Renal Tumours Flashcards
Name three benign masses that can be found in the kidney
Xanthogranulomatous Pyelonephritis
Oncocytoma
Angiomyolipoma
What is xanthogranulomatous pyelonephritis?
Infection that creates a mass
Describe the appearance of an oncocytoma
Benign, small oval well circumscribed brown/tan coloured with a central stellate scar. Aggregates of eosinophils packed with mitochondria
How does an oncocytoma appear on CT?
Wheel pattern
How may a oncocytoma present?
Incidental in 85% of cases but can present with loin pain or haematuria
What does oncotyoma look very similar to? How is it treated?
Chromophobe RCC, therefore is treated the same
Describe the appearance of a chromophobe RCC?
Malignant, raisonoid nuclei and perinuclear haloes
What causes angiomyolipoma?
80% sporadic in middle aged females
20% associated with tuberous sclerosis
What is an angiomyolipoma made up of?
Blood vessels
Fat
Smooth muscle
How may a angiomyolipoma present?
50% incidental
Loin pain
Haematuria
Mass
What does an angiomyolipoma look like on US?
Bright echo pattern
What does an angiomyolipoma look like on CT?
Fatty tumour with low density
How is an angiomyolipoma treated?
4cm cut off
Elective - partial nephrectomy or embolisation
Emergency - embolisation or nephrectomy
What is a serious complication of angiomyolipoma?
Wunderlich’s Syndrome - massive retroperitoneal bleed
Name the malignant tumours of the kidney
Conventional clear cell carcinoma Papillary carcinoma Collecting duct Medullary cell Chromophobe
Describe the typical appearance of a renal cell carcinoma
Tan coloured lobulated solid tumour
What are the two key risk factors for clear cell carcinoma?
Obesity
Von Hippel Landau gene
How does clear cell carcinoma usually present?
haematuria, mass, hypertension
Describe the appearance of a clear cell carcinoma
Partly cystic with heterogenous surface and bright yellow tumour surface
Describe a collecting duct carcinoma
Rare and very poor prognosis, often in young patients. has a high grade appearance with desmoplastic stroma
Who is affected by medially cell carcinomas?
Young sickle cell patients
How are renal cell carcinomas staged?
T1 Up to 7cm
T2 >7cm confined to kidney
T3 Beyond kidney to renal vein, sinus, IVC, perinephric fat
T4 Beyond gerotas fascia into surrounding structures
State the risk factors for renal cell carcinoma
Smoking Renal failure/dialysis Obesity Hypertension Environmental exposure VHL
How does renal cell carcinoma present?
Haematuria Loin pain Mass Pyrexia of unknown origin Varicocele Paraneoplastic syndrome
