Renal Pathology - Oncocytoma, AML, Juxtaglomerular tumours, Lymphoma, Wilm's tumour, VHL, Tuberous Sclerosis (Lecture 20b)

What are oncocytomas? What is their pt population and CP? What are the SF? What are the D/D? What is the treatment?

- Benign, large tumour of renal cortex

- Pt population: older males

- CP: asymptomatic*, palpable flank mass, flank pain

- SF: looks like RCC, inc size = inc heterogeneity, solid mass

- D/D: RCC

- Treatment: partial nephrectomy

What are angiomyolipomas (AML)? What is their alternative name? What are the causes? What is the pt population and CP? What are the SF? What is the D/D? What is the treatment?

- Benign renal neoplasm composed of blood vessels, muscle, and fat

- Alternative name: hamartoma

Causes

- Sporadic: unilateral, single

- Tuberous sclerosis: bilateral, multiple

- Pt population: middle-aged women

- CP: asymptomatic*, hematuria, flank pain, palpable mass

- SF: echogenic mass near renal sinus, speed error artifact

- D/D: small RCC

- Tx: follow growth, embolization, partial nephrectomy

What are juxtaglomerular tumours? What is the pt population and CP? What are the SF?

- Benign tumour of juxtaglomerular cells that secretes renin

- Pt population; young women

- CP: hypertension

- SF: solid, small, hyperechoic

What are the 3 common sites of origin of metastases to the kidneys? How are they spread?

Spread hematologically to kidneys from:

- lung

- breast

- RCC of contralateral kidney

What is CP for metastases to the kidneys?

- Asymptomatic in early stages

- Possibly have flank pain or hematuria

What are the SF of metastases to the kidneys?

Focal

- single solid mass

- *multiple small hypoechoic masses

Diffuse

- inc size of kidney

- loss of corticomedullary differentiation

What is the D/D for mets to the kidney?

RCC

TRUE or FALSE: Lymphoma leads to unilateral enlargement of one kidney.

FALSE: Lymphoma leads to BILATERAL enlargement of both kidney.

What is lymphoma? How is it spread? What are the types? What is CP? What are the SF? What are the D/D?

- Cancer of lymphatics

- Hematogenous spread or direct from retroperitoneal disease

- *Non-Hodgkin's/Hodgkin's

- CP: flank pain, hematuria (uncommon)

SF:

- solid, focal hypo/anechoic mass

- Diffuse: inc size of kidney, destroys renal architecture

- hypoechoic masses of retroperitoneal lymph nodes

- hypoechoic perirenal mass (peripheral of kidney)

- D/D: cortical cysts, perirenal hematoma

TRUE or FALSE: Non-Hodgkin's lymphoma is more common in the kidneys than Hodgkin's.

TRUE

What is m/c abdominal pediatric tumour?

Wilm's tumour/nephroblastoma

What are Wilm's tumours? What is the pt population and CP? What are the SF? What is the D/D? What is treatment?

- M/c malignant abdominal pediatric tumour that affects one kidney (unilateral)

- Pt population: male, 0-4 yrs old

- CP: large flank mass, pain, fever of unknown origin, hematuria, hypertension

SF

- large, hyperechoic, homogenous mass

- displaces collecting system

- if hemorrhage/necrosis = hypoechoic

- D/D = neuroblastoma (adrenal gland neoplasm)

- Tx = radical nephrectomy, chemo, rad therapy

What is Von-Hippel Lindau disease? What are its SF? What is there an increased risk of developing?

- Autosomal dominant disease characterized by cysts and masses in multiple organs

- SF: cortical cysts

- Inc risk of RCC due to malignant degeneration of renal cysts

What is tuberous sclerosis? What are its SF?

- Autosomal dominant /sporadic disorder characterized by seizures, skin lesions, and stunted mental development

- Associated w/ AMLs**, renal cysts, and RCC