UofT GU Oncology, 2004 CLINICAL CASES. UofT GU Oncology, 2004 73 y.o. female  Familiar history: Thyroid cancer (mother) Prostate cancer (father)  PMH:

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Presentation transcript:

UofT GU Oncology, 2004 CLINICAL CASES

UofT GU Oncology, 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

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 ( μmol/L)  U/A: Microscopic hematuria CLINICAL CASE 3

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