UofT GU Oncology, 2004 CLINICAL CASES
UofT GU Oncology, 2004
CLINICAL CASES
UofT GU Oncology, 2004
73 y.o. female
Familiar history: Thyroid cancer (mother)Prostate cancer (father)
PMH: hypertension, diabetes mellitus, histerectomy
CLINICAL CASE 1
UofT GU Oncology, 2004
Abdominal US:incidental
finding of a left small renal mass
CLINICAL CASE 1
UofT GU Oncology, 2004
Abdominal CT
Left 2.5 cm renal mass
CLINICAL CASE 1
UofT GU Oncology, 2004
Would you propose other diagnostic tests ?
Abdominal MRI ?
PET-CT ?
Chest x-ray/CT scan ?
Percutaneous biopsy ?
CLINICAL CASE 1
UofT GU Oncology, 2004
Percutaneous biopsy
Path: oncocytoma
CLINICAL CASE 1
UofT GU Oncology, 2004
What would you do?
Partial nephrectomy ?
RFA/cryoablation ?
Follow-up with annual abdominal US ?
No follow-up ?
CLINICAL CASE 1
UofT GU Oncology, 2004
What did we do?
Follow-up with annual abdominal US
The renal mass is stable in size at 24 mos
follow-up
CLINICAL CASE 1
UofT GU Oncology, 2004
55 y.o. male
Smoker
Asymptomatic
Incidental finding of a renal mass at US for check-up
Clinical examination: unremarkable
FBC, Biochemistry, U/A: normal
CLINICAL CASE 2
UofT GU Oncology, 2004
UofT GU Oncology, 2004
UofT GU Oncology, 2004
UofT GU Oncology, 2004
UofT GU Oncology, 2004
UofT GU Oncology, 2004
Would you propose other diagnostic tests ?
Abdominal MRI ?
PET-CT ?
Chest x-ray/CT scan ?
Percutaneous biopsy ?
CLINICAL CASE 2
UofT GU Oncology, 2004
What would you do?
Radical nephrectomy? Partial nephrectomy ?
Open
Laparoscopic
Robot-assisted
RFA/cryoablation ? Active surveillance ?
CLINICAL CASE 2
UofT GU Oncology, 2004
What did we do?
Robot-assisted partial nephrectomy
Path: pT1a clear cell RCC Fuhrman III
CLINICAL CASE 2
UofT GU Oncology, 2004
53 y.o. male Non smoker Flank pain and hematuria Clinical examination: unremarkable FBC: mild anaemia (Hb=10.2 g/dL) BUN = 49 mg/dL Creatinine = 1.7 mg/dL (150.28 μmol/L) U/A: Microscopic hematuria
CLINICAL CASE 3
UofT GU Oncology, 2004
UofT GU Oncology, 2004
UofT GU Oncology, 2004
UofT GU Oncology, 2004
What would you do?
Bilateral partial nephrectomy (PN) ? Bilateral radical nephrectomy (RN) ? Right RN and concomitant left PN ? Right RN and staged left PN ? Left PN and staged right RN ? Right RN and left RFA/cryoblation ? Right RN and active surveillance of left tumor?
CLINICAL CASE 3
UofT GU Oncology, 2004
What did we do?
Left PN and staged right RN
Path: bilateral clear cell RCC, Fuhrman III right,
Fuhrman II left
CLINICAL CASE 3