Kidney CA Flashcards
2 main benign renal lesions
- renal cyst
2. angiolyolipoma (AML)
what are renal cysts
fluid filled sac in renal parenchyma
- common
- M>F
- increase with age
- most benign, some have malig potential
what is needed to diagnose renal cysts
radiological Dx
- US is good most of the time
- CT/MR for complex issues
4 features of a simple renal cyst on US
- anechoiuc- dark
- well defined wall
- posterior acoustic enhancement
- no internal calcification or solid
3 features of simple cyst on CT
- homogenous
- low (water) density
- no internal enhancement
3 features of simple cyst on MR
- homogenous
- follows fluid on all sequences (T1 dark, T2 bright)
- no internal enhancements
what is classification system for cysts
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
what is follow up for classes
1 and 2 - no follow-up
2F - imaging surveillace
3 and 4 - surgery
what are features of type 1
- simple benign
- thin walled
- water density
- so septa or calcifications
features of type 2
features of type 3
- mural or septal thinkening
- both benign and malig. lesions
featues of type 4
fulfills type 3
- clearly malig
- enhancing soft tissue component indep. of cyst wall or septa
features of 2F
- F for follow-up
- well marginated
- may contain multiple thin walled septa
- minimal mural or septal thinkening
what is AML
- benign tumor with variable amounts of blood vessels, muscle, or fat
- f>M, rare before puberty
- most sporadic
- usually asymptomatic
what is path of AML
- see all three elements
- + HMB stain, - cytokeratin stain
how to diagnose AML
US is generally enough
- CT or MR if issues
4 features of AML on US
- sharp margins
- hyperechoic
- homo exotexture
- no calcif
4 features of AML on CT
- high spatial resolution
- mixed density lesion
- no calcif.
- no lymphadenopathy
3 features of AML on MR
- high soft tissue contrast
- mixed compostiion - fat, muscle, vessels
- bulk fat
2 possible pitfalls for imaging AML
- RCC may be echogenic on US
2. some AML with minimal fat
mgmt options
- surveillance for most
- selective angioembolization
- Nx - partial or full
indication for intervention in AML
> 4 cm
- Sx
- female of child bearing age
epi of RCC
85% of renal CA
- M>F
- later in life
- few risk factors except smoking
- 95% sporadic
RCC presentation
- most are incidental findings
- common mets
- paraneoplastic sydrome common
terrible triad for RCC
- flank pain
- flank bulge
- hematuria
5 types of RCC, sites and genes
- clear cell - 70%
- PCT
- VHL gene - papillary - 10%
- PCT
- type 1 and 2 - chromophobe
- CD
- less aggressive - collecting ducts
- CD
- more aggressive - other
what is staging and what is it based on
TNM
CT and final T stage based on patho
what is main imaging for RCC
US
- more are incidentally found on CT
features of RCC on US
- variable appearance
- solid mass
- hypo, iso, or hyper echoic
- calcification
- doppler vascularity
- narrow rim
- renal vein thrombosis
4 features of RCC on CT
- multiphase aquisition
- enhancing mass
- increased desnity after contrast - calcifications
- staging
when to use MRI
- contraindication to CT
- confirm equivocal CT
- characterize CT enhancement
- RCC subtyping
3 RCC mimics on imaging
- dromedary hump - normal variant
- coloumn of bertin
- renal abscess
*when to use a biopsy (3)
- if unsure of Dx
- if it might alter mgmt
- if have a good GU IR and patho
5 prognositic factors for RCC
- stage - most important
- grade
- tumor size
- histo variant
- patient age/health
main Tx
surgery
- chemo and RAD resistant
2 main surg
- radial nephrectomy
- gold standard for advances - partial
- preferred when feasible
2 other Tx options
- thermal ablation
2. active surveillance
