URINARY Section 2: Renal Masses

Question 1

The most common primary renal malignancy

Answer 1

RCC

Question 2

RCC til proven otherwise:

Answer 2

a. enhancing mass (>15 HU)
b. Fatty mass + calcs

Question 3

Risk factors of RCC

Answer 3

Smoking
Von Hippel Lindau
Chronic disalysis (>3 years)
Family Hx

Question 4

Metastatic charatecerisitcs of RCC

Answer 4

Hypervascular mets

Bone metes = Always lytic

Question 5

The most sensitive phase for detection of RCC in CT

Answer 5

Nephrographic phase (80 secs)

Question 6

RCC + fat

Answer 6

Clear cell

Question 7

RCC subtypes

Answer 7

1. Clear cell
2. Papillary
3. Medullary
4. Chromophobe
5. Translocation

Question 8

Most common subtype of RCC in the general population

Answer 8

Clear Cell

Question 9

RCC + VHL =

Answer 9

Clear Cell

Question 10

Answer 10

Clear Cell

Corticomedullary Enhancement = cortex

Cystic mass + Enhancing components

Question 11

This is the second most common type of RCC

Answer 11

Papillary

Question 12

Answer 12

Papillary RCC

Less aggro than CCC

Less vascularity will not enhance = to cortex on CMP

T2 Dark

Question 13

What RCC subtypes risk do transplented kidneys have?

Answer 13

Papillary subtypes.

Question 14

RCC + Sickle Cell =

Answer 14

Medullary RCC

Highly aggressive + usuallry large with mets on DX

Question 15

Birt Hoog Dube (autosomal dominant genodermatosis, usually manifesting in the third decade of life with multiple fibrofolliculomas, trichodiscomas, and acrochordons)

Answer 15

Chromophobe RCC

Question 16

Most common RCC subtype in kids.

Answer 16

Translocation RCC

Question 17

Hx Cytotoxic chemotherapy

Answer 17

Translocation RCC

Question 18

Conventional RCC Staging:

Stage 1:

Answer 18

Limited to Kidney and < 7 cm

Question 19

Conventional RCC Staging:

Stage 2:

Answer 19

Limited to Kidney and > 7 cm

Question 20

Conventional RCC Staging:

Stage 3:

Answer 20

Still inside Gerota’s Fascia
A: renal vein invaded
B: IVC below diaphragm
C: IVC above diaphragm

Question 21

Conventional RCC Staging:

Stage 4:

Answer 21

Beyond Gerota’s Fasica
Ipsilateral Adrenal

Question 22

Overall Most Common in Gen Pop + Von Hippel-Lindau

Answer 22

Clear Cell

Question 23

Does ADPKD increase your risk of RCC?

Answer 23

Nope

Dialysis does!

Question 24

Answer 24

Renal Lymphoma

most common appearance is bilaterally, enlarged kidneys, with small, low attenuation cortically based solid nodules or masses

“infiltrative soft tissue in the renal hilum”

+ lymph nodes

Solitary mass - 25%

Question 25

Most common metastatic tumor to invade the kidneys

Answer 25

Lypmphoma

Question 26

Renal Leukemia

Answer 26

The kidney is the most common visceral organ involved

Question 27

the most common benign tumor of the kidney

Answer 27

Angiomyolipoma (AML)

Question 28

Macroscopic fat

Answer 28

Angiomyolipoma

Question 29

Tuberus sclerosis

Answer 29

Angiomyolipoma

Question 30

Angiomyolipoma bleeds at this size

Answer 30

> 4cm more in pregnancy

Question 31

Never have calcificaitons

Answer 31

Angiomyolipoma

Question 32

Answer 32

T2 Dark Angiomyolipoma

Question 33

AML on MRI

Answer 33

Fat Sat or IP OOP

Question 34

Renal mass + Fat + Calcifications =

Answer 34

RCC

Question 35

Renal mass + Fat - Calcifications =

Answer 35

Probably AML

Question 36

This is the 2nd most common benign tumor (after AML).

Answer 36

Oncocytoma

Question 37

MASS + Central scar =

Answer 37

Oncocytoma RCC until proven otherwise

Question 38

Answer 38

Oncocytoma CT/MRI Solid mass + Central Scar

Question 39

Answer 39

Oncocytoma USD: "Spoke wheel" Vascular pattern

Question 40

if you are shown an enhancing renal mass with a central scar, how do you decide if it’s a RCC or an oncocytoma?

Answer 40

all enhancing renal masses are RCC till proven otherwise If cetnral scar = consider oncocytoma

Question 41

Birt Hogg Dube associated solid renal masses

Answer 41

Oncocytoma (Bilateral) Chromophobe RCC

Question 42

Answer 42

Multilocular Cystic Nephroma “Non-communicating, fluid-filled locules, surrounded by thick fibrous capsule.” By definition these things are characterized by the absence of a solid component or necrosis.

Question 43

“protrudes into the renal pelvis.”

Answer 43

Multilocular Cystic Nephroma

Question 44

Multilocular Cystic Nephroma is common in these ages

Answer 44

4 y.o BOYS 40 y.o. women

Question 45

Micheal jackson lesion

Answer 45

Multilocular Cystic Nephroma loves young boys and middle aged women

Question 46

retroperitoneum borders

Answer 46

anterior - anterior parearenal space posterior - transversalis fascia

Question 47

What part of the pancreas is not included in the retroperitoneum

Answer 47

Tail

Question 48

What part of the rectum is not included in the retroperitoneum

Answer 48

Lower 1/3.