541 - Renal Carcinomas

A 65-year-old man presents to his physician's office after noticing blood in his urine earlier this morning. This has never happened before and he denies any new medications or prior infection. He also reports to having flank pain for the past few weeks. Medical history is significant for hypertension. He has a 40 pack-year smoking history. On physical examination there is a firm, nontender, and homogeneous mass in the right

flank. What is the most likely dx?

renal cell carcinoma

Which cancer of the kidney originates in the lining of the proximal convoluted tubule, and is characterized by lack of warning signs, variable presentation and is resistant to chemo/radiation?

renal cell carcinoma

Which genetic components are associated with renal cell carcinoma?

-von Hippel-Lindau syndrome; VHL gene

-hereditary papillary renal cell carcinoma; MET oncogene

What is best initial test for renal cell carcinoma?

CT w/ contrast

2 multiple choice options

What is the dx test for renal cell carcinoma?

renal bx

Renal cell carcinoma partial nephrectomy (stage I-III):

-single kidney, bilateral lesions

-normal contralateral kidney and good renal function but a small cancer

Renal cell carcinoma radical nephrectomy (stage I-III):

cancers > 7 cm (if partial not feasible)

Renal cell carcinoma systemic tx:

Interleukin-2 (aldesleukin)

A 15-month-old male is brought to his pediatrician for routine exam. On exam, his pediatrician notices that he has no irises, consistent with aniridia. He is also found with a palpable, non-tender mass on the left side of his abdomen which does not cross midline. On further questioning, his mother reveals that her cousin had a similar abdominal mass at a young age. The patient and his mom are referred to pediatric surgeons for further management. An abdominal CT scan is obtained. What is the likely dx?

Wilm's Tumor

Which solid cancerous tumor of the kidney arises from immature kidney cells that primarily develops in children and is AKA nephroblastoma?

Wilm's Tumor

What is the best initial study for Wilm's Tumor?

renal US

2 multiple choice options

A partial nephrectomy is indicated for pts with Wilm's Tumor IF:

cancer is small or there is only one functioning kidney

The goal for radical nephrectomy for Wilm's tumors is to:

remove kidney and surrounding tissues, including part of a ureter and sometimes adrenal glands and nearby lymph nodes

Cancers of the renal pelvis and ureters are usually:

-transitional cell carcinomas

-squamous cell carcinomas (occasionally)

Cancers of the renal pelvis & ureters occur more commonly with

-bladder cancer

-Balkan nephropathy

-Lynch syndrome

What are the two dx imaging studies performed in pts with cancers of the renal pelvis & ureters?

US or CT (for pts with unexplained urinary tract sx)

Which test would confirm a dx of cancers of the renal pelvis & ureters?

cytologic/histologic

Cancer of the renal pelvis & ureter tx:

radical nephroureterectomy

Which tumor is made up of oncocytes and epithelial cells characterized by an excessive amount of mitochondria, resulting in an abundant acidophilic granular cytoplasm?

renal oncocytoma

What is the preferred dx imaging study for a pt with renal oncocytoma?

CT abdomen

What is the confirmatory test for a pt with renal oncocytoma?

biopsy

Which kidney tumor is benign and characterized by the presence of mature/immature fat tissue, thick-walled blood vessels, and smooth muscles with a rare transmission to malignancy?

renal angiomyolipoma

Renal angiomyolipoma is typically caused by mutations in which 2 genes?

TSC1/TSC2 genes

True or False. Asx renal angiomyolipomas < 5cm in diameter don't usually require intervention.

True

1 multiple choice option

Larger renal angiomyolipoma lesions may bleed and will require ______________.

angiographic embolization

Renal angiomyolipomas > 5m tx:

prophylactically w/ angioembolization

What is the MC secondary cancer of the kidney?

lung cancer

3 multiple choice options