tumori renale

Question 1

epidemiologie

Answer 1

incidenta in crestere
mai frecv la B
60-70 ani

Question 2

DR

Answer 2

obezitate
fumat
HTA
AHC +

Question 3

etiologie - sdr genetice familiale

Answer 3

AD
sdr von Hippel-Lindau
cc cel renale papilar ereditar
leiomiomatoza & ccr familial
birt-hogg-dube

Question 4

clinic

Answer 4

peste jum - asimptomatice (incidentaloame)
invazie venoasa - varicocel nereductibil, edem mb inf bilateral
stadii avansate - durere lombara, hematurie macro, masa abdominala palpabila

Question 5

sdr paraneoplazice

Answer 5

HTA
scadere ponderala, casexie
hiperpirexie
neuromiopatie
amiloidoza
VSH ridicat, anemie/policitemie
hipercalcemie
sdr Stauffer - disfunctie hepatica non-metastatica (normalizare dupa nefrectomie)

Question 6

sdr wunderlich

Answer 6

hemoragie retroperitoneala masiva spontana non-traumatica
cauza: angiomiolipom rupt
triada Lenk - durere acuta in flancuri + masa in flanc + soc hipovolemic

Question 7

imagistica

Answer 7

US + Doppler, CEUS (US cu contrast)
CT - intarire >15 UH, fen de wash-in/wash-out
RM cu contrast

Question 8

ddx

Answer 8

hipertrofia coloanei Bertin - in cont cu parenchimul renal, ~ parenchim N, contur renal pastrat, port medie a rinichiului, stg
chiste renale - clasif Bosniak
angiomiolipom (AML) - US hiperecogen + CT hipodens
oncocitom - benign, dg histopatologic

Question 9

clasif Bosniak chiste renale complexe

Answer 9

I (simplu) - benign
II - septe fine, calcificari fine, lez <3 mm -> benigne
IIF - septe groase regulate, perete ingrosat cu intarire, calcificari groase, nod, nereal -> follow up, cel mai probabil benigne
III - septe si perete gros/neregulat cu intarire masurabila -> ? benign/malign
IV - III + masa cu intarire indep de perete/septe -> cc cistic (malign)

Question 10

indicatii PBR

Answer 10

mase renale nedeterminate
supraveghere
anterior unui tratament ablativ
selectarea terapiei in cazul M1

Question 11

histopatologie

Answer 11

cu celule clare (maj)
papilar - necroza masiva, risc de ruptura daca nu are capsula
cromofob - prognostic bun
de duct colector - f rar, multe M1 la dg

Question 12

gradare histologica

Answer 12

1 - nucleoli inviz/mici si bazofili
2 - nucleoli viz la 400x, dar inviz la 100x
3 - nucleoli eo si viz la 100x
4 - nuclei pleomorfi, cel gigante, dediferentiere sarcomatoida/rhabdoida

Question 13

stadializare T

Answer 13

0 - nu
1 < 7 cm lim la rinichi
   a - <4cm
   b - 4-7 cm
2 >7cm, lim la rinichi
   a - 7-10 cm
   b - >10 cm
3 - invazie in vene, SR sau tesut perirenal
4 - invazie care depaseste fascia Gerota (extensie contigua in SR ipsilat)

Question 14

stadializare N

Answer 14

0 - nu
1 - 1 limfoggl reg
2 - >1 limgoggl
!suspect - adenopatii>1cm

Question 15

stadializare M

Answer 15

0 - fara
1 - metastaze la distante
Rx/ct toracic
ct/rm cranian, scinti osos - semne clinice/paraclinice sugestive

Question 16

tratament

Answer 16

RCC rezistent la radio si chimioterapie

in functie de varsta, co-morbiditati, stadiu, fct renala

Question 17

T1N0M0 - tratament

Answer 17

supraveghere activa - imagistica seriata a tu, mai ales la varstnici si pacienti cu comorbiditati imp
ablatie - crio, RF
nefrectomie partiala

Question 18

T2+, orice N, orice M - tratament

Answer 18

nefrectomie radicala

Question 19

M1 - tratament

Answer 19

terapie tintita