Clinical Quiz

A Testes Cancer Test

A 31-year-old man was found to have a 6 cm left testicular mass and underwent a left radical orchiectomy. Pathology demonstrates pT1 mixed non-seminomatous germ cell tumor. A staging computed tomography scan of the abdomen/pelvis and the CXR are unremarkable. His post-orchiectomy tumor markers are within normal limits.

A 25-Year-Old Woman with End-Stage Renal Disease, Low Platelet Count, and Skin Rash

A 25-year-old Caucasian woman with a past medical history of hypertension, systemic lupus erythematosus (SLE), s/p three spontaneous abortions, severe aortic stenosis, and mild pulmonary hypertension was transferred to our dialysis clinic from another outpatient dialysis center. She had been on dialysis for four years and undergone aortic valve replacement surgery two years previously. On…

Small Renal Masses and Drug-Eluting Stents — How to Best Balance the Risks?

A 55-year-old male with significant history of coronary artery disease is found to have an intraparenchymal 2 cm left-enhancing small renal mass (SRM) with a nephrometry score of 1+3+3+x+3=10x. The patient has undergone coronary artery stenting with drug-eluting stents (DES) two years previously and is currently on dual anti-platelet therapy with aspirin and clopidogrel.

66-Year-Old Woman with Acute-on-Chronic Renal Failure and Skin Rash

A 66-year-old Caucasian woman with the past medical histoty of diabetes mellitus, hypertension, ischemic heart disease with s/p myocardial infarction, and cerebrovascular accident (s/p TIA), was admitted to the hospital and transferred to the intensive care unit after she developed anuric acute renal failure. Percutaneous transluminal coronary angioplasty (PTCA) had been performed seven days prior…

High-Grade Urothelial Carcinoma Invading Lamina Propria

A 63-year-old otherwise healthy male is referred for evaluation of hematuria. A computed tomography urogram reveals a tumor on left lateral wall. The patient undergoes a transurethral resection of bladder tumor (TURBT) that demonstrates high-grade urothelial carcinoma with invasion of the lamina propria (T1). Muscularis propria is present and is uninvolved. Random bladder biopsies at…

Non-Visible Hematuria Ups Bladder Cancer Risk

More to Offer After Nephroureterectomy?

A 70-year-old man with stage 3 chronic kidney disease (glomerular filtration rate of 40 mL/min/1.73 m2) presents with gross hematuria. A magnetic resonance imaging scan reveals a large volume of tumor in the left kidney and the left ureter. There is no evidence of metastases or associated lymphadenopathy. Chest imaging is unremarkable. A MAG-3 renal…

Cavitary Lesions in a 41-Year-Old Man

A 41-year-old Venezuelan man with no past medical history was admitted last October for cough productive of blood-tinged sputum, fevers, weight loss of 25 lbs. during the previous three weeks. He was found to have acute renal failure, with a creatinine level of 3.59 mg/dL, active urinary sediment with many dysmorphic red blood cells (RBCs),…

Renal Failure Clusters in Families

Failed Kidney Transplant in a 31-Year-Old Woman

A 31-year-old woman with a history of renal failure of unknown origin presents for transplant waitlist work-up after a failed kidney transplant one year previously. She had been on hemodialysis from 2000 to 2005. She had undergone cadaver kidney transplantation in 2005 and the graft worked very well until 2010. No rejection, delayed graft function…

Does Past Pathology Predict Future Results?

A 59-year-old man with history of renal cell carcinoma (RCC) presents for urological oncological evaluation after a community urologist discovers a 5.5 cm enhancing renal mass with a nephrometry score of 2+1+3+p+1=7p in his right solitary kidney. He had undergone a left nephrectomy 14 years earlier that revealed a Grade II clear cell RCC. The…

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