Renal tumors

DR. Mohamed
Elgendy
Assistant lecturer of
urology
Assuit University
 Agenda

1. type of the film

2. finding in the film and How
to comment on the CT
3. Clinical picture
4. Treatment.
 1. type of the film
3 types of film
KUB: renal , ureteric , bladder stones and
Bladder extrophy.
IVU: BPH , HN, Congential anomlies.
Ct: bladder and renal tumours

Answer in case of renal Tumors

Msct abdomen with or without contrast
• Although intravenous pyelography was
often the first test that indicated a renal
mass in the past
• But due to The lack of sensitivity and
specificity of intravenous pyelography for
the detection of parenchyma tumors is
well documented.
• intravenous pyelography may miss small
anterior or posterior lesions that do not
distort the collecting system or the contour
of the kidney.
 it is noninvasive, accurate, and relatively
inexpensive Ultrasonography is reliable for
differentiation of solid tissue from fluid and
can establish the diagnosis of a simple renal
tumors.

A Mult-slice renal CT scan remains the

single most important radiographic test
for delineating the nature of a renal mass.
• The CT urogram is an excellent imaging choice to
evaluate the kidney, upper tract collecting system, and ureter.

• The CT urogram is highly sensitive and specific

for Renal tumors.

• Enhancement is proportionally to the vascularity

of the lesion. Enhanced renal mass is always
malignant.

• A renal mass in the kidney seen on CT urogram that

enhances more than 15 to 20 HU is most likely a renal cancer.
Value of MSCT in diagnosis of renal
tumor
• can diagnosis angiomyolipoma due to high fat
content
• Renal cysts classification
• CT features may prove useful in differentiating
RCC from benign renal tumors but
• Cannot differentiat RCC from benign renal
neoplasms, including oncocytoma and fat-poor
AML.
• Staging of renal tumors
The kidneys have a normal appearance in axial non contrast ct
Normal Coronal axis contract ct
Contrast enhanced CT scan through the kidneys in nephrogram phase
(showing corticomedullary differentiation). This is approximately 100
seconds following contrast administration and would show renal lesions
well.
A, Unenhanced CT scan shows solid, right posterior
renal
After administration of the contrast agent, CT scan shows that the mass
enhances more than 20 HU and is thus highly suggestive of RCC
CT scan shows somewhat thick-walled, complex left renal cyst also exhibiting
irregular calcification and moderate heterogeneity
CT scan shows complex left renal cystic lesion with thick, enhancing walls.
A: Transverse plain computed tomography (CT) image depicts lower pole right
renal mass (CT density: 35 HU) to the renal parenchyma;

B: Axial ct with contract showing heterogeneously enhancing (mean CT density: 60

HU). Heterogeneous contrast enhancement on imaging should always suggest renal
malignancy.
A: Axial plain image shows right heterogeneous right renal tumor
B: The tumor (arrowhead) enhances mainly in the periphery, with a mean computed
tomography density of 110 HU (compared to that of 40 HU on the unenhanced
images),
Coronal reformations clearly show venous invasion extending below the level of the
diaphragm
 3. Clinical picture

1. incidentally discover in 50 %
2. Total painless haematuria
3. urological presentation ; Classical triad palpable
abdominal mass , flank pain and haematuria is now
rarely found (too late)
4. Nonurological presenttion
• weight loss and cachixa and anemia
• Non reducting (non collapsing) 2ry varicoele due to
infileration of left renal vein (left side)
• Bilateral lower limb edema due to infilteration of
vena cava
• symptoms of metastasis as cough, bone pain
 3. Clinical picture

Para neoplastic syndromes due to hormonal

secretion by the tumor, these syndrome are reversible
after removal of the tumor
• HTN due to renin secretion
• Hyper calcemia due to parathyroid like substance
• polycythemia due to erythropoietin secretion
• stauffer syndrome ; non metastatic reversible
hepatic dysfunction (hepatitis).
• increase ESR and alkaline phosphatase
Treatment of renal tumours
Types of nephrectomy
Treatment of renal tumours

Types of nephrectomy
1. Radical nephrectomy= Remove the kidney
with its gerota"s fascia
2. Simple Nephrectomy Remove the kidney
without the gerota"s fascia as in Renal truma, stones, Doner
nephrectomy
3. Subcapsular nephrectomy =remove the
kidney without its capscule as in pyonephrosis
Treatment of renal tumours
Types of nephrectomy
4. Nephroureterectomy = Remove the kidney with the whole
ureter as in tcc of upper urinary tract
5. Patial nephrectomy (NSS) Remove part of the kidney as in
localized small renal tumour.
Treatment of renal tumours

TTT of renal tumour is surgical ttt as it is

chemoresistant
• localized rcc= Radical nephrectomy or NSS
• Locally advanced rcc = Debulking or
cytoreductive Nephrectomy
• Metastatic RCC = Palliative nephrectomy