Clinical Quiz #1:


 

History:

A 16 years old boy known with tuberous sclerosis (TSC2) and followed because of epilepsy and bilateral renal cysts. According to the recent TSC guidelines for follow-up we performed an annual abdominal MRI. The first one showed bilateral multiple renal cysts, with a lesion of 21 mm in the right kidney lower pole, most probably angiomyolipoma. The following MRI one year later showed the known bilateral multiple renal cyst, however, an increase in diameter of the lesion in the right kidney with a max of 24 mm, also showing a fatpoor lesion making the the differential diagnosis between angiomyiolipoma and renal cel carcinoma difficult (Figure).

Clinical examination showed the known facial angiofibroma. No hypertension. Laboratory results showed a normal function.

Question: What should you do for the management of this patient?

Multiple choice:

  • Refer to the urologist for a partial nephrectomy
  • Refer to the urologist for a total nephrectomy
  • Perform complementary investigation for the staging of the renal carcinoma (blood test, CT thorax, ect…)
  • Perform a biopsy
  • Follow-up closely with ultrasound to evaluate the progression
  • Follow-up closely with abdominal MRI to evaluate the progression

 

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