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16
Q

how to diagnose AML

A

US is generally enough

- CT or MR if issues

17
Q

4 features of AML on US

A
  1. sharp margins
  2. hyperechoic
  3. homo exotexture
  4. no calcif
18
Q

4 features of AML on CT

A
  1. high spatial resolution
  2. mixed density lesion
  3. no calcif.
  4. no lymphadenopathy
19
Q

3 features of AML on MR

A
  1. high soft tissue contrast
  2. mixed compostiion - fat, muscle, vessels
  3. bulk fat
20
Q

2 possible pitfalls for imaging AML

A
  1. RCC may be echogenic on US

2. some AML with minimal fat

21
Q

mgmt options

A
  1. surveillance for most
  2. selective angioembolization
  3. Nx - partial or full
22
Q

indication for intervention in AML

A

> 4 cm

  • Sx
  • female of child bearing age
23
Q

epi of RCC

A

85% of renal CA

  • M>F
  • later in life
  • few risk factors except smoking
  • 95% sporadic
24
Q

RCC presentation

A
  • most are incidental findings
  • common mets
  • paraneoplastic sydrome common
25
terrible triad for RCC
1. flank pain 2. flank bulge 3. hematuria
26
5 types of RCC, sites and genes
1. clear cell - 70% - PCT - VHL gene 2. papillary - 10% - PCT - type 1 and 2 3. chromophobe - CD - less aggressive 4. collecting ducts - CD - more aggressive 5. other
27
what is staging and what is it based on
TNM | CT and final T stage based on patho
28
what is main imaging for RCC
US | - more are incidentally found on CT
29
features of RCC on US
1. variable appearance 2. solid mass - hypo, iso, or hyper echoic - calcification - doppler vascularity - narrow rim - renal vein thrombosis
30
4 features of RCC on CT
1. multiphase aquisition 2. enhancing mass - increased desnity after contrast 3. calcifications 4. staging
31
when to use MRI
- contraindication to CT - confirm equivocal CT - characterize CT enhancement - RCC subtyping
32
3 RCC mimics on imaging
1. dromedary hump - normal variant 2. coloumn of bertin 3. renal abscess
33
*when to use a biopsy (3)
1. if unsure of Dx 2. if it might alter mgmt 3. if have a good GU IR and patho
34
5 prognositic factors for RCC
1. stage - most important 2. grade 3. tumor size 4. histo variant 5. patient age/health
35
main Tx
surgery | - chemo and RAD resistant
36
2 main surg
1. radial nephrectomy - gold standard for advances 2. partial - preferred when feasible
37
2 other Tx options
1. thermal ablation | 2. active surveillance

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