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RENAL TUMORS

Peter S. Aznar, MD, FPSP, MHPE

Benign tumors:

• Renal papillary adenoma
• Renal fibroma or hamartoma
• Angiomyolipoma
• Oncocytoma

0 cm in diameter are considered early cancers .• Renal papillary adenoma – Small tumors measuring 0.5 mm in diameter – Tumors greater than 3.

0 cm – Found in the medulla .• Renal fibroma or hamartoma – Completely benign – Less than 1.

• Angiomyolipoma – Present in patients with tuberous sclerosis (25- 50%) .

0 cm – EM findings reveal eosinophilic epithelial cells packed within the mitochondria – Almost never metastasizes .• Oncocytoma – May be large up to 12.

Malignant tumors: • Wilms tumor • Renal Cell Carcinoma (RCC) • Transitional cell carcinoma .

Wilms tumor • Most common tumor in patients with ages 2-5 yrs old • Good survival rate (90%) • Malformation syndromes occur with chromosome 11p .

aniridia. WAGR (Wilms tumor. mental retardation) – a. nephropathy and renal failure . Wilms tumor Types: 1. involves deletion of chromosome 11p band 13 2. Denys Drash syndrome – Genetic abnormality is the dominant negative mutation in the WT-1 gene – patients present with gonadal dysgenesis. genital anomalies.

Beckwith-Wiedemann syndrome – involves deletion of chromosome 11 band p15. immature stroma and tubules – may be associated with anaplasia (5%) . Wilms tumor • 3.5 (WT-2 gene) – characterized histologically by blastema.

Renal Cell Carcinoma • Also known as Hypernephroma • 80 to 90% of malignant tumor of the kidney • 1 to 3% of all cancers • Predominantly occurs on the 6 to 7 decade of life • Presents as painless hematuria (90%) .

Renal Cell Carcinoma • Risk factors: – Cigarette smoking – Obesity – Hypertension – Unopposed estrogen therapy – Exposure to heavy metals .

Renal Cell Carcinoma • Appears as yellowish spherical masses (3-15 cm diameter) • von Hippel-Lindau (VHL) syndrome 50-70% develop RCC • inherited as autosomal dominant trait .

Renal Cell Carcinoma (RCC) • Major classification types: • Clear cell (70-80%) • Papillary carcinoma (10-15%) • Chromophobe renal carcinoma (5%) .

Renal Cell Carcinoma • Prognosis – 45% five year survival rate – 70% in the absence of metastasis .

Transitional Cell Carcinoma • 2% of all malignant tumors • Predominantly found in patients between the ages to 50 to 80 • Chromosome 9 and 17p deletion are implicated • Most important evaluation tool for prognostication is depth of invasion .

Transitional cell carcinoma • Otherwise known as urothelial tumors • 95% of all bladder tumors .

Transitional cell carcinoma • Epidemiology: – 80% of patients are between 50-80 yrs ol – cigarette smoking – schistosoma haematobium infections – cyclophosphamide – industrial exposure to arylamines (2- napthylamine) .

Prognosis .

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