Case 1: Mr KerenggaMr. 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 lifeand 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.
5. What is the commonest histopathological type?6. List the histopathological types associated with the lesion above.
Cell type Features Growth Pattern Cell of Origin CytogeneticsClear Cell Most common Acinar or Proximal tubule 3p-Carcinoma sarcomatoidChromophilic Bilateral, Papillary or Proximal tubule +7, +17, -Y Multifocal sarcomatoidChromophobic Indolent course Solid, tubular, or Cortical collecting Hypodiploid sarcomatoid ductOncocytic Rarely metastasize Tumor nests Cortical collecting Undetermined ductCollecting Duct Ca Very Aggrasive Papillary or Medullary Undetermined sarcomatoid collecting duct 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%]