renal tumours

Question 1

What benign renal tumours exist? 6

Answer 1

Renal cyst
Oncocytoma
Angiomyolipoma
Fibroma
Adenoma
Juvenile granulosa cell tumour (JGCT)

Question 2

Benign renal cyst:

• What is this?
• is it common?
• what is cystic degeneration? treatment of this?
• what are the clinical features?
• how is this diagnosed?

Answer 2

=fluid filled space in kidney, solitary or multiple

Epidemiology: 1/10 people, 50% of those over 50yrs will have 1 or more, represent 70% of benign asymptomatic renal lesions

Cystic degeneration: this is where multiple cysts enlarge with time. Occurs regularly in end stage kidney disease. Treated with dialysis/transplantation

Clinical features of cyst: some may cause pain/haematuria if large

Diagnosis: USS (incidental finding), bleeding may occur within cyst, contrast CT may show if cysts have become complicated

Question 3

Renal fibroma: what is this?

Answer 3

Common benign tumour, medullary in origin with white nodules

Question 4

Renal adenoma: what is this?

Answer 4

Benign tumour, cortical in origin with yellowish nodules <2cm

Question 5

Angiomyolipoma:

• what is this?
• what is it assoc. with?
• what can this cause?
• Imaging
• When are these removed?
• what other treatment is available?

Answer 5

= RARE tumour with mixture of fat, muscle and blood vessels (imitates RCC) assoc. with tuberose sclerosis

• Blood vessels are very fragile and can cause haemorrhage (could be cause of wunderlich syndrome)
• CT shows unmistakable appearance due to fat content
• remove if larger than 6cm = high risk haemorrhage
• can do embolisation

Question 6

What do JGCT produce? what does this cause?

Answer 6

-produces renin

=secondary hypertension

Question 7

Oncocytoma:

• what is this?
• what does this imitate?
• diagnosis?
• treatment
• what is seen on CT

Answer 7

=benign tumour that imitates RCC, represents 3-7% renal masses

-imitates RCC as some areas of RCC can look like oncocytoma on biopsy

Diagnosis:

• no definitive diagnosis except on nephrectomy which should be done as may be RCC or may grow
• on CT there’s a central scar present due to central necrosis

Question 8

What 3 malignant renal cell tumours exist?

Answer 8

• Nephroblastoma (wilm’s tumour)
• Urothelial carcinoma
• Renal cell carcinoma

Question 9

Wilm’s tumour - which patient’s does this affect? what three symptoms to look out for?

Answer 9

most common intrabdominal tumour in children

abdominal mass (most common presenting feature)
painless haematuria
flank pain

Question 10

Urothelial carcinoma - where do these arise?

Answer 10

renal pelvis and calyces

Question 11

Renal cell carcinoma:

• what is this also known as?
• what is the classic triad of presentation seen in 15%
• how else can this present? 2

Answer 11

AKA clear cell Ca/hypernephroma/grawitz tumour

Triad of presentation:

• loin pain 40%
• renal mass 25%
• Frank haematuria 60%

Other presentations:

• incidental finding on imaging
• it can cause paraneoplastic syndrome even if no met.s (weight loss/anaemia/hypercalcaemia)

Question 12

RCC:

• male or female preponderance?
• common age affected
• what is seen pathologically?
• what syndrome is bilateral tumours seen in?

Answer 12

M:F 2:1

Age 65-75yo

pathology:
-adenoma of the proximal tubule - cells are clear cells of papillary type. can be multifocal or bilateral

Bilateral tumours seen in von hippel lindau

Question 13

RCC:

• what is standard treatment?
• How to treat if renal function needs to be preserved or if tumour is only small or oncologically ‘safe’
• what if the patient is not fit/multiple tumours/bilateral tumours

Answer 13

Standard treatment: radical nephrectomy usually done laparoscopically (tumour is not radiosensitive)

• if want to preserve renal function or if tumour is only small or oncologically ‘safe’ can do partial nephrectomy (open surgery/larger surgery)
• if pt. not fit/multiple tumours/bilateral tumours can do radiofrequency ablation or cryoablation

Question 14

When doing surgery for RCC are the adrenal glands also removed?

Answer 14

-only remove if involved as risk of spread to either adrenal gland is equal

Question 15

Describe the staging of renal cell carcinoma. Why does it tend to spread up the vena cava?

Answer 15

Stage 1 - tumour in capsule

Stage 2 - tumour invasion perinephric fat (confined by fascia)

Stage 3 - tumour involvement regional lymph nodes and or renal vein/vena cava

Stage 4 - adjacent organs/distant mets

-tends to spread up vena cava as the capsule of the kidney is thick

Question 16

Describe adjuvant therapy options for RCC metastases

Answer 16

Sunitab - tyrosine kinase inhibitor, acts to inhibit VEGF/PDGF (reduces neovascularisation)

Question 17

What is the prognosis of RCC if no mets?

Answer 17

-5 yr survival 60-70%