random 2 Flashcards
Name the type of renal lesion:
Centrally located renal lesion (in medulla) which is almost exclusively associated with sickle cell trait. It presents in younger patients (10-40 years old).
Renal medullary carcinoma.
What classifies an RCC as stage 4?
Extension beyond Gerota’s fascia (including adrenal gland)
distant metastases
What classifies an RCC as stage 3?
Regional lymph node involvement
Extension into renal vein or IVC
Extension beyond the kidney (not beyond Gerota’s fascia or adrenal gland)
What classifies an RCC as stage 2?
Confined to the kidney, over 7 cm.
TRUE OR FALSE
Oncocytoma is indistinguishable on imaging from RCC
TRUE
What syndrome is associated with multiple RCCs?
Von Hippel Lindau
Birt-Hog-Dube
2% of RCCs are sporadically bilateral
What is the DDx of multiple expansile renal soft tissue masses (not fat containing)?
Multiple RCC
- VHL
- Sporadic
Lymphoma
Metastases
Birt-Hog-Dube syndrome (multiple oncocytoma/RCC)What is DDx of a solitary expansile renal soft tissue mass (not fat containing)?
RCC Oncocytoma Angiosarcoma Leiomyosarcoma Leiomyoma
Define xanthogranulomatous pyelonephiritis. What is the etiology?
Chronic infection characterized by destruction of the renal parenchyma and replacement by lipid laden macrophages.
It is caused by chronic renal obstruction and infection.
What are the imaging findings of xanthogranulomatous pyelonephritis
Multiple low attenuation masses, representing dilated debris filled calyces and xanthoma collections.
There is almost always a Staghorn calculus present.
There is enhancement of rims of xanthoma collections secondary to inflammation.
Poor renal function
perinephric extension (inflammatory changes)
What is emphysematous pyelonephritis
Fulminant, necrotizing pyelonephritis, most often caused by E. Coli
What are the risk factors for emphysematous pyelonephritis
Recurrent or chronic urinary tract infections Immunocompromised patient diabetes mellitus Ureteral obstruction Renal failure
What is the treatment of emphysematous pyelonephritis?
Urgent surgical resection. 30-60% mortality!
What are the CT findings of emphysematous pyelonephritis
Air within the renal PARENCHYMA. It may extend into surrounding spaces including renal vein/IVC.
Other findings of pyelonephritis
What are the ultrasound findings of TCC of the kidney on ultrasound?
Loss of normal hyperechoic renal sinus fat
- “faceless kidney”: complete loss of renal sinus fat
Hypo or hyperechoic renal lesion
Caliectasis without pelviectasis
Why is there an increased risk of bladder neoplasm within bladder diverticula?
Because of urinary stasis. Direct contact of urine with the epithelium exposes it to carcinogens in the urine.
Where are most urothelial tumors located?
Bladder base (80% at initial diagnosis)
What is the % of multifocal bladder tumors?
30-40%
Define a Bosniak 2 renal cyst
A benign cyst that may contain a few hairline thin septa in which “perceived” enhancement may be present. Fine calcification or a short segment of slightly thickened calcification may be present in the wall or septa. Uniformly high attenuation lesions under 3 cm that are well marginated and do not enhance are included in this group.
What is the difference between Bosniak 2 and 2F renal cyst
Bosniak 2F has:
- homogeneous high attenuation >3cm
- Multiple thin, regular septations
- Thick or nodular calcification of wall or septa
Remainder similar between both
What is the duration of FU for Bosniak 2F lesion?
Initial FU is 6 months, then yearly for 3-5 years. If stable over this duration, no further followup.
What are the criteria that need to be present to definitely diagnose a simple renal cyst on ultrasound?
Anechoic Imperceptible wall Increased thru transmission Well defined back wall No internal color flow
If the cyst doesn’t meet all of these criteria, further workup is necessary.
TRUE OR FALSE
Mixed epithelial and stromal tumor of the kidney is a benign, male predominant tumor.
FALSE
Mixed epithelial and stromal tumor of the kidney is a benign, FEMALE predominant tumor. 10:1 F:M ratio, the mass contains ovarian stroma.
On imaging, indistinguishable from multicystic RCC.
What is DDx of multiple renal cysts?
Multiple benign simpe cysts
Autosomal dominant polycystic kidney disease
Acquired cystic kidney disease (dialysis)
Tuberous sclerosis complex
Von Hippel Lindau
Name the anatomic segments of the male urethra
It is divided into anterior and posterior segments
Anterior: penile, bulbar
Posterior: membranous, prostatic
What separates the anterior from the posterior portion of the male urethra?
The urogenital diaphragm
What are the causes of urethral stricture?
Iatrogenic trauma (most common) Congenital Chemical trauma Inflammatory (reiter, amyloidosis) Neoplasm Infection (syphillis, gonorrhea, TB)
What etiology should be suspected when there is multiple fistulas present in the urethra?
Tuberculous urethritis. It causes a hard fibrous scar at the distal urethra, with subsequent increased back pressure of urine.
What % of patients with a urethral neoplasm have a history of urethral stricture? STD?
50% stricture
25% STD
Where are the glands of Littre and Cowper’s glands located?
Glands of the male urethra
Glands of Littre: Penile urethra
Cowper’s glands: bulbar urethra
What is the most common location of an adenomatoid neoplasm?
Tunica vaginalis
Can also arise from epididymis and spermatic cord
What is the most common type of urethral neoplasm?
Squamous cell carcinoma
What important imaging findings need to be evaluated in urethral neoplasms because of impact on treatment?
Invasion of: - Corpus cavernosum - Bladder neck - Beyond prostatic capsule Inguinal adenopathy Metastasis
What are the most common causes of squamous cell carcinoma of the male urethra?
Urethral stricture (88%)
HPV 16 and 18
Chronic irritation/inflammation
What is fibrous pseudotumor of the scrotum?
Reactive fibrous proliferation. It is usually nodular, probably reactive proliferation of fibrous tissue and inflammatory cells. It occurs due to prior inflammation, infection, or trauma.
It most commonly arises from the tunica vaginalis.
