Genito-Urinary Tumors

Episode 4 “The Malignant Evil”

Genito-Urinary Tumors

Renal Cell Carcinoma (RCC)

Renal Cell Carcinoma

Incidence:

• 85% of renal tumors.

• ♂:♀ = 2:1

• Age: 50-70 Yrs.

Renal Cell Carcinoma

Pathology:

• Tubular epithelium.

Renal Cell Carcinoma

Pathology:

• Vary from being nearly completely cystic to being completely solid.

Renal Cell Carcinoma

Pathology:

Bilateral RCCs:1. Von Hippel-Lindau syndrome2. Tuberous sclerosis.3. Chronic dialysis.4. 2% of sporadic cases.

Multicentric RCC:- 25% of patients.

Renal Cell Carcinoma

Pathology:

Spread:1. Direct local invasion of adjacent structures.

2. Local regional lymph node metastases.

3. Extend into the renal vein and, subsequently, into the inferior vena cava.

4. The lungs are the most common sites of distant metastases.

NB: Typically, skeletal metastases are purely lytic.

Renal Cell Carcinoma

Clinical:

• Hematuria, flank pain, or less frequently a flank mass.

• Incidentally during imaging.

• Occasionally, patients present with systemic symptoms such as fever, nausea, anorexia, and weight loss.

• Rarely, patients have symptoms related to humoral factors such as parathormone, prolactin, erythropoietin, or renin.

Renal Cell Carcinoma

Plain X-Ray:

• Normal.

• Distort the normal renal contour.

• Calcifications.

• Metastasis.

Renal Cell Carcinoma

IVU:

• Normal.

• Mass effect on the collecting system.

• Distortion of the renal contour.

• Enlargement of a portion of the kidney.

• Poor or absent contrast material excretion

• Calcifications.

Renal Cell Carcinoma

US:

• Variable solid or cystic.

• RCC can be isoechoic, hypoechoic, or hyperechoic.

Renal Cell Carcinoma

CT:

NECT:

• Isodense, hypodense, or hyperdense.

• Calcifications may be present and are usually amorphous and internal.

• Metastasis.

Renal Cell Carcinoma

CT:

NECT:

• Isodense, hypodense, or hyperdense.

• Calcifications may be present and are usually amorphous and internal.

• Metastasis.

Renal Cell Carcinoma

CT:

NECT:

• Isodense, hypodense, or hyperdense.

• Calcifications may be present and are usually amorphous and internal.

• Metastasis.

Renal Cell Carcinoma

CT:

NECT:

• Isodense, hypodense, or hyperdense.

• Calcifications may be present and are usually amorphous and internal.

• Metastasis.

Renal Cell Carcinoma

CT:

CECT:

• Solid, and evidence of necrosis is often present.

Renal Cell Carcinoma

CT:

CECT:

• Predominantly cystic mass, with thick septa and wall nodularity.

Renal Cell Carcinoma

CT:

CECT:

• Predominantly cystic mass, with thick septa and wall nodularity.

Renal Cell Carcinoma

CT:

CECT:

• Completely solid enhancing mass.

Renal Cell Carcinoma

CT:

CECT:

• Metastasis.

Renal Cell Carcinoma

CT:

CECT:

• Metastasis.

Renal Cell Carcinoma

CT:

CECT:

• Metastasis.

Renal Cell Carcinoma

MRI:

Masses ranging from predominantly cystic with septa or nodularity to solid

with enhancement

Renal Cell Carcinoma

MRI:

T1WI:

• Isointense or hypointense.

• The presence of necrosis or hemorrhage may alter these signal intensity characteristics.

Renal Cell Carcinoma

MRI:

T2WI:

• Hyperintense & heterogeneous

Renal Cell Carcinoma

MRI:

• Metastasis.

Test