PEDIATRIC Section 10: SOLID Organ GenitoUrinary

Question 1

Solid organ GU diseases in Neonates

Answer 1

Nephroblastomatosis
Mesoblastic Nephroma

Question 2

Solid organ GU diseases around Age 4

Answer 2

Wilms (95% ofcases before age 10)
Wilms Variants
Lymphoma
Multilocular Cystic Nephroma

Question 3

Solid organ GU diseases in Teenagers

Answer 3

RCC
Lymphoma

Question 4

“Solid Tumor o fInfancy” (you can be bom with it)

Answer 4

Mesoblastic Nephroma

Question 5

“Nephrogenic Rests” - left over embryologic crap that didn’t go away

Might turn into Wilms (bilateral wilms especially)

“Next Step” - f’u ultrasound till 7-8 years old

Variable appearance

Answer 5

Nephroblastomatosis

Question 6

90% + Renal Tumors (95% o f cases before age 10)

Answer 6

Wilms

Question 7

“Solid Tumor o f Childhood” - Never born with it

Answer 7

Wilms

Question 8

Grows like a solid ball (will invade rather than incase)

Answer 8

Wilms

Question 9

Most common metastasis to the pediatric lung

Answer 9

Wilms

Question 10

Met to Bone

Answer 10

Clear Cell - Wilms

Question 11

Brain Tumors
It fucks you up, it takes the money (it believes in nothing Lcbowski)

Answer 11

Rhabdoid - Wilms

Question 12

Micheal Jackson Tumor (Young Boys, Middle Age Women) Big cysts that don’t communicate
Septal Enhancement
Can’t Tell it is not Cystic Wilms (next step = resection)

Answer 12

Multi-Cystic Nephroma

Question 13

“Solid Tumor o fAdolescent” - most common in 2nd decade

Answer 13

Renal Cell Carcinoma (RCC)

Question 14

RCC Subtype?
VHL (these RCCs are usually bilateral)

Answer 14

Clear Cell Subtype

Question 15

RCC Subtype?
Prior Chemotherapy

Answer 15

Translocation RCC

Question 16

RCC Subtype?
Sickle cell Trait

Answer 16

Medullary RCC

Question 17

Non-Hodgkin
Multifocal

Answer 17

Renal Lymphoma

Question 18

These are persistent nephrogenic rests beyond 36
weeks. It’s sorta normal (found in 1% of infants). But, it can be a precursor to Wilms so you follow it.

Answer 18

Nephroblastomatosis

Question 19

When Wilms is bilateral, 99% of the time it had what?

Answer 19

But, it can be a precursor to Wilms so you follow it. When Wilms is bilateral, 99% of the time it had nephroblastomatosis first

It goes away on its own (normally).

Question 20

Do you see necrosis in nephroblastomatosis?

Answer 20

It should NOT have necrosis - this makes
you think Wilms.

Question 21

Appearance of Nephroblastomatosis

Answer 21

It has a variable appearance, and is often described as “homogeneous.” Although more commonly a focal homogeneous ball, the way it’s always shown in case conferences and case books is as a hypodense rind.

Question 22

“Solid renal tumor o f infancy.”

Answer 22

Mesoblastic Nephroma

Question 23

This is a fetal hamartoma, and generally benign.

It is the most common neonatal renal tumor (80% diagnosed in the first month on life).

Answer 23

Mesoblastic Nephroma

Question 24

Appearnace of Mesoblastic Nephroma?

Answer 24

Often involves the renal sinus. Antenatal ultrasound may have shown polyhydramnios.

Question 25

Renal mass that looks like Wilms but in <1y.o.

Answer 25

Mesoblastic Nephroma

Question 26

You have multiple tiny cysts forming in utereo.

Answer 26

Multicystic Dysplastic Kidney

Question 27

What you need to know in Multicystic Dysplastic Kidney

Answer 27

1. No functioning renal tissue 2. contralateral renal tract abnormalities occur like 50% of the time (most commonly UPJ obstruction).

Question 28

MCDK vs Bad Hydro?

Answer 28

In hydronephrosis, the cystic spaces are seen to communicate. In difficult cases renal scinfigraphy can be useful. MCDK will show no excretory function.

Question 29

Age 0-3 + Multiple macroscopic cysts that DO NOT Communicate?

Answer 29

Multicystic Dysplastic Kidney

Question 30

This is by far the most common solid renal tumor of childhood. This is NOT seen in a newborn.

Answer 30

Wilms Repeat, you can NOT be bom with this tumor.

Question 31

How does Wilms tumor spread?

Answer 31

Direct invasion

Question 32

Assosiacted Syndromes of Wims tumor

Answer 32

Overgrowth 1. Beckwith-Wiedemann 2. Sotos Non Overgrowth 1. WAGR - Wilms, Aniridia, Genital, Growth Retardation 2. Drash -

Question 33

Wilms, Pseudohermaphroditism, Progressive Glomerulonephritis

Answer 33

Drash Syndrome

Question 34

Wilms + Omphalocele + Hepatoblastoma

Answer 34

Beckwith- Wiedemann

Question 35

What are the Wimls NEVERS?

Answer 35

NEVER Biopsy! - Seeds the tract and Ups the Stage NEVER occurs before 2 months (But neuroblastoma can!

Question 36

Wilms + 1.y.o.? Think about this

Answer 36

Associated Syndromes Hemihypertrophy Hypospadias, Cryptorchidism

Question 37

Rhabdoid =

Answer 37

"Terrible Prognosis" Associated with aggresive Rhabdoid tumors

Question 38

Clear cell =

Answer 38

likes to go to bones (lytic)

Question 39

“Non-communicating, fluid-filled locules, surrounded by thick fibrous capsule.” NO solid component or necrosis

Answer 39

Multilocular Cystic Nephroma

Question 40

"protrudes into therenal pelvis"

Answer 40

Multilocular Cystic Nephroma

Question 41

Multilocular Cystic Nephroma occurs in what age group?

Answer 41

4 y.o. boys 40 y.o. women Michel Jackson Lesion

Question 42

DIagnosis?

Answer 42

Multilocular Cystic Nephroma Non-communicating, fluid-filled locules, surrounded by thick fibrous capsule. protruding into the pelvis

Question 43

This is the second most common renal malignancy of childhood

Answer 43

Rencal Cell CA (Wilms #1) in ages 15-19

Question 44

RCC in kids vs RCC in adults

Answer 44

Both are enhancing solid masses Kids = Translocation CA Adults = Clear Cell RCC (#1 in adults, rare in kids

Question 45

Teenage + Clear cell RCC =

Answer 45

Screen for VHL (Von Hippel Lindau

Question 46

Common Hx in Translocation Carcinaoma RCC?

Answer 46

Cytotoxic Chemotherapy

Question 47

Lymphoa in the kidneys characteristic

Answer 47

NEVER primary + Hematogeneous spread or direct invation of another lymphoma

Question 48

Renal mass in a teenager Diagnosis?

Answer 48

Lymphoma

Question 49

This is by far the most common malignant tumor of the bladder in kids.

Answer 49

Rhabdomyosarcoma It is a cancer of “muscle” so you can find these almost anywhere in the body but ~ 20% of them occur in either the prostate or bladder.

Question 50

DIagnosis?

Answer 50

“botryoid.” This is the one that looks like a bunch of grapes (supposedly).

Question 51

Most common location of Rhabdomyosarcoma

Answer 51

orbit and nasopharynx.

Question 52

By far the most common extra-testicular mass in young men and the only one really worth mentioning.

Answer 52

Paratesticular Rhabdomyosarcoma If you see a mass in the scrotum that is not for sure in the testicle this is it (unless the history is kick to the balls from a spiteful young lady -then you are dealing with a big fucking hematoma).