Renal Tumours

Question 1

Name three benign masses that can be found in the kidney

Answer 1

Xanthogranulomatous Pyelonephritis
Oncocytoma
Angiomyolipoma

Question 2

What is xanthogranulomatous pyelonephritis?

Answer 2

Infection that creates a mass

Question 3

Describe the appearance of an oncocytoma

Answer 3

Benign, small oval well circumscribed brown/tan coloured with a central stellate scar. Aggregates of eosinophils packed with mitochondria

Question 4

How does an oncocytoma appear on CT?

Answer 4

Wheel pattern

Question 5

How may a oncocytoma present?

Answer 5

Incidental in 85% of cases but can present with loin pain or haematuria

Question 6

What does oncotyoma look very similar to? How is it treated?

Answer 6

Chromophobe RCC, therefore is treated the same

Question 7

Describe the appearance of a chromophobe RCC?

Answer 7

Malignant, raisonoid nuclei and perinuclear haloes

Question 8

What causes angiomyolipoma?

Answer 8

80% sporadic in middle aged females

20% associated with tuberous sclerosis

Question 9

What is an angiomyolipoma made up of?

Answer 9

Blood vessels
Fat
Smooth muscle

Question 10

How may a angiomyolipoma present?

Answer 10

50% incidental
Loin pain
Haematuria
Mass

Question 11

What does an angiomyolipoma look like on US?

Answer 11

Bright echo pattern

Question 12

What does an angiomyolipoma look like on CT?

Answer 12

Fatty tumour with low density

Question 13

How is an angiomyolipoma treated?

Answer 13

4cm cut off
Elective - partial nephrectomy or embolisation
Emergency - embolisation or nephrectomy

Question 14

What is a serious complication of angiomyolipoma?

Answer 14

Wunderlich’s Syndrome - massive retroperitoneal bleed

Question 15

Name the malignant tumours of the kidney

Answer 15

Conventional clear cell carcinoma 
Papillary carcinoma 
Collecting duct 
Medullary cell 
Chromophobe

Question 16

Describe the typical appearance of a renal cell carcinoma

Answer 16

Tan coloured lobulated solid tumour

Question 17

What are the two key risk factors for clear cell carcinoma?

Answer 17

Obesity

Von Hippel Landau gene

Question 18

How does clear cell carcinoma usually present?

Answer 18

haematuria, mass, hypertension

Question 19

Describe the appearance of a clear cell carcinoma

Answer 19

Partly cystic with heterogenous surface and bright yellow tumour surface

Question 20

Describe a collecting duct carcinoma

Answer 20

Rare and very poor prognosis, often in young patients. has a high grade appearance with desmoplastic stroma

Question 21

Who is affected by medially cell carcinomas?

Answer 21

Young sickle cell patients

Question 22

How are renal cell carcinomas staged?

Answer 22

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

Question 23

State the risk factors for renal cell carcinoma

Answer 23

Smoking 
Renal failure/dialysis 
Obesity 
Hypertension 
Environmental exposure 
VHL

Question 24

How does renal cell carcinoma present?

Answer 24

Haematuria 
Loin pain 
Mass
Pyrexia of unknown origin 
Varicocele
Paraneoplastic syndrome

Question 25

What investigations are done on a patient with suspected RCC?

Answer 25

USS
CT chest abdomen pelvis
FBC
Renal and liver function

Question 26

How is RCC treated?

Answer 26

<3cm surveillance or ablation
>3cm partial nephrectomy (robotic) or radical nephrectomy
Large tumour - laparoscopic nephrectomy

Question 27

Why does polycythaemia arise?

Answer 27

Due to decreased erythopoetin

Question 28

Why does hypertension arise?

Answer 28

Renin/renal artery compression

Question 29

Why does hypercacaemia arise?

Answer 29

PTH like substance increases

Question 30

What causes gynaecomastia?

Answer 30

Increased gonadotrophin