Renal Masses

Question 1

Posterior Acoustic Enhancement vs. Shadowing

Answer 1

Enhancement for cysts, shadowing for mass

Question 2

Bosniak Scale

Answer 2

To classify renal cysts, >1 has some chance of malignancy

Question 3

Simple Renal Cysts

Answer 3

Anechoic, NO chance of malignancy, naturally w/ age but should never have >2 at one time. Can cause some problems like rupture and HTN

Question 4

Acquired Renal Cystic Disease

Answer 4

Exclusively on pts w/ ESRD (from extended CKD), related to duration of dialysis not cause of ESRD. Chronic atrophy and degeneration w/ some malignancy risk

Question 5

Renal Cell Carcinoma

Answer 5

Most common, general term for in tubular parenchyma

Question 6

Classic Triad of RCC

Answer 6

Hematuria (non dysmorphic)
Fever
Abdominal Mass

Question 7

3 Paraneoplastic Syndromes w/ RCC

Answer 7

Hypercalcemia from PTHrP
Polycthemia from increased erythropoeitin
Hepatic Dysfunction

Question 8

RCC Unique Metastasis

Answer 8

Through renal vein-> IVC -> R atrium

Question 9

5 Kinds of RCC (location & most common)

Answer 9

Clear Cell (conventional) - most common, in PT
Chromophilic (papillary) - 2nd most, in PT
Chromophobe - intercalated cells of CCT
Collecting Duct (Bellini’s duct)
Medullary carcinoma - medullary CDs, sickle cell trait

Question 10

Von Hippel Lindau

Answer 10

AD disorder requiring 2nd hit, involved w/ angiogenesis and gives you Clear Cell RCC. Treat w/ anti-angiogenesis factors

Question 11

C-Met

Answer 11

Overactive hepatocyte growth factor receptor so overactivates tyrosine kinase and causes papillary carcinoma

Question 12

Oncocytoma

Answer 12

Benign tumor of kidney w/ stellate central scar

Question 13

Angiomyolipoma (AML) - renal hamartomas

Answer 13

Fat, smooth muscle, and vascular tissue, major complication is flank pain and hemorrhage and can be associated w/ tuberous sclerosis

Question 14

Tuberous Sclerosis (TS)

Answer 14

AD disease on Ch 16, which basically causes benign hamartomas everywhere

Question 15

Wilm’s Tumor (Nephroblastoma) (3.3)

Answer 15

Most common renal malignancy found in children
Can be associated w/ multiple congenital abnormalities: WAGR, Beckwith-Wiedemann, Denys-Drash
Precursed by nephroenic rests (bunch of embryonic cells)

Question 16

Xanthogranulomatous Pyelonephritis (2)

Answer 16

Complication of chronic pyelonephritis/renal infection/stone obstruction
Characterized by macrophages (NOT an abscess) laden w/ cholesterol w/ yellow color (XANTHOMA CELL)