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A 65-year-old male presents with left flank pain for 4 months and a palpable left-sided abdominal mass. An elevated hemoglobin level is noted alongside a normal white cell count but elevated CRP. What is the MOST appropriate initial differential diagnosis to consider?
A 65-year-old male presents with left flank pain for 4 months and a palpable left-sided abdominal mass. An elevated hemoglobin level is noted alongside a normal white cell count but elevated CRP. What is the MOST appropriate initial differential diagnosis to consider?
- Ureteric Mass
- Adrenal Mass
- Renal Mass (correct)
- Splenomegaly
What laboratory finding would MOST strongly suggest infection as a significant component of a renal or colonic mass?
What laboratory finding would MOST strongly suggest infection as a significant component of a renal or colonic mass?
- Elevated Hemoglobin
- Decreased Hemoglobin
- Normal White Cell Count
- Elevated CRP (correct)
Which imaging modality is MOST suitable as an initial diagnostic step for evaluating a left-sided abdominal mass suspected to be of renal origin?
Which imaging modality is MOST suitable as an initial diagnostic step for evaluating a left-sided abdominal mass suspected to be of renal origin?
- Barium Enema
- Ultrasound Abdomen (correct)
- Abdominal X-ray
- MRI of Abdomen
An ultrasound reveals an 8cm mass on the left kidney. Which of the following is LEAST likely to be included in the differential diagnosis based solely on this finding?
An ultrasound reveals an 8cm mass on the left kidney. Which of the following is LEAST likely to be included in the differential diagnosis based solely on this finding?
Following the discovery of an 8cm renal mass, which of the following investigations would provide the MOST information for diagnosis and staging?
Following the discovery of an 8cm renal mass, which of the following investigations would provide the MOST information for diagnosis and staging?
A CT scan reveals a hypodense mass in the left kidney. In the context of evaluating renal masses, what does 'hypodense' MOST likely indicate?
A CT scan reveals a hypodense mass in the left kidney. In the context of evaluating renal masses, what does 'hypodense' MOST likely indicate?
In which of the following scenarios would a biopsy of a renal mass be MOST warranted, despite CT features suggestive of malignancy?
In which of the following scenarios would a biopsy of a renal mass be MOST warranted, despite CT features suggestive of malignancy?
What is the MOST likely diagnosis for a renal mass in a 65-year-old male presenting with flank pain and microscopic hematuria?
What is the MOST likely diagnosis for a renal mass in a 65-year-old male presenting with flank pain and microscopic hematuria?
What is the MOST common subtype of renal parenchymal carcinoma?
What is the MOST common subtype of renal parenchymal carcinoma?
Which genetic condition is MOST closely associated with the development of renal cell carcinoma?
Which genetic condition is MOST closely associated with the development of renal cell carcinoma?
What is the standard first-line treatment for localized renal parenchymal cell carcinoma?
What is the standard first-line treatment for localized renal parenchymal cell carcinoma?
What cell type is the MOST common origin of renal parenchymal cell carcinoma?
What cell type is the MOST common origin of renal parenchymal cell carcinoma?
Which of the following paraneoplastic syndromes is MOST commonly associated with renal cell carcinoma??
Which of the following paraneoplastic syndromes is MOST commonly associated with renal cell carcinoma??
A 56-year-old male presents with hematuria on two separate occasions but is otherwise well. What is the MOST crucial initial step in evaluating his hematuria?
A 56-year-old male presents with hematuria on two separate occasions but is otherwise well. What is the MOST crucial initial step in evaluating his hematuria?
Which of the following is a renal cause of hematuria that involves the glomeruli?
Which of the following is a renal cause of hematuria that involves the glomeruli?
A patient presents with hematuria, and cystoscopy reveals a papillary tumor in the bladder. What statement BEST reflects the expected likelihood of malignancy in such tumors?
A patient presents with hematuria, and cystoscopy reveals a papillary tumor in the bladder. What statement BEST reflects the expected likelihood of malignancy in such tumors?
Which of the following is LEAST likely to lead to bladder cancer?
Which of the following is LEAST likely to lead to bladder cancer?
A patient has bladder cancer staged as T3b. According to the TNM staging system, what does the 'T' refer to in this context?
A patient has bladder cancer staged as T3b. According to the TNM staging system, what does the 'T' refer to in this context?
What is the MOST appropriate management strategy for carcinoma in situ (CIS) of the bladder?
What is the MOST appropriate management strategy for carcinoma in situ (CIS) of the bladder?
A 43-year-old male presents with sudden onset of severe colicky left loin pain. What diagnostic test is MOST appropriate to initially distinguish between renal colic and other potential causes of abdominal pain?
A 43-year-old male presents with sudden onset of severe colicky left loin pain. What diagnostic test is MOST appropriate to initially distinguish between renal colic and other potential causes of abdominal pain?
Which type of urinary stone is LEAST likely to be visible on standard abdominal X-ray (plain film)?
Which type of urinary stone is LEAST likely to be visible on standard abdominal X-ray (plain film)?
A patient is diagnosed with a Proteus UTI and subsequently develops triple stones. What best describes the mechanism connecting these two events?
A patient is diagnosed with a Proteus UTI and subsequently develops triple stones. What best describes the mechanism connecting these two events?
Which of the following is LEAST likely to directly cause renal colic?
Which of the following is LEAST likely to directly cause renal colic?
What sequence of events is MOST likely to cause Pyelonephritis?
What sequence of events is MOST likely to cause Pyelonephritis?
A patient with a history of recurrent kidney stones develops a stricture of the ureter. What long-term complications are MOST directly associated with ureteral stricture?
A patient with a history of recurrent kidney stones develops a stricture of the ureter. What long-term complications are MOST directly associated with ureteral stricture?
For a 65-year-old male presenting with left flank pain, microscopic hematuria, and a left-sided abdominal mass, if further paraneoplastic workup is done, what blood result is most likely?
For a 65-year-old male presenting with left flank pain, microscopic hematuria, and a left-sided abdominal mass, if further paraneoplastic workup is done, what blood result is most likely?
Given a CT scan showing an 8cm hypodense mass on the left kidney, in a patient with no other relevant history, which is MOST warranted for further investigation?
Given a CT scan showing an 8cm hypodense mass on the left kidney, in a patient with no other relevant history, which is MOST warranted for further investigation?
A 56 year old male presents with haematuria on two occasions, what follow up procedure is MOST appropriate?
A 56 year old male presents with haematuria on two occasions, what follow up procedure is MOST appropriate?
Which of the following is LEAST correlated with increased risk of bladder cancer?
Which of the following is LEAST correlated with increased risk of bladder cancer?
Which of the following is BEST for treating Carcinoma in Situ (CIS) of the bladder?
Which of the following is BEST for treating Carcinoma in Situ (CIS) of the bladder?
Flashcards
Flank Pain
Flank Pain
Pain in the side of the body between the abdomen and the back, often associated with kidney issues.
Haematuria
Haematuria
The presence of blood in the urine.
Differential Diagnosis of Flank Pain
Differential Diagnosis of Flank Pain
Renal Mass, Colonic Mass, Adrenal Mass, Ureteric Mass, Splenomegaly.
Renal Mass
Renal Mass
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Colonic Mass
Colonic Mass
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Adrenal Mass
Adrenal Mass
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Ureteric Mass
Ureteric Mass
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Splenomegaly
Splenomegaly
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Elevated Hb (Hemoglobin)
Elevated Hb (Hemoglobin)
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Elevated CRP (C-Reactive Protein)
Elevated CRP (C-Reactive Protein)
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Differential Diagnosis of a Kidney Mass
Differential Diagnosis of a Kidney Mass
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Tumour (Kidney)
Tumour (Kidney)
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Abcess (Kidney)
Abcess (Kidney)
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Further Investigation of Kidney Abnormality
Further Investigation of Kidney Abnormality
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Renal Tumour
Renal Tumour
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Types of Renal Cell Carcinoma
Types of Renal Cell Carcinoma
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Aetiology of Renal Cell Carcinoma
Aetiology of Renal Cell Carcinoma
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What Cell Types Cause Carcinoma?
What Cell Types Cause Carcinoma?
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Learning Outcomes
Learning Outcomes
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Differential of Haematuria
Differential of Haematuria
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Renal Causes of Haematuria
Renal Causes of Haematuria
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Non-Renal Causes of Haematuria
Non-Renal Causes of Haematuria
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Types of Bladder Carcinoma
Types of Bladder Carcinoma
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Investigations of Haematuria
Investigations of Haematuria
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PC of Bladder Carcinomas
PC of Bladder Carcinomas
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Urinalysis For Blood
Urinalysis For Blood
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Tests to Distinguish.
Tests to Distinguish.
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What are the Types of Urinary Stones
What are the Types of Urinary Stones
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Causes of Types of Urinary Stones
Causes of Types of Urinary Stones
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Complications of Urinary Stones
Complications of Urinary Stones
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Study Notes
Pathology CPC
- Pathology CPC covers flank pain and haematuria.
Case A: Male 65
- Presents with left flank pain for 4 months and a left sided abdominal mass.
- Vitals are stable and he was previously well with no radiation.
Differential Diagnosis for Flank Pain
- The differential diagnosis includes renal mass, colonic mass, adrenal mass, ureteric mass, and splenomegaly.
Laboratory Investigations
- Hb: 17 g/dL
- CRP: 40
- WCC: Normal
Significance of Lab Results
Other Investigations
- Other investigations are classified into laboratory, diagnostic imaging, and organ/site-specific categories.
Abdominal Imaging
- This can be achieved with an ultrasound of the abdomen and/or a CT scan.
- Ultrasound reveals an 8cm mass in the left kidney, appearing iso- to hypoechoic and arising from the lower pole.
Differential Diagnosis of Kidney Mass
- Kidney mass differentials are tumors (benign/malignant) and abscesses.
- Tumors are primary (carcinoma, sarcoma, lymphoma) or secondary (carcinoma, sarcoma, melanoma, other).
Renal Tumor Diagnosis
- Renal tumor is the most likely diagnosis in this age group.
Further Action if mass is renal
- A CT scan should be the next course of action
- Angiography may also be required
CT Scan Findings
- May reveal a hypodense mass
Biopsy
- Biopsies aren't always needed due to pathognomonic features on CT scans.
- Biopsies may be done where there's a solitary kidney or when the patient is suitable for partial nephrectomy.
Differential Diagnosis of Renal Mass
- This includes carcinoma, lymphoma, sarcoma, metastasis, and benign tumors.
- Carcinomas originate from kidney tubules or urothelium in the renal pelvis.
- Benign tumors include angiomyolipomas (associated with Tuberous Sclerosis), oncocytoma, and adenoma.
Carcinoma types
- Clear cell carcinoma
- Papillary carcinoma
- Collecting duct carcinoma
- Chromosomal associated carcinoma
- Chromophobe carcinoma
Aetiology of Renal Cell Carcinoma
- Genetic factors like Von Hippel Lindau Syndrome and chromosomal translocations
- Polycystic disease
- Cystic disease related to dialysis
- Smoking
- Other translocations
Treatment of Renal Parenchyma Cell Carcinoma
- Main treatment is nephrectomy
- Chemotherapy may be used
Renal Cell Carcinoma
- Originates from the renal tubule.
- Urothelial carcinoma is another type, arising from the renal pelvis.
Prognosis of Renal Cell Carcinoma
- The prognosis depends on stage, grade, and type.
- A kidney-confined tumor has a 70% 5-year survival rate.
- Renal vein involvement decreases the 5-year survival rate to 15%.
Paraneoplastic Effects
- Can be seen in renal carcinoma, including polycythaemia, hypercalcaemia, and hypertension (P.U.O.).
Summary
- Key aspects of renal carcinoma concern presentation, aetiology, prognosis, and management.
Case B: Male 56
- Presents with overview of haematuria
- Presents with haematuria on two occasions and is otherwise well
Differential for Haematuria
- Divided into renal, post-renal, and general/systemic causes.
Renal Causes of Hematuria
- Tumors which can be benign or malignant
- Glomerulonephritis
- Calculi
- Pyelonephritis
- Trauma
- Infarction
Non-Renal Causes of Hematuria
- Tumors in the urinary tract specifically bladder, ureter and urethra
- Urothelial Cancer, squamous cell cancer & adeno carcinomas
- Stones
- Infections like cystitis
- Side effect of anticoagulant treatment
Investigations for Haematuria
- Classification of investigations are laboratory, diagnostic imaging, and organ/site-specific.
Further Tests
- Ultra sound of kidney
- Cystoscopy and Biopsy of bladder lesion if present
- IVP (intravenous pyelogram) uncommonly used
Evaluation of bladder
- Cystoscopy revealed a papillary tumor in the bladder.
- Resection of bladder specimen
Bladder Tumors
- Benign tumors and malignant tumors both exist but malignant tumors are more common
- Papilloma as well as papillary urothelial carcinoma. high grade
Types of Bladder Carcinoma
- Urothelial Ca (Transitional cell)
- Squamous Ca with Schistosomiasis and calculi (metaplasia)
- Adenocarcinoma in urachal remnant, (Very rare) and colo/recto-vesical fistulae (also metaplasia)
- Very occasional e.g. metastases
Other Bladder Neoplasms
- Sarcoma
- Lymphoma
- Rare
Presentation of Bladder Carcinomas
- Primary carcinoma symptoms and complications – Haematuria, dysuria, urgency, hydro ureter due to obstruction of ureter, hydronephrosis – due to obstruction of renal pelvis, and ureteric outflow obstruction
Prognosis of Bladder Carcinoma
- Prognosis is determined by type, grade, and stage
- 'T' refers to level of invasion through the bladder
Management of Urothelial/TCC Bladder
- Excision of Ca if early, radical cystectomy for muscle invasive carcinoma or Treatment of Carcinoma in Situ - BCG
Aetiology of Bladder Cancer
- Aetiology include: Smoking, Aniline Dye, Stones, Chronic inflammation and Schistosomiasis
Haematuria
- It has many causes and Could be from Kidney, Bladder, Ureter or Urethra
- Imaging is needed to find the cause
- Side effects of Anticoagulation therapies eg. Warfarin and Heparin
Case C: Male 43
- Presents withSevere colicky left loin pain that onset very suddenly and was extremely severe
- Was never unwell before
Differential Diagnosis
- Renal Colic , GIT obstruction and/or Gallstone colic
Other Causes of Renal Colic
- Can be causes from obstruction from tumors
- Potential Trauma – Blood clot in ureter or glomerular causes of haematuria
Initial Test for Abdominal Pain
- Urinalysis is a routine test for blood during clinical examinations, GP surgery, bedside assessment and OPD
Types of Urinary Stones
- Calcium Oxalate 80%, -Triple (Staghorn, MG, Ammonium, 15% Phosphate), Uric Acid, and Cystinuria / Oxalosis
Causes of Urinary Stones
- Causes vary by stone type like Calcium/Oxalate Stones, Triple Stones, Uric Acid Stones, etc and are often caused by UTI's especially Proteus that breaks down urea which increases with Alkaline urine and → precipitation of salts
Complications of Urinary Stones
- Obstructed ureter from Hydro ureter, Hydronephrosis and/or Pyelonephritis
- Stricture of the Ureter and Recurrent stones
Pyelonephritis
Learning outcomes
- Summarise the clinical and pathological features of renal cell carcinoma
- List the differential diagnosis
- Explain the prognosis of renal cell carcinoma with reference to grade and stage
- Classify renal calculi
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