RCC

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.


Pathology:

• Tubular epithelium.


Pathology:

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


Pathology:

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

Multicentric RCC:- 25% of patients.


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.


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.


Plain X-Ray:

• Normal.

• Distort the normal renal contour.

• Calcifications.

• Metastasis.


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.


US:

• Variable solid or cystic.

• RCC can be isoechoic, hypoechoic, or hyperechoic.


CT:

NECT:

• Isodense, hypodense, or hyperdense.

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

• Metastasis.


CT:

CECT:

• Solid, and evidence of necrosis is often present.


CT:

CECT:

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


CT:

CECT:

• Completely solid enhancing mass.


CT:

CECT:

• Metastasis.


MRI:

Masses ranging from predominantly cystic with septa or nodularity to solid

with enhancement


MRI:

T1WI:

• Isointense or hypointense.

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


MRI:

T2WI:

• Hyperintense & heterogeneous


MRI:

• Metastasis.

RCC

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Transcript of RCC