URINARY Section 2: Renal Masses Flashcards
The most common primary renal malignancy
RCC
RCC til proven otherwise:
a. enhancing mass (>15 HU)
b. Fatty mass + calcs
Risk factors of RCC
Smoking
Von Hippel Lindau
Chronic disalysis (>3 years)
Family Hx
Metastatic charatecerisitcs of RCC
Hypervascular mets
Bone metes = Always lytic
The most sensitive phase for detection of RCC in CT
Nephrographic phase (80 secs)
RCC + fat
Clear cell
RCC subtypes
- Clear cell
- Papillary
- Medullary
- Chromophobe
- Translocation
Most common subtype of RCC in the general population
Clear Cell
RCC + VHL =
Clear Cell
Clear Cell
Corticomedullary Enhancement = cortex
Cystic mass + Enhancing components
This is the second most common type of RCC
Papillary
Papillary RCC
Less aggro than CCC
Less vascularity will not enhance = to cortex on CMP
T2 Dark
What RCC subtypes risk do transplented kidneys have?
Papillary subtypes.
RCC + Sickle Cell =
Medullary RCC
Highly aggressive + usuallry large with mets on DX
Birt Hoog Dube (autosomal dominant genodermatosis, usually manifesting in the third decade of life with multiple fibrofolliculomas, trichodiscomas, and acrochordons)
Chromophobe RCC
Most common RCC subtype in kids.
Translocation RCC
Hx Cytotoxic chemotherapy
Translocation RCC
Conventional RCC Staging:
Stage 1:
Limited to Kidney and < 7 cm
Conventional RCC Staging:
Stage 2:
Limited to Kidney and > 7 cm
Conventional RCC Staging:
Stage 3:
Still inside Gerota’s Fascia
A: renal vein invaded
B: IVC below diaphragm
C: IVC above diaphragm
Conventional RCC Staging:
Stage 4:
Beyond Gerota’s Fasica
Ipsilateral Adrenal
Overall Most Common in Gen Pop + Von Hippel-Lindau
Clear Cell
Does ADPKD increase your risk of RCC?
Nope
Dialysis does!
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%
Most common metastatic tumor to invade the kidneys
Lypmphoma
Renal Leukemia
The kidney is the most common visceral organ involved
the most common benign tumor of the kidney
Angiomyolipoma (AML)
Macroscopic fat
Angiomyolipoma
Tuberus sclerosis
Angiomyolipoma
Angiomyolipoma bleeds at this size
> 4cm
more in pregnancy
Never have calcificaitons
Angiomyolipoma
T2 Dark
Angiomyolipoma
AML on MRI
Fat Sat or IP OOP
Renal mass + Fat + Calcifications =
RCC
Renal mass + Fat - Calcifications =
Probably AML
This is the 2nd most common benign tumor (after AML).
Oncocytoma
MASS + Central scar =
Oncocytoma
RCC until proven otherwise
Oncocytoma
CT/MRI Solid mass + Central Scar
Oncocytoma
USD: “Spoke wheel” Vascular pattern
if you are shown an enhancing renal mass with a central scar, how do you decide if it’s a RCC or an oncocytoma?
all enhancing renal masses are RCC till proven otherwise
If cetnral scar = consider oncocytoma
Birt Hogg Dube associated solid renal masses
Oncocytoma (Bilateral)
Chromophobe RCC
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.
“protrudes into the renal pelvis.”
Multilocular Cystic Nephroma
Multilocular Cystic Nephroma is common in these ages
4 y.o BOYS
40 y.o. women
Micheal jackson lesion
Multilocular Cystic Nephroma
loves young boys and middle aged women
retroperitoneum borders
anterior - anterior parearenal space
posterior - transversalis fascia
What part of the pancreas is not included in the retroperitoneum
Tail
What part of the rectum is not included in the retroperitoneum
Lower 1/3.
