RENAL NEOPLASIA

classification
• Benign
-Hamartoma
-oncocytoma
-Lipoma
• Malignant
-Renal Cell Carcinoma
(Adenocarcinoma of Kidney)
-Wilms Tumor
 1. ANGIOMYOLIPOMA
(RENAL HAMARTOMA)
• The benign renal tumours
• Often but not always associated with TUBEROUS SCLEROSIS
• Histologically,they are composed of fat cells,blood
vessels,and sheets of smooth muscle cells
• More common in women than men (4 :1)
• Often found incidentally
• Symptomatic presentation is most frequently with
spontaneous retroperitoneal hemorrhage;the risk of
bleeding is proporsional to the size of the lession (>4 cm
diameter)
• Other symptoms:flank pain,hematuria,hypertension,etc.
 2. RENAL CELL CARCINOMA
• Cancer arising from the lining of proximal
convulated tubule
• The most common type of kidney cancer
• Also known as Renal Adenocarcinoma or
Grawit’s Tumor
• Most lethal of all the genitourinary tumors
• Epidemiology
-More common in men than women (2 : 1)
- Blacks at an higher risk than whites
-Age > 40 years
• ETIOLOGY
-Ciggarette smoking
-Obesity
-Hypertension
-Family history of disease
-Patient with inherited disease like von
Hippel Lindau disease
-Analgetic
-Estrogen suplement
 CLASSIFICATION
• CLEAR CELL
• GRANULAR
• SARCOMATOID
• MIXED CELL (MOST COMMON AND MOST
AGGRESSIVE)
 SIGN AND SYMPTOMS
• Classic triad of : - Hematuria
- Flank pain
- Abdominal mass
Sign may include:
-Malaise,weight loss and anorexia
-Anemia
-Hypertension
-Hypercalcemia
-Polychytemia
-Febris
-Varicocele enlargement of testicle on left side
 PARANEOPLASTIC SYNDROME
• Stauffer’s syndrome Reversible hepatic dysfunction
• Hypercalcemia  osseous metastatic RCC lession apper to
elaborate substances that activated osteoclasts,causing release of
calcium from bone.The local secretion of prostaglandin by
metastatic RCC lessions has also been implicated in the elevated
serum calcium levels seen in these patient.PTH binds to the PTH
receptors in both bone and renal tissue.This binding leads to
increase bone resorpsion and decrease renal clearence of calcium
as well as increase phosphorus excretion
• Hypertension increased renin secretion
• Polycythemia In RCC EPO production occurs in the tumor cell
themselves
 DIAGNOSTIC
-History,Physical examination
-Laboratory studies
-Radiographic studies
=USG Excellent is distinguishing cystic from solid masses
=IVP  starting point for hematuria evaluation and
function of contralateral kidney
=CT SCAN Provides an excellent assessment of the
parenchyma and nodal status
=MRI excellent demonstration of solid renal masses and
is image test of choice to demonstrate extent of vena caval
involvement with tumor.Useful in patient with renal insufficiency.
 MANAGEMNET
• Surgery
-Radical nephrectomyRemoval of kidney
including Gerota’s fascia
-Nephron sparring partial nephrectomy
• Other modalities
-Radiotherapy >>radioresistant
-Chemotherapy
-Targeted molecular therapy
 2. WILM’S TUMOR
• Also known as Nephroblastoma,is the most
common solid renal solid renal tumor of
childhood,accounting for roughly 5 % of chilhood
cancers from blastema methanephric
• The peak age for presentation is during the third
year of life and there is no sex predilection
• In 10 % of cases the tumors are bilateral
 ETIOLOGY
• Wilm’s tumor occurs in familial and non familial forms
• The occurence of a familial wilm’s tumor shows deletions of
WT 1,located chromosome 11p13
• A second wilm’s tumor gene,WT2,has been identified on
chromosome 11p15
• Wilm’s tumor may be associated with:
-Hemihyperthrophy one side of body is larger
than other
-Aniridia cmplete loss of iris
-Genitourinary anomalies
 CLINICAL MANIFESTATIONS
• The most common fature is an upper quadrant
abdominal mass
• Abdominal pain occurs in 30-40 % of
cases,related to rapid growth of tumor
• Other sign include hypertension,fever caused by
tumor necrosis,hematuria,and anemia
• The neoplasm metastasize either by direct
extension or by bloodstreamlung (85%)
 HISTOLOGIC FINDINGS
• Favorable histology (90% of cases) is characerized
by all 3 histological elements,without any
anaplastic features.The cure rate in these cases is
close to 90%
• Unfavorable histology (10 %) is characterized by
the presence of anaplasia
 DIAGNOSTIC
• IVP  Pelvicalyces system distortion or non
visualized renal
• CT scan
• MRI
• USG renal
 TREATMENT
• Early stadium with normal contralateral renal
function radical nephrectomy.This surgery is
sometimes preceded by the administration of
cytostatics or radiation