Kidney & Ureter tumors and infection

Question 1

Most common primary malignant neoplasm of kidney?

Answer 1

Renal cell carcinoma or Grawitz tumor

Question 2

Most common site of origin of RCC is?

Answer 2

Proximal convoluted tubules

Question 3

Risk factors for RCC?

Answer 3

Tobacco exposure(most significant)
Obesity
Hypertension

• Analgesics: inc risk for RCC
• Lead compounds
• Various chemicals(eg: aromatic hydrocarbons)
• Trichloroethylene exposure
• Occupational exposure(chemical, rubber and printing industries)
• Asbestos or cadmiun exposure
• Radiation therapy

Question 4

subtypes of RCC?

Answer 4

• Clear cell
• Papillary
• Chromophobic
• Collecting duct

Question 5

Cell of origin of following:
1 Clear cell
2 Papillary
3 Chromophobic
4 Collecting duct

Answer 5

1. Proximal tubule
2. Proximal tubule
3. Cortical collecting duct
4. Medullary collecting duct

Question 6

most common subtype of RCC?

Answer 6

Clear Cell Carcinoma

Question 7

most common subtype of RCC in dialysis associated cystic disease?

Answer 7

Papillary carcinoma

Question 8

Subtype associated with sickle cell trait?

Answer 8

Renal medullary cell carcinoma

Question 9

subtype with best diagnosis?

Answer 9

Chromophobe carcinoma

Question 10

subtype which tend to be bilateral?

Answer 10

Papillary

Question 11

classical triad of RCC?

Answer 11

1. Hematuria
2. Flank pain
3. Palpable flank mass

Question 12

characteristic feature of RCC regarding spread/invasion/metastasis?

Answer 12

Tendency to invade Renal vein. further extension extends into IVC and even right side of heart

Question 13

MC site of distant metastasis is?

Answer 13

Lung(xray shows canon ball secondaries)

Question 14

Investigation of choice for RCC?

Answer 14

Contrast enhanced CT scan

Question 15

what are the primary indications for needle aspiration or biopsy of renal mass?

Answer 15

They are:

• when a renal abscess or infected cyst is suspected and when
• RCC must be differentiated from metastatic malignant disease or renal lymphoma

Question 16

treatment of choice for RCC?

Answer 16

Radical nephrectomy

chemotherapy and radiotherapy is not effective

Question 17

major clinical manifestations in von Hippel-Lindau syndrome?

Answer 17

• Clear cell RCC
• Hemangioblastomas of CNS
• Retinal angiomas
• Pheochromocytoma

Question 18

major clinical manifestations in Birt- Hogg-Dube syndrome?

Answer 18

• Chromophobe RCC
• Oncocytoma
• Occasional clear cell RCC
• Cutaneous fibrofolliculomas
• Lung cysts
• Spontaneous pneumothorax

Question 19

what is partial nephrectomy(Nephron sparing surgery)?

Answer 19

partial nephrectomy is preferred surgical approach for a small(<4cm) localized tumor; especially in patients with functionally and anatomically solitary kidney

Question 20

partial nephrectomy should be considered in which clinical situations?

Answer 20

• Renal mass less than 4cm(T1 stage)
• Localized mass in patient with single kidney or with compromised renal function
• Synchronous bilateral renal tumors
• Patients with VHL syndrome as they are at high risk of renal cancer in contralateral kidney

Question 21

MC carcinomas of renal pelvis and ureter?

Answer 21

• Transitional cell carcinoma(MC, 90-97%)
• Squamous cell carcinoma
• Adenocarcinoma