Urological malignancy

Question 1

Name the 3 renal tumours

+1 peadiatric

Answer 1

Renal cell carcinoma
Oncocytoma
Angiomyolipoma
Nephroblatoma

Question 2

Name the 2 penile cancers

Answer 2

Squamous cell carcinoma

Carcinoma in situ

Question 3

Name the 2 testicular cancers

Answer 3

Seminoma
Teratoma
Intratubular germ cell neoplasia (ITGCN)

Question 4

Imaging in renal tumours

• types
• why used

Answer 4

Ultrasound- to determine if cysts are solid

CT- contrast enhanced

MRI- can see haemorrhage

Question 5

mode of imaging and appearance of Benign renal cysts

Answer 5

-US, single or multiple, fluid filled

Question 6

Angiomyolipoma

• character
• components
• imaging
• complications
• management

Answer 6

• Benign
• Blood vessels, fat , muscle
• CT, high fat content
• Haemorrhage due to fragile vasculature when 6cm+
• Embolization

Question 7

Oncocytoma

• character
• imaging
• management

Answer 7

• benign
• Central stellate scar due to central necrosis
• Nephrectomy- definitive diagnosis

Question 8

Presentation of RCC

• triad
• others

Answer 8

-Loin pain
haematuria
Addo mass

-incidental on imaging
Paraneoplastic syndromes: Weight loss
anaemia
hypertension
Hypercalcaemia

Question 9

Define RCC

Answer 9

Adenoma of the proximal convoluted tubule

clear cell, papillary tumour

Question 10

what would bilateral RCC suggest?

Answer 10

Von Hippel-Lindau

Question 11

Diagnosis of RCC?

Answer 11

via USS and CT

biopsy- high false negative

Question 12

RCC staging

• describe stages 1-4
• mets to?

Answer 12

-1, within capsule
2, invasion of perinephric fat
3, regional lymph nodes/renal vein
4, adjacent organs/distant mets

-lungs, liver, bones brain

Question 13

Management of RCC

• surgery
• medication

Answer 13

• Radical nephrectomy (laproscopic, whole kidney and perinephric fat)
• Partial nephrectomy (nephron sparing, more risky)
• Radiofrequency ablation, cryoablation
• Tyrosine kinase inhibitors e.g. Sunitinib, they are VEGF inhibitors and prevent neovascularisation

Question 14

Give 2 premalignant cutaneous lesions of the penis?

Answer 14

Balanitis xerotica obliterans leukoplakia

Question 15

What is Balanitis xerotica obliterates?

• appearance
• management

Answer 15

Lichenus sclerosus

-white patches, fissuring ,bleeding and scarring at prepuce and glans

-Circumcision
Meatal stenosis requiring dilatation
Glans resurfacing

Question 16

Squamous Carcinoma in situ

• names
• appearance
• management

Answer 16

-Erythroplasia of Queyrat
(Glans, prepuce or shaft of penis)
Bowen’s disease (Remainder of genitalia)

-red velvety patches

-circumcision if prepuce alone
topical 5 fluorouracil

Question 17

Invasive Squamous Carcinoma

• presentation
• diagnosis
• treatment

Answer 17

-delayed: Red raised area
Fungating mass, foul smelling
Phimosis

-physical examination + biopsy
USS
CT if lymph node biopsy +

-surgery (total/partial penectomy and reconstruction)
inguinal lymphnodes and sentinel biopsy
Radiotherapy

Question 18

Testicular tumours

• presentation
• Imaging
• Markers
• management
• increased risk in?

Answer 18

• painless, insensitive testicular swelling, usually mets
• US + CXR, CT abdomen/thorax

-AFP=Teritoma
HCG= usually Teritoma
PLAP= Seminoma

-orchidectomy (inguinal approach, high ligation of the cord and prosthesis
radiotherapy and sperm storage

-undescended testis