Renal Tumors And Congenital Anomalies

Question 1

Renal Tumors
- Malignant:

Answer 1

• 85% Adenocarcinoma.
• 15% Wilms, TCC, sarcomas.

Question 2

Renal Tumors Benign

Answer 2

Oncocytoma, angiomyolipoma.

Question 3

Renal Cell Carcinoma “RCC”

Answer 3

• Most lethal urological cancer.
• 5th most lethal cancer.
• Adenocarcinoma from the renal cortex.
• Arises mostly from proximal tubule.
• More common in males.
• In 50-60s.
• Unilateral, solitary, solid.

Question 4

Renal Cell Carcinoma “RCC” RFs

Answer 4

• Smoking: ×2.3.
• Renal failure with cysts: ×30.
• Obesity, HTN.
• Polycystic kidney disease.
• Sickle cell.

Question 5

RCC Histological types:

Answer 5

• Clear cell: MC.
→ Proximal tubule, very vascular, VHL gene on Ch 3.
• Papillary: bilateral, Ch 7, 17.
• Chromophobe: cortical part of collecting, least aggressive.
• Collecting duct: young, poor prognosis, rare.
• Medullary: sickle cell, young and aggressive

Question 6

RCC genetics

Answer 6

VHL syndrome:
Sporadic RCC associated in 80% with VHL mutation.
Papillary RCC: AD, CH 7 C-met activation.

Question 7

VHL syndrome:

Answer 7

→ Autosomal Dominant.
→ Mutation in VHL gene in chromosome 3.
→ Associated with: bilateral RCC, hemangioblastoma,
polycythemia.

Question 8

RCC Presentation:

Answer 8

• Mostly incidental.
• Painless hematuria: 60%, MC.
• Loin pain: 40%.
• Mets symptoms: 30%.
• Para-neoplastic syndrome: 30%.
→ Hypercalcemia, polycythemia, fever, hypertension, hepatic dysfunction, hypoglycemia.

Question 9

RCC Investigations:
• Labs:

Answer 9

→ CBC, ESR.
→ KFT.
→ LFT.
→ Urine analysis & culture.

Question 10

RCC Images:

Answer 10

→ Renal protocol enhanced CT: GOLD STANDARD.
→ Chest CT for staging.
→ Bone scan: if symptomatic.

Question 11

RCC Spread:

Answer 11

• Renal Vein 44%.
• Bone 25%.
• Hematogenous: lung (MC). bone, liver, brain.
→ Paired organs metastasize to lung more.
→ Single organs metastasize to liver more.
• Lymphatic.

Question 12

RCC Treatment:

Answer 12

• Radical nephrectomy or partial nephrectomy (nephron
sparing surgery).
• Chemotherapy usually has no role.
• Radiotherapy: palliation in metastatic patients.

Question 13

Wilms Tumor “Nephroblastoma”

Answer 13

• The MC renal cancer in childhood.
• Usually bilateral.

Question 14

Wilms Tumor “Nephroblastoma” DDx

Answer 14

Neuroblastoma, Hydronephrosis.

Question 15

Wilms Tumor “Nephroblastoma” Investigations

Answer 15

• Tests:
→ Bone marrow biopsy.
→ Urine collection for VMA & metanephrines.
• Images:
→ IVU, MRI.

Question 16

Wilms Tumor “Nephroblastoma” Tx:

Answer 16

nephrectomy -/+ chemoradioimmunotherapy.

Question 17

Oncocytoma

Answer 17

• Central scar: spoke wheel appearance.
• Looks like chromophobe RCC in histology.
• Biopsy is not diagnostic in most cases
• Tx: Nephrectomy.

Question 18

Angiomyolipoma

Answer 18

• Females more than males.
• Associated with tuberous sclerosis(AD).
• Histology: very vascular and contains fat.
• Presentation: incidental vs bleeding.
• Tx: if symptomatic→ surgery, angioembolization.
• Can be differentiated from renal cell carcinoma by contrast CT.

Question 19

Hypospadias

Answer 19

• Urethra opens in an abnormal position on the ventral
aspect of the penis.
• Associated with chordee and hooded prepuce

Question 20

Vesico-ureteral reflux (VUR):

Answer 20

• Child with HTN and recurrent UTI.
• Urographic demonstration of longitudinal folds in renal
pelvis and ureter in children.

Question 21

MC cancer in renal transplant patients:

Answer 21

skin cancer (BCC).

Question 22

Renal transplantation is usually defined as a

Answer 22

heterotopic graft.

Question 23

MC site of ureteral urothelial tumor:

Answer 23

bladder and pelviuretric

Question 24

Horseshoe kidneys:

Answer 24

• The MC fusion anomaly.
• More in males.
• True fusion of the lower poles at the level of L4 or L5
→ Which forms an isthmus and becomes medially directed.
• High incidence of neoplasia.

Question 25

Ectopic ureter

Answer 25

A ureter that opens some location other than the bladder.

Question 26

Ectopic ureter: MC sites in males:

Answer 26

Posterior urethra and seminal vesicles

Question 27

Ectopic ureter: MC sites in females:

Answer 27

Urethra, vestibula and vagina.