Renal Tumors Flashcards
What are the charicteristics of Angiomyolipomas(AML)?
Benign solid renal tumor
BV, SM, ADIPOSE
Tuberous Sclerosis
What is Tuberous Sclerosis?
AD dis w/ epilepsy, mental retardation, adenoma sbaceum
Multi organ hamartoma
What is the Presentation of Angiomyolipoma?
Incidental finding
Spon Bleeding
What is the Tx of Angiomyolipoma?
Obs for 4cm?
Embolization
Part or radical nephroectomy
What is an oncocytoma?
Benign tumor from distal tubles
Cannot be diff from RCC
Biopsy indeterminate
Tx as if malignant.
What is the etiology of RCC?
Arise from Proximal Convoluded Tubule (Clear Cell and Pap types)
What are the charicteristics of Von Hippel Lindau Dis?
AD char by devt of RCC, pheo, Retinal Angiomas, hemangioblastoma
Mutation of VHL tumor supressor Gene at Chromosome 3p 25-26
What is the presentaion of RCC?
50% found incidentally
Can only palpate mass in advanced disease
Paraneoplastic Syndromes
What are the paraneoplastic syndromes associated with RCC?
Hypercalcemia HTN Polycythemia Nonmetastatic liver dysfunction Normalizes with removal of 1^ tumor
What are the RCC tumor subtypes?
Conventional/Clear-VHL Papillary- c-met oncogene Chromophobe-distal tubules -Birt-Hogg-Dube Collecting Duct Medullary-Sickle cell trait
How is RCC diagnosed?
CT urogram with and without contrast
MRI can eval for Renal vein/IVC involvement
What are the indications for renal biopsy?
Prior to active surveillance or tumor ablation Indeterminite lesion Rule out mets renal tumor Primary tumor diagnosis Little role if CA confined to organ
What is included in Eval for Mets disease?
Review of Abdom andPelvic CT findings
CXR
LFT
Bone scan reserved for Pts w/ elv serum Alk Phos or bone pain
Chest CT for Pt with pulm symptoms or abn chest radiograph
Where is the most common site of Mets Kidney disease?
Retroperitoneal LN
Lung, liver, bone, brain
What is the Tx for Localized RCC?
Active surviellance
Radical Nephrectomy
Partial Nephrectomy/neph sparing
Thermal ablation- Cryoablation, Radiofreq ablation
What is included in Radical Nephrectomy?
Remove Kidney including Gerota’s fascia, regional LN and Adrenal Gland
What is Hyperfiltration injury?
Inc BF to remaining renal tissue to restore filt capacity
Leads to renal injury and Focal Segmental Glomerulosclerosis
Proteinuria
What is Thermal/radiofreq/ Cryoablation?
Deliver lethal tx to cancer cells leaving no viable cancer cells
What is the Tx of Metastatic RCC?
Resistant to Radiation and Chemo
Interleukin2, Interferon***
-Very toxic but only one shown to induce remission
Antoangiogenic Agents
What is the Tx of Tumors of Renal pelvis and Ureter?
Radical Nephroureterectomy is gold standard
-Remove kidney, ureter, and bladder cuff
Endoscopic resection or laser Ablation of small, low grade tumors
