Describe the different types of renal tumour?
Benign
Renal Pelvis Tumours
Renal Parynchema Tumours
Embryonic Tumours
Describe imaging of renal tumours?
Ultrasound
CT
MRI
How are the majority of renal tumours discovered?
Incidental Findings
Describe benign renal cysts?
Diagnosis?
How are they often found?
70% of benign asymptomatic renal lesions
Fluid filled lesion
They can be single or multiple cysts
Very common (1/10 people)
Ultrasound is the best way
Contrast CT
Often incidental finding
Describe Angiomyolipoma?
Diagnosis?
Risks/Side effects?
Benign
Composed of muscle, blood vessels and fat
Diagnosed using CT
Can haemorrhage and requires embolization
Describe Oncocytoma?
Diagnosis?
Treatment?
Benign - doesn’t metastases
Make up about 3-7% of renal tumours
CT shows central scar
Often there is nephrectomy due to size and also concern that is may be cancerous (very hard to differentiate)
Describe the classic presentation of a renal cell carcinoma?
How is this often found?
Loin Pain
Renal Mass
Haematuria
Often incidental finding
Renal Cell Carcinoma:
Men/Women?
Age?
More common in males
Peak age range about 65-75
Describe the types of renal cell carcinoma?
Adenocarcinoma of proximal convoluted tubule
Can be clear cell (most common) or papillary
Diagnosis of renal cell carcinoma?
Ultrasound
CT
Biopsy (High False Negative)
Describe the staging of Renal Cell Carcinoma?
Where does this metastases to?
Robson Staging
Bone, Brain, Lungs, Liver
Treatment of renal cell carcinoma?
Radical Nephrectomy
Partial Nephrectomy
Radiofrequency Ablation
Describe BXO?
Balanitis Xerotica Obliterans
Pre-malignant cutaneous lesions
There is white patches, fissuring, scaring, bleeding
Main cause tight foreskin in older men
Treated with circumcision
Describe squamous cell carcinoma in situ?
Erthyroplasia of Queyrat - if on the glans, prepuce or shaft
Bowen’s Disease - anywhere else on penis
Presents as red velvety patches
Needs differentiated from benign causes
What does this photo show?
BXO
What does this photo show?
Squamous Carcinoma in Situ (bowen’s disease of erythroplasia of Queyrat)
Describe presentation of squamous carcinoma of penis?
Often late presentation
Red raised area of penis
Foul smelling
Phimosis (Unable to retract foreskin)
Diagnosis of squamous cell carcinoma of the penis?
Biopsy
Ultrasound
MRI
Peak age incidence of squamous cell carcinoma of penis?
Common?
Role of HPV?
Role of circumcision?
80
Not that common
HPV 16 indicated
Circumcision is protective
Treatment of carcinoma of the penis?
Surgery for primary tumour
Radiotherapy
Describe the germ cell tumours of the testis?
How common are these?
Seminoma
Teratoma
ITGCN (Intra-tubular germ cell neoplasia)
Not that common
Describe presentation of testicular tumours?
Diagnosis?
Painless swelling of testis
Non tender
Diagnosis based on ultrasound and markers
Describe the markers in testicular tumours?
AFP - Alpha Feta Protein
HCG (Beta-HCG)
LDH
True or False:
AFP is always raised in pure seminoma
False
AFP is never raised in pure seminoma
Raised HCG suggests… (Which tumour)?
Teratoma
Describe the role of the markers POST surgery?
Can be used to see if the surgery has been sucessful
Treatment of testicular tumours?
Surgery (Orchidectomy)
Chemotherapy
Radiotherapy
Management of carcinoma in situ?
Radiotherapy
Management of Seminoma?
Radiotherapy
Chemotherapy
Management of Teratoma?
Surveillance
Chemotherapy