RENAL SYSTEMDr.Hafiz Muhammad Bilal Saleh

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%.

CASE 2

Carefully examine the given photomicrograph and answer the following questions:

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

2. Give the incidence rate of this lesion?3. Name the extra renal sites of this lesion?

ANSWERS

1. Wilm’s tumour (Nephroblastoma) 2. Incidence: 1 in 10,000 3. Mediastinum,testis,uterus,inguinal

canal,retroperitoneum.

CASE 4

What are the clinical presentations of Wilm’ Tumor ?

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

THANK YOU