Renal Neoplastic Disease

Question 1

Renal Cell Carcinoma Epidemiology

Answer 1

Male predominance: RCC is approximately 50% more common in men than women
Highest incidence between age 60-80

Question 2

Renal Cell Carcinoma Risk factors

Answer 2

Smoking 1/3 of cases
Hypertension
Obesity
Acquired cystic disease of the kidney
Occupational Exposure
Analgesics
Genetic factors
Chronic hepatitis C infection

Question 3

Renal Cell Carcinoma Types : Clear cell carcinomas (75-85%)

Answer 3

arise from the proximal tubule
typically have a deletion of chromosome 3p
Macroscopically, they may be solid or less commonly cystic.
In addition to occurring in sporadic disease, associated with von Hippel-Lindau disease.

Question 4

Renal Cell Carcinoma Types: Papillary (“chromophilic”) carcinoma (familial or sporadic) (10-15%)

Answer 4

Thought to arise from proximal convoluted tubule
Trisomy 7 common
Tends to be multifocal and bilateral
Recent study shows better prognosis than clear cell carcinoma

Question 5

Renal Cell Carcinoma Types: Chromophobe renal cell carcinoma

Answer 5

Histologically, composed of sheets of cells that are darker than clear cell carcinoma
5-10% of renal cell carcinomas
Arise from intercalated cells of collecting ducts
lower risk of disease progression and death compared to clear cell carcinomas

Question 6

Renal Cell Carcinoma Types: Collecting duct carcinoma (Bellini duct carcinoma)

Answer 6

Approximately 1% of renal cell carcinomas
Aggressive clinical course
Affects younger adults and black patients more frequently

Question 7

Renal Cell Carcinoma Types: Oncocytomas (3-7%)

Answer 7

originate from the intercalated cells of the collecting ducts
consist of oncocytes, which are large well-differentiated neoplastic cells with intensely eosinophilic granular cytoplasm
Mutations in c-met oncogene associated with papillary RCC
Tends to be unilateral and single, but multiple and bilateral oncocytomas have been described

Question 8

Renal Cell Carcinoma: Classic” triad (found in 9% only)

Answer 8

Hematuria (60%)
Flank pain (40%)
Palpable mass (45%)

Question 9

3 Major Criteria for simple cyst

Answer 9

Mass is round and sharply demarcated with smooth walls
No echoes (anechoic) within the mass
Strong posterior wall echo indicating good transmission through the cyst

Question 10

Wilms’ Tumor (Nephroblastoma)

Answer 10

Pediatric Tumor
The most common renal malignancy in children
Mean age 3.5 years
Caused by abnormal renal development in utero, or genetic mutation

Question 11

Wilms’ Tumor: Clinical Features

Answer 11

Palpable mass in 90% of cases: May be large, extending into pelvis
Abdominal pain in 30% 
Hematuria 12-25%
Hypertension in 25% 
5-10% bilateral

Question 12

Benign Renal Tumors

Answer 12

Papillary adenoma
fibroma/hamartoma
Angiomyolipoma