renal system mod
Post on 07-Dec-2015
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CASE 1
A 37 years old male presented with back pain. CT scan reveals a mass in kidney with associated hematoma.
a) Give your diagnosis?b) Describe its two histological features?c) Name extra-renal sites of this lesion?d) With which disease, this tumour is most commonly associated?
ANSWERS
a) Angiomyolipoma
b) (1) bundles of atypical smooth muscle cells radiating from arteries (2) well formed mature fat cells admixed with the smooth muscle cells.
c) Liver, pelvis, retroperitoneum, chest, large bowel, nasal cavity and bone.
d) Tuberous sclerosis. 25-30%.
1. 1. Identify the lesion?2. 2. Give two points of
identification in favor of your diagnosis?
3. Name the histological types of this lesion?
ANSWERS 1. Renal cell carcinoma 2. (i) Neoplastic cells have clear cytoplasm
(ii) Neoplastic cells are arranged in nests with
intervening blood vessels 3. Clear cell carcinoma
Papillary carcinoma
Chromophobe renal carcinoma
Collecting duct (Bellini) carcinoma
CASE 3 A mother brought her 3 years old child to the clinic
with complaint of feeling of large abdominal mass during handling. The mass was resected surgically
1. Identify the given specimen and give your diagnosis
ANSWERS
1. Wilm’s tumour (Nephroblastoma) 2. Incidence: 1 in 10,000 3. Mediastinum,testis,uterus,inguinal
canal,retroperitoneum.
ANSWER 4
Asymptomatic abdominal mass ( 80 % ) Abdominal pain or hematuria ( 25 % ) UTI and varicocele ( Less common ) Hypertension, gross hematuria and fever( 5-
30%)
CASE 4
A 45 years old woman came in emergency with complaints of hematuria for three months and flank pain for 2 days on right side. On inquiry, she gave history of NSAIDS use for five years due to osteoarthritis. O/E, right kidney is palpable
1. What is your likely diagnosis? 2. How will you investigate her? 3. Write down three risk factors of this lesion?
ANSWERS 1.Urothelial tumor of renal pelvis 2. USG,IVP,Retrograde pyelography,CT scan 3.Smoking,cyclophosphamide,raditions,analgesics
CASE 5 A 40 years male, who is known case of CRF, came to
the dialysis unit for dialysis and gave H/O intermittent hematuria and diagnosed as having renal cell carcinoma (RCC)
1. Name 3 classical diagnostic clinical features of RCC 2. What paraneoplastic syndromes are associated with
RCC? 3. What is 5-year survival rate of patients with RCC? 4. What is the treatment of choice?
ANSWERS
1. Costovertebral pain, palpable mass, hematuria
2. Polycythemia, hypercalcemia, leukemoid reaction, amyloidosis, hypertension, hepatic dysfunction, Cushing syndrome, eosinophilia.
3. Nephrectomy
RENAL CYST
A fluid-filled sac arising from a dilatation in any part of the nephron or collecting duct
NONGENETIC
Acquired disorders 1. Simple renal cysts - solitary or multiple 2. Cysts of the renal sinus (lymphangiectasis) 3. Acquired cystic kidney disease (in patients
with chronic renal impairment) 4. Multilocular cyst (multilocular cystic
nephroma) 5. Hypokalemia-related cysts Developmental
disorders
GENETIC
Autosomal-dominant
1. Autosomal-dominant polycystic kidney
disease
2. Tuberous sclerosis complex
3. Von Hippel-Lindau disease
4. Medullary cystic disease
5. Glomerulocystic kidney disease
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