KIDNEYKIDNEY

IX. NeoplasmsIX. Neoplasms

Cortical adenomaCortical adenomaRenal cell carcinoma (RCC)Renal cell carcinoma (RCC)– The most frequent renal cancer in adultThe most frequent renal cancer in adult– It may have endocrine-like effect It may have endocrine-like effect procuce procuce

polycytemia, hypercalcemia, hypertension (renin) polycytemia, hypercalcemia, hypertension (renin) Cushing’s syndrome, etc.Cushing’s syndrome, etc.

Wilms’ tumorWilms’ tumor- More common tumor in childhood- More common tumor in childhoodTansitional cell carcinomaTansitional cell carcinoma- 5-10% of adult cancer- 5-10% of adult cancer

Pathology ofPathology of The Adrenal GlandsThe Adrenal Glands

Here are normal adrenal glands. Each adult adrenal gland Here are normal adrenal glands. Each adult adrenal gland weighs from 4 to 6 grams.weighs from 4 to 6 grams.

Sectioning across the adrenals reveals a golden Sectioning across the adrenals reveals a golden yellow outer cortex and an inner red to grey yellow outer cortex and an inner red to grey

medulla.medulla.

normal adrenal glands, atrophy, hyperplasianormal adrenal glands, atrophy, hyperplasia

The pair of adrenals in the center are normal. Those at the top come from a The pair of adrenals in the center are normal. Those at the top come from a patient with adrenal atrophy (with either Addison's disease or long-term patient with adrenal atrophy (with either Addison's disease or long-term corticosteroid therapy). The adrenals at the bottom represent bilateral corticosteroid therapy). The adrenals at the bottom represent bilateral cortical hyperplasia. This could be due to a pituitary adenoma secreting cortical hyperplasia. This could be due to a pituitary adenoma secreting ACTH (Cushing's disease), or Cushing's syndrome from ectopic ACTH ACTH (Cushing's disease), or Cushing's syndrome from ectopic ACTH production, or idiopathic adrenal hyperplasia.production, or idiopathic adrenal hyperplasia.

Normal adrenal glandNormal adrenal gland

normal adrenal glandsnormal adrenal glands

Lapisan dari kanan ke kiri :Lapisan dari kanan ke kiri :

periadrenal fatperiadrenal fat

capsulecapsule

zona glomerulosazona glomerulosa

zona fasiculatazona fasiculata

zona reticulariszona reticularis

medulamedula

NORMAL CORTEX ADRENALNORMAL CORTEX ADRENAL

ADRENOCORTICAL HYPERPLASIAADRENOCORTICAL HYPERPLASIAThe adrenal cortex are yellow, thickened and multinodularThe adrenal cortex are yellow, thickened and multinodular

ADRENAL CORTICAL ADENOMAADRENAL CORTICAL ADENOMA

ADRENOCORTICAL ADENOMAADRENOCORTICAL ADENOMASolitary, circumscribedSolitary, circumscribed

Adrenal Cortical AdenomaAdrenal Cortical Adenoma

Gross appearance. Both tumors are well circumscribed, of homogenous appearance, without hemorrhage or necrosis.

The tumor in A has the typical golden yellow color associated with aldosterone secretion.

Adrenal Cortical CarcinomaAdrenal Cortical Carcinoma

Gross appearance. Both tumors are large and exhibit areas of hemorrhage and necrosis. The tumor shown in A has destroys

the upper pole of the kidney.

The Adrenal Cortical AdenomaThe Adrenal Cortical Adenoma

The tumor showing numerous lipid-laden clear cells similar to those of the normal fasciculata layer

Cells in adrenocortical adenomaCells in adrenocortical adenoma

Aldosterone-secreting AdrenalAldosterone-secreting AdrenalCortical AdenomaCortical Adenoma

Various morphologic pattern

G F R

normal adrenal glandsnormal adrenal glands

Lapisan dari kanan ke kiri :Lapisan dari kanan ke kiri :

periadrenal fatperiadrenal fat

capsulecapsule

zona glomerulosazona glomerulosa

zona fasiculatazona fasiculata

zona reticulariszona reticularis

medulamedula

Compact adenomaCompact adenoma

Adrenal Cortical CarcinomaAdrenal Cortical Carcinoma

There is nuclear hyperchromasia, diffuse pattern of growth, and mitotic activity

Renal cell carcinoma (RCC)Renal cell carcinoma (RCC)

Renal cell carcinomaRenal cell carcinoma

Typical cross-section Typical cross-section of yellowish, of yellowish, spherical neoplasm spherical neoplasm in one pole of the in one pole of the kidneykidney

Note the tumor in the Note the tumor in the dilated, thrombosed dilated, thrombosed renal vainrenal vain

Renal cell carcinomaRenal cell carcinoma

Renal cell carcinomaRenal cell carcinoma

chomophope renal cell cachomophope renal cell ca

chomophope renal cell cachomophope renal cell ca

papillary renal cell carcinomapapillary renal cell carcinoma

Wilms’ tumor Wilms’ tumor (kidney)(kidney)

NEPHROBLASTOMANEPHROBLASTOMA

NEPHROBLASTOMANEPHROBLASTOMA

Wilms’ tumor Wilms’ tumor (kidney)(kidney)

Nephroblastoma(HE) x 50