Renal Tumors — MCQs
Which of the following statements about hypernephroma is true?
A patient presents with headache, confusion, and a diagnosis of a brain tumor. The family history reveals brain and kidney tumors. What is the most likely diagnosis?
Renal cell carcinoma is characterized by which of the following histopathological features?
Clear cell variety of renal cell carcinoma is related to a gene located on which chromosome?
Which of the following is not part of the classical triad of renal cell carcinoma?
On USG, a mass was found in the abdomen which was displacing the kidney laterally in a 1-year-old child. What is the most likely diagnosis?
Most common presentation of Wilms' tumor?
Investigation of choice for confirming Henoch Schönlein Purpura is
Most common type of renal carcinoma is:
All of the following are true about xanthogranulomatous pyelonephritis except which of the following?
Renal Tumors Indian Medical PG Practice Questions and MCQs
Question 1: Which of the following statements about hypernephroma is true?
- A. May present with rapidly developing varicocele
- B. Usually an adenocarcinoma
- C. Not radiosensitive (Correct Answer)
- D. Arises from the cortex, usually from a pre-existing adenoma
Explanation: ***Radiosensitive*** - Hypernephroma, or renal cell carcinoma, is typically resistant to **radiation therapy**, making this statement false. - It is generally treated with **surgery** and targeted therapies rather than radiation. *Usually adenocarcinoma* - Hypernephroma is indeed a type of **adenocarcinoma**, as it originates from the renal tubular epithelium [1]. - It is the most common form of **kidney cancer**, supporting this as a true statement. *May present with rapidly developing varicocele* - Rapidly developing **varicocele** can occur due to **renal vein obstruction** associated with renal tumors [2], so this statement is true. - Varicocele is a recognized clinical feature in renal cell carcinoma due to its anatomical relationships. *Arise from cortex usually from pre existing adenoma* - Hypernephroma does arise from the **renal cortex**, often from pre-existing renal adenomas or other lesions. - This establishes its origin, making the statement accurate. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Kidney, pp. 959-961. [2] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Diseases Of The Urinary And Male Genital Tracts, pp. 492-493.
Question 2: A patient presents with headache, confusion, and a diagnosis of a brain tumor. The family history reveals brain and kidney tumors. What is the most likely diagnosis?
- A. Neurofibromatosis
- B. Li-Fraumeni syndrome
- C. VHL syndrome (Correct Answer)
- D. Churg-Strauss syndrome
Explanation: ***VHL syndrome*** - **Von Hippel-Lindau (VHL) syndrome** is an inherited disorder characterized by the growth of tumors and cysts in various parts of the body, including the **brain (hemangioblastomas)** and **kidneys (renal cell carcinoma)**. - The presentation of a brain tumor, kidney tumors, and a positive family history for both organs strongly points to VHL syndrome. *Neurofibromatosis* - **Neurofibromatosis (NF)** typically presents with **cafe-au-lait spots**, neurofibromas, optic gliomas, and Lisch nodules. - While it involves brain tumors, kidney tumors are not a primary feature of NF. *Li-Fraumeni syndrome* - **Li-Fraumeni syndrome** is associated with an increased risk of various cancers, including **sarcomas**, **breast cancer**, **adrenocortical carcinomas**, and **leukemia**. - While brain tumors can occur, the specific combination of brain and kidney tumors with a clear family history is less characteristic of Li-Fraumeni than VHL syndrome. *Churg-Strauss syndrome* - **Churg-Strauss syndrome (Eosinophilic Granulomatosis with Polyangiitis)** is a systemic vasculitis characterized by **asthma**, **eosinophilia**, and **granulomatous inflammation**. - It does not involve the development of brain or kidney tumors.
Question 3: Renal cell carcinoma is characterized by which of the following histopathological features?
- A. Clear cell morphology with abundant cytoplasm (Correct Answer)
- B. Nested/alveolar growth pattern
- C. High nuclear grade with prominent nucleoli
- D. Rich capillary network
Explanation: ***Invades Renal Vein*** - **Renal cell carcinoma** is known for **venous invasion**, particularly involving the renal vein, which can lead to **thrombus formation** [1][2]. - This feature is significant for staging and prognosis, often indicating **advanced disease** [2]. *Hematuria usually absent* - **Hematuria** is often present in renal cell carcinoma, contrary to this assertion. - The presence of **blood in urine** is a common symptom that can raise suspicion for malignancy. *Arises from proximal convoluted tubule* - While renal cell carcinoma originates from the **epithelial cells**, it primarily arises from the **proximal tubule**, but this option lacks the specificity related to its histopathology. - More accurately, the clear cell type is the most common variant associated with this tumor [1]. *More common in females* - Renal cell carcinoma is actually more prevalent in **males**, contradicting this statement. - The male-to-female ratio is approximately **2:1**, making it less common in females. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Kidney, pp. 959-961. [2] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Diseases Of The Urinary And Male Genital Tracts, pp. 492-493.
Question 4: Clear cell variety of renal cell carcinoma is related to a gene located on which chromosome?
- A. X
- B. 22
- C. 20
- D. 3 (Correct Answer)
Explanation: ***3*** - The **clear cell variety of renal cell carcinoma** (RCC) is associated with **mutations in the VHL gene**, which is located on chromosome **3** [1]. - This gene plays a crucial role in the **regulation of angiogenesis**, and its inactivation leads to tumor development. *22* - Chromosome **22** is associated with other disorders but not specifically with clear cell RCC or its genetic mutations. - Renal cell carcinoma primarily relates to **chromosome 3**, not chromosome 22 [1]. *X* - The **X chromosome** has other oncogenes and tumor suppressor genes but is not linked to clear cell RCC specifically. - Mutations in the **VHL gene** on chromosome 3 are the key factors, not those found on the X chromosome. *20* - Chromosome **20** does not contain significant genes linked to clear cell renal cell carcinoma. - The notable genetic association is with chromosome **3**, specifically the VHL gene [1]. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Kidney, pp. 958-959.
Question 5: Which of the following is not part of the classical triad of renal cell carcinoma?
- A. Loin Mass
- B. Hematuria
- C. Loin Pain
- D. Oliguria (Correct Answer)
Explanation: ***Oliguria*** - **Oliguria** (decreased urine output) is not considered part of the classical triad for renal cell carcinoma. - It usually indicates significant **renal dysfunction** or **obstruction**, which might occur in advanced stages or with complications, but not always as an initial presenting symptom. *Loin Mass* - A **palpable abdominal or flank mass** is one of the key components of the classical triad, indicating a larger, more advanced tumor. - This symptom often suggests that the tumor has grown significantly to be detectable by physical exam or patient sensation. *Hematuria* - **Hematuria** (blood in the urine), often macroscopic and painless, is a common and important early symptom of renal cell carcinoma. - It results from the tumor invading the **collecting system** of the kidney, causing bleeding. *Loin Pain* - **Loin pain** (flank pain) is another component of the classical triad, often caused by tumor growth stretching the **renal capsule** or invading adjacent structures. - The pain can be dull, aching, or more severe if there is acute bleeding or obstruction.
Question 6: On USG, a mass was found in the abdomen which was displacing the kidney laterally in a 1-year-old child. What is the most likely diagnosis?
- A. Neuroblastoma (Correct Answer)
- B. Wilms' tumor
- C. Renal cell carcinoma
- D. All of the options
Explanation: ***Neuroblastoma*** - A retroperitoneal mass displacing the kidney laterally in an infant is highly characteristic of **neuroblastoma**, which originates from neural crest cells in the adrenal gland or sympathetic ganglia. - The key finding is **extrarenal origin** - the mass pushes the kidney aside rather than arising from within it. - Most common extrarenal abdominal mass in children under 2 years. *Wilms' tumor* - This is an **intrarenal mass** that originates within the kidney parenchyma. - Wilms' tumor **expands and distorts the kidney** rather than displacing it laterally from outside. - Most common renal tumor in children (peak age 3-4 years), presenting with abdominal mass, hematuria, and hypertension. *Renal cell carcinoma* - Exceedingly **rare in a 1-year-old child** - primarily an adult malignancy (typically >40 years). - Would be an intrarenal mass, not an extrarenal mass displacing the kidney laterally. *All of the options* - Incorrect because the specific imaging finding of **lateral kidney displacement** indicates an extrarenal origin, which is pathognomonic for neuroblastoma, not the intrarenal tumors listed.
Question 7: Most common presentation of Wilms' tumor?
- A. Asymptomatic abdominal mass (Correct Answer)
- B. Abdominal pain
- C. Headache
- D. Hematuria
Explanation: ***Asymptomatic abdominal mass*** - **Wilms' tumor** is often discovered incidentally during routine examination or when a parent notices an **enlarged abdomen** or a lump. - The tumor can grow quite large before causing any noticeable symptoms beyond the mass itself, indicating its **asymptomatic nature** initially. *Abdominal pain* - While some children with Wilms' tumor may experience abdominal pain, it is less common as the primary presenting symptom compared to the discovery of a visible or palpable **mass**. - Pain usually occurs if the tumor is particularly large, ruptures, or causes secondary complications like **bowel obstruction**. *Headache* - Headache is **not a typical presenting symptom** of Wilms' tumor, as it is a renal tumor and does not directly affect the central nervous system in its early stages. - Headaches might rarely occur in very advanced cases with **metastatic disease** to the brain, but this is not the most common initial presentation. *Hematuria* - Microscopic or gross **hematuria** can occur in children with Wilms' tumor due to irritation or invasion of the renal collecting system. - However, it is reported in a minority of cases (around 20-30%) and is **less frequent** as the initial primary complaint compared to the discovery of an abdominal mass.
Question 8: Investigation of choice for confirming Henoch Schönlein Purpura is
- A. Serum IgA levels
- B. CRP levels
- C. DTPA
- D. Renal Biopsy (Correct Answer)
Explanation: ***Renal Biopsy*** - **Biopsy (renal or skin)** showing **IgA deposition** is the **confirmatory investigation** for Henoch-Schönlein Purpura (HSP) when histological confirmation is needed [1]. - **Renal biopsy** demonstrates characteristic **IgA-dominant immune deposits** in the mesangium and glomerular capillaries, along with **mesangial proliferation** [1]. - While HSP is primarily a **clinical diagnosis** based on palpable purpura, age < 20 years, abdominal pain, and renal involvement, biopsy provides **definitive confirmation** in atypical presentations or when diagnosis is uncertain. - Immunofluorescence showing **IgA deposition** is the pathognomonic finding [1]. *Serum IgA levels* - Serum IgA levels may be elevated in approximately **50% of HSP cases**, but this is **neither sensitive nor specific**. - **Normal serum IgA does NOT exclude HSP**, making it unreliable as a confirmatory test. - Elevated IgA can occur in many other conditions (IgA nephropathy without vasculitis, liver disease, infections). - Provides only supportive evidence, not confirmation. *CRP levels* - **C-reactive protein (CRP)** is a **non-specific inflammatory marker** that may be elevated in HSP. - Cannot distinguish HSP from other inflammatory or infectious conditions. - Has no role in confirming the diagnosis. *DTPA* - **DTPA scan** assesses **renal perfusion and function** but does not provide diagnostic information about the underlying pathology. - Cannot detect the characteristic **IgA-mediated vasculitis** of HSP. - Not useful for confirming the diagnosis. **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Diseases Of The Urinary And Male Genital Tracts, pp. 526-527.
Question 9: Most common type of renal carcinoma is:
- A. Clear cell type (Correct Answer)
- B. Chromophobe type
- C. Papillary type
- D. Collecting duct type
Explanation: ***Clear cell type*** - The **clear cell type** is the most common subtype of renal carcinoma, constituting about **70-80%** of cases [3]. - It is typically associated with **von Hippel-Lindau syndrome** and presents with clear or "foamy" cells due to lipid accumulation [3]. *Chromophobe type* - This type comprises about **5-10%** of renal cell carcinomas and usually has a better prognosis [1]. - Characterized by **pale cells with distinct cell borders** and lacks the common features of clear cell carcinoma [1]. *Tubular type* - The tubular variant is less common and does not represent a major subtype of renal cell carcinoma. - It is often confused with other variants but lacks the distinct characteristics of the clear cell type. *Papillary type* - The papillary type accounts for about **10-15%** of renal carcinomas and is characterized by papillary structures [2]. - This type generally has a distinct chromosomal mutation profile compared to the clear cell type [2]. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Kidney, p. 959. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Kidney, pp. 958-959. [3] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Kidney, pp. 959-961.
Question 10: All of the following are true about xanthogranulomatous pyelonephritis except which of the following?
- A. It is a form of chronic pyelonephritis
- B. Focal form is common in children
- C. Seen only in infancy (Correct Answer)
- D. Proteus mirabilis is the most common organism
Explanation: ***Seen only in infancy*** - Xanthogranulomatous pyelonephritis can occur in **adults** as well, not just in infancy, making this statement false [1]. - It is often associated with obstructive uropathy and chronic infection across various age groups. *Proteus is most common organism* - While **Proteus** species are commonly associated [1], the most frequent organism in xanthogranulomatous pyelonephritis can also include **E. coli**. - It reflects a polymicrobial infection rather than being limited to a single organism. *It is a form of chronic pyelonephritis* - Xanthogranulomatous pyelonephritis is indeed a variant of **chronic pyelonephritis**, characterized by extensive **granulomatous inflammation** [1]. - This chronic condition arises typically due to obstructive pathology leading to chronic infection. *Focal form is common in children* - The **focal form** is less common in children and is more frequently observed in **adults** with underlying conditions. - Children tend to present with a more diffuse form of **xanthogranulomatous pyelonephritis** when it occurs. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Kidney, pp. 939-940.
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