Internal Medicine

0521779407-18 CUNY1086/Karliner 0 521 77940 7 June 13, 2007 8:1

Renal Masses and Tumors 1287

Type IV Cyst

■Solid enhancing elements associated with cystic elements

■Incidence of malignancy 70–100%

Solid Renal Masses

■Solid renal tumors should be presumed malignant until surgical

pathology demonstrates otherwise

■Percutaneous biopsy of solid renal neoplasms is rarely appropriate,

and should be limited to cases in which the renal lesion is suspected

to be a metastasis from another site. Consider formal urologic con-

sultation prior to such biopsy.

Solid Renal Tumors

Renal Pseudotumors

■Hypertrophied Column of Bertin

➣Functional renal parenchyma

➣Distinguished from renal neoplasm by functional radioisotope

study demonstrating normal uptake/excretion of tracer

Benign Neoplasm

■Oncocytoma (3–7% of solid renal tumors)

➣Note: 15–30% of oncocytomas may occur in conjunction with

Renal Cell CA

■Angiomyolipoma

■Fibroma

■Leiomyoma

■Juxtaglomerular tumors

■Hemangioma

■Lipoma

Primary Malignant Neoplasm

■Renal Cell Carcinoma (85% of solid renal neoplasms)

■Transitional Cell Carcinoma/Urothelial Carcinoma (8% of renal

malignancies)

■Sarcoma

Secondary Malignant Neoplasm

■Retroperitoneal sarcoma

■Pancreatic carcinoma, colon carcinoma (direct extension)

■Lung, breast, GI (hematogenous spread)

■Lymphoma, leukemia

management

■RCC is primarily a surgical disease

■Non-surgical treatments are of limited efficacy at present