Renal Neoplasms
Angiomyolipoma (AML) (aka Renal Hamartoma)
-Composed of fat, muscle, & blood vessels -Often seen in cortex -More common in WOMEN (40-60yrs) -More common on right side -Multiple and bilateral masses are associated with tuberous sclerosis in children
Renal Oncocytoma
-Consists of large epithileal cells -Originate from the intercalated cells of the renal collecting duct -More often in older men -Often mistaken for CA -Can also occur in parathyroid and thyroid gland -Size Varies (average size 7cm) -Patients are typically asymptomatic in the beginning- can have hematuria and pain, grow large and cause pain, prognosis after total of partial nephrectomy is excellent
AML on Ultrasound
-Focal, solid hyperechoic mass in the cortex -May have posterior enhancement -Solitary - nonhereditary -Multiple - tuberous sclerosis
Renal carcinoma (CA) clinical symptoms
-Hematuria -Palpable mass -Flank or abdominal pain -Can cause hypertension if tumor causes RA stenosis -Weight loss, leg edema, nausea & vomiting - 5 year survival rate ~50%
SCC of the Kidney on Ultrasound
-Large Mass in the Renal Pelvis --Often obstruction of Kidney Stones
TCC of the Bladder
-Majority of bladder tumors in adults are TCC (95%) -Not usually detected until advanced -More common in men -Symptoms: Hematuria, dysuria, urinary frequency/urgency -Could be primary to the bladder or mets from prostate, colon or uterine cancers -U/S very useful in detection -FOCAL NON-MOBILE WALL MASS OR FOCAL WALL THICKENING
Wilms' Tumor (Nephroblastoma)
-Most common abdominal malignancy in children & most common solid renal tumor in pediatric patients (1-8 years) -Peaks around age 2 to 3 (90% younger than 5 yrs, 70% younger than 3 yrs.)
Renal Adenoma
-Most common benign renal tumor -Made of tubular epithelial cells -Patient asymptomatic and usually found incidentally -Well defined, hyperechoic masses with calcifications in the renal cortex
Transitional Cell CA
-Most common tumor of collecting system/ renal pelvis. - Also frequently found in bladder -Often multiple masses -Men 2x more likely -Peak occurrence in 7th decade of life - May be flat or papillary -Most often seen as a hypoechoic mass within the collecting system.
Clinical Signs of AML
-Normal lab values -Usually an incidental finding -As many as 50% of patients with tuberous sclerosis will have AML
Adenocarcinoma of the Kidney
-Rare -Almost all patients will have a UTI and a stone (often staghorn calculus) -Hematuria -Poor prognosis
Squamous Cell Carcinoma (SCC) of the Kidney
-Rare -Highly invasive tumor with a poor prognosis -Can be caused by; Chronic Infections, Irritation, Stones, & Hematuria. -Often a palpable kidney secondary to severe hydronephrosis
Transitional Cell Cancer (TCC) of the Ureter
-Rare. -More common in men. -Typically found on lower 1/3 of ureter. -Best seen with retrograde pyelography
Benign Renal Tumors
*RARE -Adenoma -Angiomyolipomas -Lipoma -Oncocytoma
Symptoms of TCC of the Ureter
-Hematuria, dysuria, and pain
Renal Metastases
-Common finding at autopsy -Primarily from: Malignant melanoma, Lymphoma, Lung Cancer, Breast Cancer,Stomach/Colon cancer, cervix, pancreas
Renal Lipomas
-A well defined echogenic mass that is made up of fat -More common in females -Typically asymptomatic -Can cause hematuria
Renal Oncocytoma on Ultrasound
-Appear with a spokeswheel pattern of enhancement with a central scar -Can be variable in appearance but usually has a central scar
Renal Lymphoma
-Secondary process (primary is rare, 3%) -Usually from retroperitoneum -Usually bilateral invasion with multiple nodules -Kidneys are a common place for metastases from lymphoma. -Non-Hodgkins is more common than hodgkins -Appearance non specific: -Usually hypoechoic, enlargement of kidneys, may be no definite mass identified, poorly defined margins, can appear cystic but will not have posterior enhancement.
Renal CA ultrasound appearance
-Usually solid w/areas of hemorrhage and necrosis -Isoechoic or hyperechoic -RCC less than 2-3cm in diameter appears hyperechoic -May have hyperechoic rim ( vascular pseudocapsule on color Doppler) -The bigger the tumor the more heterogeneous echo texture - Can contain calcifications within -Hypervascular -Renal vein or IVC thrombosis -Will not meet simple cyst criteria -Will have thick irregular walls, septations, calcifications, etc.
Clincal signs of Wilms' Tumor (Nephroblastoma)
-Usually unilateral -90% have a palpable abdominal mass -Abdominal pain -Fever -Hematuria -Hypertension -Associated with Beckwith-Wiedemann Syndrome (14% of cases), sporatic aniridia (no color in eye), comphalocele, hemihypertrophy (one side of the body larger than other)
malignant tumors
-renal cell CA (RCC) -transitional cell CA (TCC) -renal lymphoma -wilms tumor (nephroblastoma) -squamous cell carcinoma -adenocarcinoma
Neuroblastoma
Adrenal Tumor -If the kidney is displaced inferiorly=adrenal tumor
Clinical Signs of Transitional Cell CA
Hematuria. Weight Loss. Fatigue. Fever. Flank pain.
Stage 4 Renal Cancer
Invasion of adjacent organs or distant metastases
Renal Cell CA
Look for IVC thrombus or invasion. Peripheral vascularity "basket sign"
Transitional Cell CA
Mass in renal pelvis with low level echoes. Not well defined. Low vascularity. Rarely calcifications. May invade adjacent renal tissue.
Renal Cell Carcinoma (RCC)
Most common of all renal tumors (85%) -2x greater incidence in males -usually occurs 60-70 yrs of age -can be multiple -most often unilateral -increased incidence in patients with von hippel-lindau disease, tuberous sclerosis, and those on long term dialysis
Nephroblastoma
Renal Tumor
Stage 1 Renal Cancer
Tumor confined within renal capsule
Stage 2 Renal Cancer
Tumor invasion of perinephric fat (still within Gerotas fascia)
Stage 3 Renal Cancer
Tumor involvement of regional lymph nodes or venous structures. (Renal vein, IVC)
Wilms' Tumor (Nephroblastoma) on Ultrasound
Tumor may spread beyond renal capsule, invade venous channels, or extend to IVC
2 COMMON types of renal cancer
renal cell carcinoma (RCC) transitional cell carcinoma (TCC)