renal tumors Flashcards by Alex Grushky

RCC is more common in men or women?

Peak incidence age?

Risk factors?

Associated conditions?

Men, 2x

6th decade

Tobacco, first degree family history, dialysis

VHL

How well did you know this?

Not at all

Perfectly

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

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%

How well did you know this?

Not at all

Perfectly

Which subtype RCC has best prognosis? worst?

Best - Chromophobe

Worst - conventional, clear cell

How well did you know this?

Not at all

Perfectly

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

VHL gene

Chromosome 3

How well did you know this?

Not at all

Perfectly

What is the chromosome in papillary RCC?

7 and 17, and loss of chromosome y

How well did you know this?

Not at all

Perfectly

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

Clear cell more common

Papillary more aggressive

How well did you know this?

Not at all

Perfectly

What is birt hogg dube syndrome?

Lung cysts
RCC/oncocytoma
Hair follicle hamartoma

How well did you know this?

Not at all

Perfectly

What is the imaging appearance of oncocytoma?

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

How well did you know this?

Not at all

Perfectly

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

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

How well did you know this?

Not at all

Perfectly

What is the staging classification system for renal tumors?

TNM

How well did you know this?

Not at all

Perfectly

Is there a relationship between tumor size and mets?

Larger size - increase risk of mets

How well did you know this?

Not at all

Perfectly

What type/shape of calcification suggests malignancy?

Central or thick mural calcification

Thin, peripheral, curvilinear - cyst

How well did you know this?

Not at all

Perfectly

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

Unilocular cystic mass

Multiloculated cystic mass

Discrete mural nodule in a cystic nodule

How well did you know this?

Not at all

Perfectly

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

Renal tumor

How well did you know this?

Not at all

Perfectly

What are the charateristic ct imaging features of:

Clear cell/conventional
Chromophobe
Papillary

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

How well did you know this?

Not at all

Perfectly

Which RCC subtype is more likely to be multifocal?

Which is more likely to have contralateral recurrence?

Papillary

Clear cell

How well did you know this?

Not at all

Perfectly

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

How well did you know this?

Not at all

Perfectly

What are the US features that help distinguish RCC?

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

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

How well did you know this?

Not at all

Perfectly

What are the MR chracteristics of RCC?

Homogenous tumors are isointense with renal parenchyma, but will enhance

Hypovascular tumors are better detected with fat saturation techniques

How well did you know this?

Not at all

Perfectly

What are the basic imaging findings seen in renal carcinoma?

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

How well did you know this?

Not at all

Perfectly

What is a cytoreductive nephrectomy?

Surgical resection of kidney with known metastatic disease for palliative reasons

How well did you know this?

Not at all

Perfectly

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

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

Everything in the perirenal space

T1 tumors, less than 4 cm in diameter

How well did you know this?

Not at all

Perfectly

When is radiofrequency ablation or cryoablation used?

T1a and T1b tumors

When is angiography used in treatment of RCC?

Presurgical embolization to stop operative blood loss

Treatment on nonsurgical patients, such as with gelfoam

EtOH can occlude the renal artery

What are the pathways of metastatic spread in RCC?

Hematogenous - renal vein -> lungs Lymphatic - regional lymph nodes in the perinephric space -> thoracic duct

When do most tumor recurrences of RCC occur?

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

Where is the most common site of mets?

Lung - bone - tumor site - brain - liver

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

Nephroblastoma arising from metanephric blastema 50%

What are the associations with Wilms tumor?

Sporadic aniridia - usually bilateral Hemihypertrophy Pseudohermaphroditism, glomerulonephritis, wilms tumors (DRASH syndrome) Beckwidth-Wiedemann - macroglossia, omphalocele, adrenal cytomegaly, visceromegaly, microcephaly, malformed ears, GU abnormalities

What chromosome is associated with wilms/aniridia?

What are the contents of wilms tumor?

Epithelial (striated muscle, adipose, cartilage, bone) Blastemal Stromal elements

What is the US appearance of wilms tumor?

Solid, hyper/hypoechoic mass with welldefined margins May have intratumoral hypoechoic areas representing hemorrhage or necrosis Can have dystrophic calcification

What is the CT appearance of wilms tumor?

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

Where are the common sites of mets with wilms tumor?

Lung and liver

What is the median age of presentation with Rhabdoid tumor What is the association?

11months Second primary malignancy of the CNS - astrocytoma, ependymoma PNET

What is nephroblastomatosis? IS it malignant?

Group of pathologic entities characterized by persistent nephrogenic blastema Not malignant, but associated with wilms

What are the imaging findings with nephroblastomatosis?

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

What is mesoblastic nephroma?

Fetal mesenchymal hamartoma present at birth Comprised of interlacing sheets of fibromatous cells

What is the appearance of mesoblastic nephroma?

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

What is the treatment of mesonephric nephroma

surgical excision

Which sex gets sporadic AML more often?

Females, age 40yo

What is the association with bilateral AML?

Tuberous sclerosis

What is the renal involvement of LAM?

Smooth muscle hamartomas (AML) along lymphatic system XR - lucent mass

What are the US findings of AML? CT?

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

Is there an increased risk of RCC with AML?

yes, but small

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

Primary renal osteosarcoma

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

Lower pole Female

Where are renal hemangiomas usually located?

Apex

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

Tumor of juxtaglomerular apparatus essential hypertension peripherally not malignant

What are the imaging findings of JGA tumors?

US - echogenic mass due to abundant vascular channels CT - isodense enhancement Arteriography - splaying of renal vessels by a hypovascular mass

Which lymphoma has renal involvement more commonly?

NHL, usually bilateral involvement Burkitts and AIDS related subtypes

What is the appearance of renal lymphoma?

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

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

Proximal - lateral due to paraaortic LN Distal - medial due to external iliac chain

What is the US of renal lymphoma? ct?

Hypoechoic due to homogenous nature CT - Homogenous round mass with hypoenhancement relative to the surrounding parenchyma

What is the associated nephropathy with renal leukemia?

Urate

What are the common primary sources of kidney mets?

Lung, breast, colon, melanoma

What is a small indeterminate renal mass?

Small,