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Neoplasmsof
Renal system
Dr. MOHAMED IQBAL MUSANI
& Dr.SOHEIR SAAD
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Renal cell carcinoma (Clear cell type) :
Tumor consists of groups of cells with clearcytoplasm and slightly enlarged nuclei.
The stroma consists of delicate vascularconnective tissue
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Nephroblastoma1. Kidney tissue is seen at the right side
2. Tumor tissue at left consists of spindle sarcomatous backgroundwith abortive glomeruli and abortive tubules
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The multiple irregular bilateral masses (many of which show central indentations, or
"umbilications", from necrosis)
here represent metastases of carcinoma to thekidneys. Kidney is not a usual site for metastases.
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Benign Adenoma, oncocytoma, angiomyolipoma,
fibroma (rare!)
Malignant:
Renal cell carcinoma (common adults)
Wilms tumor (childhood)
Transitional cell carcinoma of renal pelvis
Renal tumors
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Renal Papillary Adenoma
Papillary Common
Histopathology similarto renal CellCarcinoma.
< 3cmbenign
> 3cm - malignant
All tumors consideredmalignant until provedotherwise.
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Lobulated tumors mass encapsulated
Histology: mixture of immature cells
metanephric, stromal, tubular
Chemotherapy + surgery = 5 years = 90%
Children < 2 years better prognosis
Wilms Tumor Features:
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Childhood tumor (2-5y) 98%< 10 years Most common tumor in childhood
Sporadic, unilateral (90%)
Bilateral more common in familial cases (20%)
Familial syndromic (5%), nonsyndromic (5%)
WAGR sy
Aniridia, genital abn, Mental Ret.WT1
Beckwith Wiedemann sy - Hemihypertrophy WT2
Wilms tumor
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Introduction
Incidence:
Etiology:
Clinical
Features:
Lab:
Path:
Clinical
Course:
Embryonic renal tissue (metanephric
blastema). Genetic abnormalities.
Palpable abdominal mass. Abdominal
pain, fever, anorexia, nausea/vomiting.
Hematuria.
No specific clinical laboratory findings.
Diagnosis by radiographic techniques.
5-yr. Survival 80%. Metastases to lung,
liver, bone, brain.
Gross: Solitary/multiple cystic mass,
sharply delineated. Soft, bulging, gray-
white with focal hemorrhage and necrosis.
Micro: Triphasic mesenchymal stroma,
tubules, and solid areas (blastema).Primitive glomeruli, skeletal muscle,
cartilage, bone, etc. (embryonic tissues)
Most common renal tumor ofchildhood. Peak age - 2.5 - 3.5 years.
Treatment: Prompt resection with chemotherapy
radiotherapy.
Synonyms: Nephroblastoma.
Wilms Tumor
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Wilms Tumor:1. An illdefined
noncapsulated tumormass.
2. The mass is lobulated.3. Cut section is fleshy,
tan-white mass
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Most common renal tumor
Peak age 60y M:F = 3:1
Incidence increasing world wide
Tobacco; Obesity, genetics (VHLgene,familial cases)
Von Hippel-Lindau syndrome
Hemangioblastoma cerebellum retina
Bilateral renal cysts,
Clear cell type RCC common.
Renal Cell Carcinoma
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Yellow orange tumor Hypernephroma.
Partially encapsulated
Extends into renal vein
tubular clear cell (77%)
papillary (15%)
granular, chromophobe, sarcomatoid (5%)
RCC - Pathology
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Hypernephroma :
1. Tumor arises from lowerpole of the kidney.
2. Tumor forms an illdefinednoncapsulated mass.
3. Cut section shows areas ofhemorrhage and necrosis
as well as golden yellowareas.
4. Kidney forms a crescentabove the tumor
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Renal cell carcinoma(Invasion of renal vein) :
Kidney shows an illdefinednoncapsulated tumor mass with
the cut section showing goldenyellow areas.Tumor tissue is seen invadingrenal vein (Prognostic significane)
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Renal Cell Carcinoma:
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Classical triad (hematuria, flank pain, mass)
(
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Introduction
Incidence:
Etiology:
Clinical
Features:
Lab:
Path:
Clinical
Course:
Cells of proximal convoluted tubule. Risk
factors are smoking, obesity, analgesic
abuse, APCKD.
Hematuria*, flank pain, palpable mass.
Frequently metastasize (lungs, bone, skin,
liver, brain).
Gross or microscopic hematuria.
Specific Dx by radiographic techniques.
5-yr. survival 40%. Poor prognosis with
metastases.
Gross: Large yellow mass with hemorrhage
and necrosis. Invade renal vein.
Micro: Usually clear or granular cells with
little anaplasia. Other histologic variants
(great mimicker).
5thand 6thdecades, most commonprimary renal malignancy.
Treatment: Chemotherapy, surgery, immunotherapy.
Synonyms: Hypernephroma, clear cell carcinoma.
Renal Cell Carcinoma:
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Transitional Cell Carcinoma:
5-10% of adult renal ca.
Etiology: Analgesic abuse, dye, rubber
etc.. Multiple common.
Malignant cells in urine
Desquamated tissue may cause
obstruction.
Hematuria & pain.
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Transitional cell Carcinoma:
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