mr. kerengga [cpc]

3

Case 1: Mr Kerengga Mr. Kerengga, 80 years old Male with 3 day history of gross hematuria. Haematuria associated with clots. Patient is has no known medical problems and is not taking any medication. Patient has a good quality of life and is able to care for himself. Classical Triad: Abdominal Pain, Haematuria and abdominal Mass. 1. What is your management during admission? 2. List the differential diagnoses? 3. What are the Investigations required for this patient to confirm the diagnosis? U/S: Size and Shape kidney, mass [solid / cystic], dilatation of renal pelvis or ureters. Flexible cystoscopy – inspect any growth in the bladder CT Scan 4. Describe the lesion seen and stage it from the CT Abdomen below.

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Page 1: Mr. Kerengga [CPC]

Case 1: Mr Kerengga Mr. Kerengga, 80 years old Male with 3 day history of gross hematuria. Haematuria associated with clots. Patient is has no known medical problems and is not taking any medication. Patient has a good quality of life and is able to care for himself. Classical Triad: Abdominal Pain, Haematuria and abdominal Mass.

1. What is your management during admission? 2. List the differential diagnoses? 3. What are the Investigations required for this patient to confirm the diagnosis?

U/S: Size and Shape kidney, mass [solid / cystic], dilatation of renal pelvis or ureters. Flexible cystoscopy – inspect any growth in the bladder CT Scan

4. Describe the lesion seen and stage it from the CT Abdomen below.

Page 2: Mr. Kerengga [CPC]

5. What is the commonest histopathological type?

6. List the histopathological types associated with the lesion above.

Page 3: Mr. Kerengga [CPC]

7. Descibe the common sign and symptoms associated with the above. [Renal Cell Ca] - Macroscopic Haematuria [40-60%], Flank Pain [40%], Abdominal mass [25%]: 10% pt yg ade 3-3 nie

8. What are the common paraneoplastic syndromes associated with this lesion? 9. What are the risk factors for this condition?

Age: 40-60 Gender: Men Smoking Obesity & A high caloric diet & Lack of exercise Occupational exposure: iro n steel, asbestos, cadmium

10. What are the common syndromes or genetic conditions associated with this lesion? Von Hippel-Lindau [VHL] – PCKD – Fam Hx of Renal Cell Ca

11. Describe the treatment options for this patient? Nephrectomy – n response

12. What is the prognosis for this patient? Stage 1 [90%], Stage 2 [85%], 3 [60%], 4 [10%]

Cell type Features Growth Pattern Cell of Origin Cytogenetics

Clear Cell Carcinoma

Most common Acinar or sarcomatoid

Proximal tubule 3p-

Chromophilic Bilateral, Multifocal

Papillary or sarcomatoid

Proximal tubule +7, +17, -Y

Chromophobic Indolent course Solid, tubular, or sarcomatoid

Cortical collecting duct

Hypodiploid

Oncocytic Rarely metastasize Tumor nests Cortical collecting duct

Undetermined

Collecting Duct Ca Very Aggrasive Papillary or sarcomatoid

Medullary collecting duct

Undetermined

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