Pathology of the Kidneys and UUT Part 2 Flashcards

Renal Cell Carcinoma (RCC)

• Definition: Most common of all renal neoplasms (85-95%)

• Demographics: More frequent in men, age >40 years, often develops in the sixth or seventh decade of life.

• Because they are in the renal parenchyma; direct contact with the renal blood supply they metastasize via the renal veins (IVC→Heart→ body) and through direct invasion into adjacent structures

• Important to know origin - if it started at the level of the renal veins and went superioly then you know it’s from an RCC

• Clinical Presentation:

  • Often non-specific symptoms

  • Haematuria (blood in urine)

  • Flank pain and palpable mass

• Ultrasound Presentation:

  • Most RCCs appear isoechoic but can also be hyperechoic.

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Transitional Cell Carcinoma (TCC)

• Definition: Rare type of kidney cancer; more common in the bladder and lower urinary tract but can also form in renal pelvis or calyces

• Metastasize up or down the ureters not IVC - always scan ureters and bladders - EXTEND THE EXAM

• Clinical Presentation:

  • Pain in the back

  • Haematuria

  • Frequent urination

• Ultrasound Presentation:

  • Solid hypoechoic lesions originating from the renal pelvis or calyces

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Lymphoma

• Definition: Renal lymphoma typically occurs within a broader spectrum of systemic lymphoma; sometimes presents as a primary disease.

• Ultrasound Presentation:

  • Appears as solid hypoechoic lesions.

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Wilm's Tumour

• Also Known As: Nephroblastoma.

• Demographics: Most common cancer in children, typically affects those aged 3-4 years; less common after age 5.

• Clinical Presentation:

  • Symptoms include constipation, abdominal pain, swelling, nausea, vomiting, fever, and loss of appetite.

• Ultrasound Presentation:

  • Large solitary, predominantly solid and echogenic mass.

  • May contain cystic areas, forming a multi-loculated mass.

  • Can be detected in utero.

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Renal Metastases

• Definition: Most common renal metastases arise from carcinomas originating from various sites including lung, colorectal, ENT, breast, soft tissue, and thyroid cancers.

• Clinical Presentation:

  • Flank pain

  • Haematuria

  • Weight loss

• Ultrasound Presentation:

  • Variable imaging characteristics depending on primary source of metastases.

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Review Questions

• Describe using sonographic terminology pathologies mentioned in this lecture as well as differential diagnoses.

• Given a solid hypoechoic lesion within the left kidney with internal vascular flow on color Doppler, what are the differential diagnoses?

• Given a solid lesion within the calyx with internal colour Doppler flow, what would be the provisional diagnosis?