Wilm’s tumour

Renal cell ca= adenocarcima=Grawitz’s Carcioma of urinary bladder

=nephroblastoma
Chromosome 11 Occupation : naphthlamin
WAGR syndrome Aromatic amines
Associate
Wilm. Aniridia, Benzidine
d
Genitodeformity,retardation Smoking - gentic - irradiation
Stone -bilharzias- chronic cystitis
Incidence 10% of childhood Most common neoplasm of kidney 2nd commonest maligncy
Usually Unilateral Unilateral , bilateral 1-2 % TCC 90%
Pathology
Sq.c.c 8 %
Upper pole Upper pole Bladder base”Trigone” in T.c.c
Site
Infero-lateral wall in Sq.c.c
1-Direct 1-Direct 1-Direct
2-Blood (lung) 2- Lymphatic 2- Lymphatic
Spread
3-Lymphatic 3- Blood( lung… cannon ball) 3- Blood ( very late)
4-implantation
i-limited to kidney i-within renal capsule
ii-extend beyond kidney ii-outside capsule
Staging iii-residual tumour iii-renal vein, regional LN, I.V.C
iv-distant metastasis iv-adjacent organs
v-Bilateral tumour
1-Flank mass 1-Typical : hematuria Early : painless intermittent
2-pyrexia Pain hematuria ,Urgency ,frequency ,dys
3-Pain Mass uria
4-Hypertension 2-Atypical :Varicocele No signs ( diagnosed by cyctoscope)
5-hematuria Fever
C\P
6-wt loss,aniridia Para malignant syndrome: Late: anemia , wt loss, uremia
Hypercalcemia Sign: hard mass
Polycthemia
Amyloidosis
3-metastatic : hemoptysis
U\S, CT scan, IVU U\S, CT scan, IVU, renal angio KUB, U\S, IVU, ascending cystosop
Dx Cystosop for biopsy and visuallizatio

1-Nephrectomy 1-Renal sparing surgery See

Rx 2-Partial Nephrectomy
3-Palliative Rx
5Y survival rate is 80% <1Y
Prognosis
Bad if older children
2-Redical Nephrectomy
3-interferone alpha, IL-2
5Y survival rate is 65%

TNM T0= renal mass –ve for tumour

T1=A <5 cm ,,,, B 5-7 cm
T2=>7 Cm
T3=invading pelvic calycel system
T4=distant metasis
 T0 =insitu TURP,Cystoscopy, local installation of chemotherapy as BCG

TURP
T1 =basement mm”lamina propria” Csytoscopy progarme : check every 3 m 2y
6m 2y
12m 2y
T2 = T1+1st half of M.s layer TURP , Csytoscopy. Redical resection
Surgical if No metastasis
Partial cystectomy w safe margin + cystoscopy programe
Redical cystectomy then urinary diversion
=T2+ whole ms layer Male: remove bladder+distal ureter, prostate,Ln,seminal
T3
Female:bladder+distal urter+Uterus+fallopian +LN

Radiotherapy if no metastasis

Chemotherapy if metastasis

T4 A =spread to pericystic fat Palliative radiotherapy

B = spread to adjacent organs

N1 =LN below bifurication of common iliac @

N2 = Above

M0 = no metasis
M1 =metasis