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Uroradiology > renal tumors > Flashcards

renal tumors Flashcards

1
Q

RCC is more common in men or women?

Peak incidence age?

Risk factors?

Associated conditions?

A

Men, 2x

6th decade

Tobacco, first degree family history, dialysis

VHL

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2
Q

What are the 5 types of RCC? What are the cells of origin?

A

Clear cell - 65%, proximal tubule
Papillary - 15%, distal convoluted tubule
Chromophobe - 5%, collecting duct
Collecting Duct - 1%, medullary collecting duct
Oncocytoma - 5%, collecting duct
Unclassified - 5%

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3
Q

Which subtype RCC has best prognosis? worst?

A

Best - Chromophobe

Worst - conventional, clear cell

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4
Q

What is the gene/chromosome defect in conventional/clear cell RCC?

A

VHL gene

Chromosome 3

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5
Q

What is the chromosome in papillary RCC?

A

7 and 17, and loss of chromosome y

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6
Q

With regards to mets, which has more common and which are more malignant?

A

Clear cell more common

Papillary more aggressive

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7
Q

What is birt hogg dube syndrome?

A

Lung cysts
RCC/oncocytoma
Hair follicle hamartoma

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8
Q

What is the imaging appearance of oncocytoma?

A

CT - well defined with sharp interface and central stellate scar

MRI - low T1, high T2 (RCC usually high T1), enhancement

Angiography - vascular renal tumor with dense tumor blush and spoke wheel appearance

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9
Q

What is renal medullary carcinoma? What is the association? Where is it located? What is the prognosis?

A

Variant of collecting duct carcinoma seen with sickle cell carcinoma

Dominant tumor in medulla, grows in an infiltrative pattern

Invades the renal sinus with caliectasis WITHOUT pelvicaliectasis

Poor prognosis

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10
Q

What is the staging classification system for renal tumors?

A

TNM

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11
Q

Is there a relationship between tumor size and mets?

A

Larger size - increase risk of mets

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12
Q

What type/shape of calcification suggests malignancy?

A

Central or thick mural calcification

Thin, peripheral, curvilinear - cyst

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13
Q

What are the 3 basic radiologic patterns of cystic renal cell carcinoma?

A

Unilocular cystic mass

Multiloculated cystic mass

Discrete mural nodule in a cystic nodule

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14
Q

What is the most common cause of perinephric hemorrhage in nonanticoagulated patients?

A

Renal tumor

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15
Q

What are the charateristic ct imaging features of:

Clear cell/conventional
Chromophobe
Papillary

A

heterogenous, hypervascular (60-100HU), central necrosis

Enhancement (less so than clear cell, 30-50HU), homogenous enhancement, usually peripheral enhancement, focal calcification

Enhancement (less so than clear cell, 30-50HU), homogenous enhancement, focal calcification

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16
Q

Which RCC subtype is more likely to be multifocal?

Which is more likely to have contralateral recurrence?

A

Papillary

Clear cell

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17
Q

What amount of houndsfield enhancement suggests papillary/chromophobe vs clear cell

A
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18
Q

What are the US features that help distinguish RCC?

What is the doppler cutoff suggested for diagnosis of vascular RCC?

A

Hypoechoic rim - if hyperechoic mass, helps distinguish from AML

Poorly defined margins - if hypoechoic

Thickened walls, +/- internal echoes if cystic

doppler shift of 2.5 MHz suggest carcinoma of inflammatory mass

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19
Q

What are the MR chracteristics of RCC?

A

Homogenous tumors are isointense with renal parenchyma, but will enhance

Hypovascular tumors are better detected with fat saturation techniques

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20
Q

What are the basic imaging findings seen in renal carcinoma?

A

May have calcification
Heterogenous mass
Diffuse margin with normal parenchyma
Enhances with intravascular contrast media

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21
Q

What is a cytoreductive nephrectomy?

A

Surgical resection of kidney with known metastatic disease for palliative reasons

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22
Q

What is removed in a radical nephrectomy? When is nephron sparing surgery undertaken?

A

Kidney, regional LN, paraaortic-left sided tumors, adrenal glands

Everything in the perirenal space

T1 tumors, less than 4 cm in diameter

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23
Q

When is radiofrequency ablation or cryoablation used?

A

T1a and T1b tumors

24
Q

When is angiography used in treatment of RCC?

A

Presurgical embolization to stop operative blood loss

Treatment on nonsurgical patients, such as with gelfoam

EtOH can occlude the renal artery

25
Q

What are the pathways of metastatic spread in RCC?

A

Hematogenous - renal vein -> lungs

Lymphatic - regional lymph nodes in the perinephric space -> thoracic duct

26
Q

When do most tumor recurrences of RCC occur?

A

Within 2 years of ablation

lung/bone mets 1-2years
tumor bed recurrence 1-3 years

27
Q

Where is the most common site of mets?

A

Lung - bone - tumor site - brain - liver

28
Q

What is a wilms tumor? What age group gets them?

A

Nephroblastoma arising from metanephric blastema

50%

29
Q

What are the associations with Wilms tumor?

A

Sporadic aniridia - usually bilateral

Hemihypertrophy

Pseudohermaphroditism, glomerulonephritis, wilms tumors (DRASH syndrome)

Beckwidth-Wiedemann - macroglossia, omphalocele, adrenal cytomegaly, visceromegaly, microcephaly, malformed ears, GU abnormalities

30
Q

What chromosome is associated with wilms/aniridia?

A

11

31
Q

What are the contents of wilms tumor?

A

Epithelial (striated muscle, adipose, cartilage, bone)

Blastemal

Stromal elements

32
Q

What is the US appearance of wilms tumor?

A

Solid, hyper/hypoechoic mass with welldefined margins

May have intratumoral hypoechoic areas representing hemorrhage or necrosis

Can have dystrophic calcification

33
Q

What is the CT appearance of wilms tumor?

A

Hypoenhancing mass with varying heterogeneity based on amount of hemorrhage/necrosis

34
Q

Where are the common sites of mets with wilms tumor?

A

Lung and liver

35
Q

What is the median age of presentation with Rhabdoid tumor

What is the association?

A

11months

Second primary malignancy of the CNS - astrocytoma, ependymoma PNET

36
Q

What is nephroblastomatosis? IS it malignant?

A

Group of pathologic entities characterized by persistent nephrogenic blastema

Not malignant, but associated with wilms

37
Q

What are the imaging findings with nephroblastomatosis?

A

Diffuse - enlarged kidney, parenchymal nodules
Multinodular - microscopic nodules

Hypoechoic usually

SUBCAPSULAR is key finding to separate from between polycystic renal disease and lymphoma

Poor enhancement, scalloping of the kidney

38
Q

What is mesoblastic nephroma?

A

Fetal mesenchymal hamartoma present at birth

Comprised of interlacing sheets of fibromatous cells

39
Q

What is the appearance of mesoblastic nephroma?

A

Large tumor >6cm with a whorled appearance resembling leiomyoma of uterus

No capsule, finger like extensions

Nontender abdominal mass

Usually homogeneously echoic, occasionally with necrosis or hemorrhage

40
Q

What is the treatment of mesonephric nephroma

A

surgical excision

41
Q

Which sex gets sporadic AML more often?

A

Females, age 40yo

42
Q

What is the association with bilateral AML?

A

Tuberous sclerosis

43
Q

What is the renal involvement of LAM?

A

Smooth muscle hamartomas (AML) along lymphatic system

XR - lucent mass

44
Q

What are the US findings of AML? CT?

A

Highly echogenic mass depending on fat content

Fat is the key finding, though there can be lipid poor AML

Calcification is rare in AML, so this would suggest fatty RCC

45
Q

Is there an increased risk of RCC with AML?

A

yes, but small

46
Q

Formed bone in the kidney in an older patient suggests what?

A

Primary renal osteosarcoma

47
Q

Where are leiomyomas found in the kidney? is there a sex predominance?

A

Lower pole

Female

48
Q

Where are renal hemangiomas usually located?

A

Apex

49
Q

What is a juxtaglomerular tumor? What are the symptoms? Where is it located?

A

Tumor of juxtaglomerular apparatus

essential hypertension

peripherally
not malignant

50
Q

What are the imaging findings of JGA tumors?

A

US - echogenic mass due to abundant vascular channels

CT - isodense enhancement

Arteriography - splaying of renal vessels by a hypovascular mass

51
Q

Which lymphoma has renal involvement more commonly?

A

NHL, usually bilateral involvement

Burkitts and AIDS related subtypes

52
Q

What is the appearance of renal lymphoma?

A

Multiple masses - most common
Solitary/diffuse involvement
Direct extension from adjacent disease

53
Q

Which way is the proximal/distal ureter displaced in lymphoma?

A

Proximal - lateral due to paraaortic LN

Distal - medial due to external iliac chain

54
Q

What is the US of renal lymphoma? ct?

A

Hypoechoic due to homogenous nature

CT - Homogenous round mass with hypoenhancement relative to the surrounding parenchyma

55
Q

What is the associated nephropathy with renal leukemia?

A

Urate

56
Q

What are the common primary sources of kidney mets?

A

Lung, breast, colon, melanoma

57
Q

What is a small indeterminate renal mass?

A

Small,

Uroradiology (11 decks)

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