Malignant Renal Masses (Chap 97 12th ed) Flashcards
Which part of the nephron do clear cell RCCs originate from? How about oncocytomas and chromophobe RCCs?
Clear cell RCC: proximal tubule
Chromophobe RCC and oncocytomas: distal tubule
Most common malignant RCC?
RCC pathologically is classified as clear cell: 70% to 80%; papillary:
10% to 15%; chromophobe: 3% to 5%; collecting duct: less than
1%; and medullary: rare.
What are the paraneoplastic syndromes of renal masses?
Paraneoplastic syndromes include hypercalcemia, hypertension,
polycythemia, and hepatic dysfunction (Stauffer syndrome).
How do you manage Stauffer syndrome?
Stauffer syndrome is a paraneoplastic syndrome associated with RCC
that results in elevated liver function tests. If hepatic function does
not normalize after nephrectomy, persistent hepatic dysfunction is
indicative of persistent disease.
What is the cut off size of LN in CT scan for renal masses?
Enlarged perirenal lymph nodes noted on CT may be inflammatory,
particularly if they are less than 2 cm in diameter. Lymph nodes
larger than 2 cm generally contain metastases.
How does tumor thrombus involving the vena cava affect prognosis?
RCC involving the vena cava that infiltrates the wall of the vena cava
has an extremely poor prognosis.
A patient with a tumor thrombus involving the vena cava associated
with metastatic regional nodal disease has a very poor prognosis.
A patient with a tumor thrombus involving the vena cava in which
the nodes are negative and there is no invasion of the vein wall
(except the ostia) has a relatively good prognosis.
When should ipsilateral adrenalectomy be done?
Ipsilateral adrenalectomy as part of a radical nephrectomy is not
necessary unless there is CT evidence of adrenal involvement,
contiguous spread of the tumor to the adrenal, or large upper pole
renal masses that are adjacent to with concern for involvement of the
adrenal gland.
What are the most common primary lesions that metastasize to the kidney?
Metastatic tumors to the kidney are common, appearing in 12% of
patients who die of other cancers; the most common primary lesions
are those of the lung, breast, or gastrointestinal tract, melanoma, or
hematologic.
What are the major prognostic indicators relating to the characteristic of the tumor?
Major poor prognostic indicators include tumors that extend beyond
Gerota fascia to involve contiguous organs (pT4), have lymph node
involvement (N1), or are metastatic (M1).
How do you monitor hyperfiltration injury after partial nephrectomy?
Patients with a significant reduction in renal mass are at risk for
developing long-term renal functional impairment from
hyperfiltration renal injury. These patients should have their urinary
protein excretion monitored because proteinuria is the initial
manifestation of hyperfiltration injury.
Characteristics of tuberous sclerosis syndrome
Approximately 20% of angiomyolipomas are found in patients with
the tuberous sclerosis (TS) syndrome, an autosomal dominant
disorder characterized by mental retardation, epilepsy, and adenoma
sebaceum, a distinctive skin lesion. TS, similar to VHL, is
transmitted in an autosomal dominant manner.
Characteristics of VHL syndrome
The VHL syndrome’s major manifestations can include the
development of renal cell carcinoma, pheochromocytoma, retinal
angiomas, and hemangioblastomas of the brain stem, cerebellum, or
spinal cord.
What chromosome is commonly altered in clear cell RCC?
Chromosome 3 alterations and VHL mutations are common in clear
renal cell carcinoma, and mutation or inactivation of this gene (VHL)
has been found in over 75% of sporadic cases.
