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Renal tumors. Dr. Abdelaty Shawky Dr. Gehan Mohamed. Learning objectives. 1. List the classification of renal tumors. 2. Describe renal oncocytoma . 3. Describe renal cortical adenoma. 4 . Discuss risk factors for renal cell carcinoma. 5 . Discuss clinical presentation of RCC. - PowerPoint PPT Presentation
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Renal tumors Renal tumors Dr. Abdelaty Shawky Dr. Gehan MohamedDr. Abdelaty Shawky Dr. Gehan Mohamed
Learning objectives1. List the classification of renal tumors.2. Describe renal oncocytoma.3. Describe renal cortical adenoma.4. Discuss risk factors for renal cell carcinoma.5. Discuss clinical presentation of RCC.6. list the different histologic subtypes of RCC.7. understand the TNM staging, grading of RCC.8. Recognize the pathological features of Wilms tumor.
* Classification of Renal tumors:
I. Benign tumors:I. Benign tumors:
•Cortical adenoma.
•Oncocytoma.
II. Malignant tumors:II. Malignant tumors:
•Renal cell carcinoma.
•Wilms tumor.
• Both benign and malignant tumors occur in the kidney.
• With the exception of oncocytoma, the benign tumors rarely cause clinical problems.
• Malignant tumors, on the other hand, are of great importance clinically and deserve considerable emphasis. By far the most common of these malignant tumors is renal cell carcinoma, followed by Wilms tumor, which is found in children
Renal cortical adenomaRenal cortical adenoma
* Clinical Features:
•Usually an incidental finding.
•Often seen in patients receiving long-term
hemodialysis, also more common in kidneys
scarred from chronic pyelonephritis.
* Gross Pathology:
•The tumors are smaller than 5 mm.
•Soft, well-circumscribed mass with yellow to
gray cut surface surrounded by compressed
adjacent kidney parenchyma
• On microscopic examination:
• They are composed of complex, branching,
papillomatous structures. The cells may also
grow as tubules, glands, cords, and sheets of
cells.
• The cells are cuboidal to polygonal in shape and
have regular, small central nuclei, scanty
cytoplasm, and no atypia.
Renal adenoma
Renal oncocytoma
* Clinical Features:
•Most are asymptomatic, although flank pain
may be a presenting complaint; hematuria may
be seen.
•Computed tomography or magnetic resonance
imaging may identify central scar.
* Gross Pathology:•Well-circumscribed, homogeneous cortical tumor
•Mahogany-brown cut surface.
•Often shows a central, irregular fibrous scar (in about
40% of cases).
•Bilateral or multicentric in 2% to 3% of cases
Renal Renal oncocytomaoncocytoma
• On microscopic examination: the
tumor consists of large, eosinophilic cells
having small, round, benign-appearing nuclei
that have large nucleoli. The cells are
arranged in nests separated by edematous
and hyalinized fibrous stroma.
Renal oncocytomaRenal oncocytoma
Renal cell carcinomaRenal cell carcinoma
* Epidemiology:
•Renal cell carcinomas represent about 1% to 3%
of all visceral cancers and account for 85% of
renal malignancy in adults.
•The tumors occur most often in older individuals,
usually in the sixth and seventh decades of life,
showing a male preponderance in the ratio of 3:1.
• Because of their gross yellow color and the resemblance of the tumor cells to clear cells of the adrenal cortex, they were at one time called hypernephroma. It is now clear that all these tumors arise from tubular epithelium and are therefore renal adenocarcinomas.
• Most renal cancer is sporadic, but unusual forms of autosomal-dominant familial cancers occur, usually in younger individuals.
* Risk factors for RCC:1. Cigarette smoking is the most significant risk
factor.2. Obesity (particularly in women).3. Hypertension. 4. Unopposed estrogen therapy.5. Exposure to asbestos, petroleum products,
and heavy metals.6. Acquired polycystic kidney disease secondary
to dialysis
* Clinical presentation of RCC:1. Hematuria. 2. Flank pain.3. Flank lump.• This triad is seen in only 10% of cases. The most
reliable of the three is hematuria, but it is usually intermittent and may be microscopic; thus, the tumor may remain silent until it attains a large size. At this time, it gives rise to generalized constitutional symptoms, such as fever, malaise, weakness, and weight loss.
• This pattern of asymptomatic growth occurs in many patients, so the tumor may have reached a diameter of more than 10 cm when it is discovered.
• However, many of these tumors are being discovered in the asymptomatic state by incidental radiologic studies (e.g., computed tomographic scan or magnetic resonance imaging) usually performed for non-renal indications.
• Renal cell carcinoma tends to produce a diversity of systemic symptoms not related to the kidney. In addition to the fever and constitutional symptoms mentioned earlier, renal cell carcinomas produce a number of paraneoplastic syndromes, ascribed to abnormal hormone production, including polycythemia, hypercalcemia, hypertension, hepatic dysfunction, feminization or masculinization, Cushing syndrome, eosinophilia, leukemoid reactions, and amyloidosis.
• One of the common characteristics of this tumor is its tendency to metastasize widely before giving rise to any local symptoms or signs. In 25% of new patients with renal cell carcinoma, there is radiologic evidence of metastases at the time of presentation.
• The most common locations of metastasis are the lungs (more than 50%) and bones (33%), followed in order by the regional lymph nodes, liver and adrenals, and brain.
* Classification of Renal Cell Carcinoma:
1. Clear cell RCC.1. Clear cell RCC.
2. Papillary RCC.2. Papillary RCC.
3. Chromophobe RCC. 3. Chromophobe RCC.
4. Collecting duct carcinoma.4. Collecting duct carcinoma.
1. Clear cell RCC.1. Clear cell RCC.• This is the most common type, accounting for 70%
to 80% of RCC.* Gross Pathology:• Solitary renal cortical mass• Bilaterality and multifocality more common in
familial cases.• Well-circumscribed, lobulated with golden-yellow
cut surface.• Cystic change, hemorrhage, necrosis, and• calcification often present
* Histopathology:•Nests of clear cells interspersed by delicate vascular network.
References:Robbins and Cotran’s:
Pathologic Basis of Disease. Seventh edition.