Renal tumors Flashcards
what is the inheritance of tuberous sclerosis? what are the symptoms?
- autosomal dominant
- epilepsy
- mental retardation
- adenoma sebaceum
- multiorgan hamartomas
if there is fat within a renal mass, what does that point to? what can be excluded?
- angiomyolipoma
- RCC
what is the treatment for angiomyolipoma under 4cm? over 4cm?
- under 4cm: observation
- over 4cm: selective embolization, partial nephrectomy, radical nephrectomy
is an oncocytoma benign or malignant? from what cell type does it derive?
- benign
- distal tubules
RCC typically arises from what cell type(s)?
proximal convoluted tubules (clear cell and papillary types)
is RCC primarily sporadic or genetic?
sporadic
when RCC is genetic-based, it is associated with what disease?
von hippel lindau
what is the inheritance of von hippel lindau?
AD
von hippel lindau is characterized by development of what cancers, and where?
- RCC
- pheochromocytomas
- retinal angiomas
- hemangioblastomas of brain stem, cerebellum, spinal cord
von hippel lindau is associated with a mutation on what chromosome?
3
what are the paraneoplastic syndromes found in RCC?
- hypercalcemia (PTRP)
- HTN (renin)
- polycythemia (EPO)
- nonmetastatic liver dysfunction (Stauffer’s)
medullary type renal carcinoma is associated with what condition?
sickle cell trait
papillary subtype renal carcinoma is associated with what oncogene mutation?
c-met
chromophobe subtype renal carcinoma is derived from what cell type?
distal tubules
what is the diagnostic study of choice for renal cancer?
CT urogram
what test is the best way to evaluate extent of renal vein / IVC involvement?
MRI
what are the indications for renal biopsy?
- prior to surveillance / ablation
- indeterminate lesion in high risk patient
- rule out metastasis
- primary tumor dx in metastatic disease
what are the sites of metastasis for renal cancer?
- retroperitoneal lymph nodes
- lung
- liver
- bone
- brain
what is the name of the grading system for clear cell RCC? what are the criteria?
- fuhrman system
- increasing nuclear size / irregularity / prominence
which is more important for prognosis - grade or stage?
stage
what are the treatment options for RCC?
- active surveillance
- radical nephrectomy
- partial nephrectomy
- thermal / cryo/ radio frequency ablation
what is hyperfiltration injury? what can it lead to? what is the first sign
- glomerular hyperfiltration occurs in remaining tissue following removal of functional renal tissue
- can lead to focal segmental GN (first sign is proteinuria)
what is the only therapy shown to produce a complete and durable remission of RCC? what are the downsides?
- IL-2 and IFN
- poor response rate, highly toxic
what is the most common finding in tumors of the renal pelvis and ureter?
filling defect in collecting system with contrast
diagnosis for renal pelvis and ureter tumors is made using which tests?
- urine cytology
- cystoscopy
- ureteroscopy
what is the gold standard treatment for tumors of the renal pelvis and ureter?
radical nephroureterectomy (kidney, ureter, bladder cuff)
