Kidney Pathology

Question 1

RCC

Answer 1

Primary malignant adenocarcinomas derived from the renal tubular epithelium and are the most common malignant renal tumour
80-90% of primary malignant adult renal neoplasms

Main metastatic sites:
Lungs, bones, lymph nodes, liver, adrenals and the brain

Appearance:
Not as sensitive as CT/MRI
May appear solid or partially cystic
Hyper, hypo or iso to surrounding renal parenchyma
Sometimes hyperechoic halo
CEUS- heterogeneously hyper vascular in arterial phase
Early washout in delayed phase

Symptoms/Causes:
Almost half found incidentally
Usually 50-70YO
Macroscopic haematuria 60%
Flank pain 40%
Palpable flank mass 30-40%
Male 2:1
Cigarette smoking
Dialysis-related cystic disease
Obesity
Treatment with cyclophosphamide
Hypertension
Post-renal transplant

Outcome:
Around 25% develop paraneoplastic syndrome
Hypercalcaemia 20%
Hypertension 20%
Polycythaemia ~5%
Stauffer syndrome
Feminisation
Limbic encephalitis

Associated with:
von Hippel-Lindau syndrome
Tuberous sclerosis

Differential diagnosis:

Question 2

Adenocarcinoma

Answer 2

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Question 3

Lymphoma

Answer 3

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Question 4

Simple cyst

Answer 4

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Question 5

Squamous/ TCC

Answer 5

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Question 6

Metastasis

Answer 6

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Question 7

Oncocytoma

Answer 7

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Question 8

Angiomyofibroma

Answer 8

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Question 9

Hydronephrosis

Answer 9

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Question 10

Renal calculus

Answer 10

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