PEDIATRIC Section 10: SOLID Organ GenitoUrinary Flashcards
Solid organ GU diseases in Neonates
Nephroblastomatosis
Mesoblastic Nephroma
Solid organ GU diseases around Age 4
Wilms (95% ofcases before age 10)
Wilms Variants
Lymphoma
Multilocular Cystic Nephroma
Solid organ GU diseases in Teenagers
RCC
Lymphoma
“Solid Tumor o fInfancy” (you can be bom with it)
Mesoblastic Nephroma
“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
Nephroblastomatosis
90% + Renal Tumors (95% o f cases before age 10)
Wilms
“Solid Tumor o f Childhood” - Never born with it
Wilms
Grows like a solid ball (will invade rather than incase)
Wilms
Most common metastasis to the pediatric lung
Wilms
Met to Bone
Clear Cell - Wilms
Brain Tumors
It fucks you up, it takes the money (it believes in nothing Lcbowski)
Rhabdoid - Wilms
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)
Multi-Cystic Nephroma
“Solid Tumor o fAdolescent” - most common in 2nd decade
Renal Cell Carcinoma (RCC)
RCC Subtype?
VHL (these RCCs are usually bilateral)
Clear Cell Subtype
RCC Subtype?
Prior Chemotherapy
Translocation RCC
RCC Subtype?
Sickle cell Trait
Medullary RCC
Non-Hodgkin
Multifocal
Renal Lymphoma
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.
Nephroblastomatosis
When Wilms is bilateral, 99% of the time it had what?
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).
Do you see necrosis in nephroblastomatosis?
It should NOT have necrosis - this makes
you think Wilms.
Appearance of Nephroblastomatosis
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.
“Solid renal tumor o f infancy.”
Mesoblastic Nephroma
This is a fetal hamartoma, and generally benign.
It is the most common neonatal renal tumor (80% diagnosed in the first month on life).
Mesoblastic Nephroma
Appearnace of Mesoblastic Nephroma?
Often involves the renal sinus. Antenatal ultrasound may have shown polyhydramnios.
Renal mass that looks like Wilms but in <1y.o.
Mesoblastic Nephroma
You have multiple tiny cysts forming in utereo.
Multicystic Dysplastic Kidney
What you need to know in Multicystic Dysplastic Kidney
- No functioning renal tissue
- contralateral renal tract abnormalities occur like 50% of the time (most commonly UPJ obstruction).
MCDK vs Bad Hydro?
In hydronephrosis, the cystic spaces are seen to communicate.
In difficult cases renal scinfigraphy can be useful. MCDK will show no excretory function.
Age 0-3 + Multiple macroscopic cysts that DO NOT Communicate?
Multicystic Dysplastic Kidney
This is by far the most common solid renal tumor of childhood. This is NOT seen in a newborn.
Wilms
Repeat, you can NOT be bom with this tumor.
How does Wilms tumor spread?
Direct invasion
Assosiacted Syndromes of Wims tumor
Overgrowth
1. Beckwith-Wiedemann
2. Sotos
Non Overgrowth
1. WAGR - Wilms, Aniridia, Genital, Growth Retardation
2. Drash -
Wilms, Pseudohermaphroditism, Progressive Glomerulonephritis
Drash Syndrome
Wilms + Omphalocele + Hepatoblastoma
Beckwith- Wiedemann
What are the Wimls NEVERS?
NEVER Biopsy! - Seeds the tract and Ups the Stage
NEVER occurs before 2 months (But neuroblastoma can!
Wilms + 1.y.o.? Think about this
Associated Syndromes
Hemihypertrophy
Hypospadias,
Cryptorchidism
Rhabdoid =
“Terrible Prognosis” Associated with aggresive Rhabdoid tumors
Clear cell =
likes to go to bones (lytic)
“Non-communicating, fluid-filled locules, surrounded by thick fibrous capsule.”
NO solid component or necrosis
Multilocular Cystic Nephroma
“protrudes into therenal pelvis”
Multilocular Cystic Nephroma
Multilocular Cystic Nephroma occurs in what age group?
4 y.o. boys
40 y.o. women
Michel Jackson Lesion
DIagnosis?
Multilocular Cystic Nephroma
Non-communicating, fluid-filled locules, surrounded by thick fibrous capsule. protruding into the pelvis
This is the second most common renal malignancy of childhood
Rencal Cell CA (Wilms #1)
in ages 15-19
RCC in kids vs RCC in adults
Both are enhancing solid masses
Kids = Translocation CA
Adults = Clear Cell RCC (#1 in adults, rare in kids
Teenage + Clear cell RCC =
Screen for VHL (Von Hippel Lindau
Common Hx in Translocation Carcinaoma RCC?
Cytotoxic Chemotherapy
Lymphoa in the kidneys characteristic
NEVER primary + Hematogeneous spread or direct invation of another lymphoma
Renal mass in a teenager
Diagnosis?
Lymphoma
This is by far the most common malignant tumor of the bladder in kids.
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.
DIagnosis?
“botryoid.”
This is the one that looks like a bunch of grapes (supposedly).
Most common location of Rhabdomyosarcoma
orbit and nasopharynx.
By far the most common extra-testicular mass in young men and the only one really worth mentioning.
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).
