Kidney CA

Question 1

2 main benign renal lesions

Answer 1

1. renal cyst

2. angiolyolipoma (AML)

Question 2

what are renal cysts

Answer 2

fluid filled sac in renal parenchyma

• common
• M>F
• increase with age
• most benign, some have malig potential

Question 3

what is needed to diagnose renal cysts

Answer 3

radiological Dx

• US is good most of the time
• CT/MR for complex issues

Question 4

4 features of a simple renal cyst on US

Answer 4

1. anechoiuc- dark
2. well defined wall
3. posterior acoustic enhancement
4. no internal calcification or solid

Question 5

3 features of simple cyst on CT

Answer 5

1. homogenous
2. low (water) density
3. no internal enhancement

Question 6

3 features of simple cyst on MR

Answer 6

1. homogenous
2. follows fluid on all sequences (T1 dark, T2 bright)
3. no internal enhancements

Question 7

what is classification system for cysts

Answer 7

Bosniak system - radiologic based
1. simple - no malig
2. mild complex - 1-2% malig
2F. complex - 10-15 malig
3. sig. complex - 40-50 malig
4. CA until proven otherwise

Question 8

what is follow up for classes

Answer 8

1 and 2 - no follow-up
2F - imaging surveillace
3 and 4 - surgery

Question 9

what are features of type 1

Answer 9

• simple benign
• thin walled
• water density
• so septa or calcifications

Question 10

features of type 2

Question 11

features of type 3

Answer 11

• mural or septal thinkening

- both benign and malig. lesions

Question 12

featues of type 4

Answer 12

fulfills type 3

• clearly malig
• enhancing soft tissue component indep. of cyst wall or septa

Question 13

features of 2F

Answer 13

• F for follow-up
• well marginated
• may contain multiple thin walled septa
• minimal mural or septal thinkening

Question 14

what is AML

Answer 14

• benign tumor with variable amounts of blood vessels, muscle, or fat
• f>M, rare before puberty
• most sporadic
• usually asymptomatic

Question 15

what is path of AML

Answer 15

• see all three elements

- + HMB stain, - cytokeratin stain

Question 16

how to diagnose AML

Answer 16

US is generally enough

- CT or MR if issues

Question 17

4 features of AML on US

Answer 17

1. sharp margins
2. hyperechoic
3. homo exotexture
4. no calcif

Question 18

4 features of AML on CT

Answer 18

1. high spatial resolution
2. mixed density lesion
3. no calcif.
4. no lymphadenopathy

Question 19

3 features of AML on MR

Answer 19

1. high soft tissue contrast
2. mixed compostiion - fat, muscle, vessels
3. bulk fat

Question 20

2 possible pitfalls for imaging AML

Answer 20

1. RCC may be echogenic on US

2. some AML with minimal fat

Question 21

mgmt options

Answer 21

1. surveillance for most
2. selective angioembolization
3. Nx - partial or full

Question 22

indication for intervention in AML

Answer 22

> 4 cm

• Sx
• female of child bearing age

Question 23

epi of RCC

Answer 23

85% of renal CA

• M>F
• later in life
• few risk factors except smoking
• 95% sporadic

Question 24

RCC presentation

Answer 24

• most are incidental findings
• common mets
• paraneoplastic sydrome common

Question 25

terrible triad for RCC

Answer 25

1. flank pain 2. flank bulge 3. hematuria

Question 26

5 types of RCC, sites and genes

Answer 26

1. clear cell - 70% - PCT - VHL gene 2. papillary - 10% - PCT - type 1 and 2 3. chromophobe - CD - less aggressive 4. collecting ducts - CD - more aggressive 5. other

Question 27

what is staging and what is it based on

Answer 27

TNM | CT and final T stage based on patho

Question 28

what is main imaging for RCC

Answer 28

US | - more are incidentally found on CT

Question 29

features of RCC on US

Answer 29

1. variable appearance 2. solid mass - hypo, iso, or hyper echoic - calcification - doppler vascularity - narrow rim - renal vein thrombosis

Question 30

4 features of RCC on CT

Answer 30

1. multiphase aquisition 2. enhancing mass - increased desnity after contrast 3. calcifications 4. staging

Question 31

when to use MRI

Answer 31

- contraindication to CT - confirm equivocal CT - characterize CT enhancement - RCC subtyping

Question 32

3 RCC mimics on imaging

Answer 32

1. dromedary hump - normal variant 2. coloumn of bertin 3. renal abscess

Question 33

*when to use a biopsy (3)

Answer 33

1. if unsure of Dx 2. if it might alter mgmt 3. if have a good GU IR and patho

Question 34

5 prognositic factors for RCC

Answer 34

1. stage - most important 2. grade 3. tumor size 4. histo variant 5. patient age/health

Question 35

main Tx

Answer 35

surgery | - chemo and RAD resistant

Question 36

2 main surg

Answer 36

1. radial nephrectomy - gold standard for advances 2. partial - preferred when feasible

Question 37

2 other Tx options

Answer 37

1. thermal ablation | 2. active surveillance