FN: Renal Tumours Flashcards
Renal cell carcinoma/Hypernephroma epi
90$ of renal cancers
Age: 55 yrs
Sex: M>F =2:1
Renal cell carcinoma/Hypernephroma RF
Obesity Smoking HTN Dialysis (15% of pts. develop RCC) 4% heritable e.g. VHL syndrome
Renal cell carcinoma/Hypernephroma pathology
Adenocarcinoma from proximal renal tubular epithelium
Renal cell carcinoma/Hypernephroma subtypes
Clear cell (glycogen):70-80%
Papillary: 15%
Chromophobe:5%
Collecting duct:1%
Renal cell carcinoma/Hypernephroma PResentation
50% incidental finding
Systemic: anorexia, malaise, wt. loss, PUO
Clot retention
Invasion of L renal vein - varicocel (1%)
Cannonball mets - SOB
Renal cell carcinoma/Hypernephroma Triad
HAematuria
Loin pain
loin mass
Renal cell carcinoma/Hypernephroma Paraneoplastic features
EPO - polycythaemia PTHrP - raised Calcium Renin - HTN ACTH - Cushings syn Amyoidosis
Renal cell carcinoma/Hypernephroma spread
Direct: renal vein
Lymph
Haematogenous: bone, liver and lung
Renal cell carcinoma/Hypernephroma Investigations blood shows
Polycythaemia, ESRm U+E, ALP, Ca
Renal cell carcinoma/Hypernephroma Urine
Dip
Cytology
Renal cell carcinoma/Hypernephroma Imaging
CXR: cannonballmets
US: mass
IVU: filling defect
CT/MRI
Renal cell carcinoma/Hypernephroma Robson staging
- Confined to kidney
- Involves perinephric fat, but not Garotas fascia
- Involves perinephric fat, but not Garotas fascia
- Spread into renal vein
- Spread to adjacent/distant organs
Renal cell carcinoma/Hypernephroma Medical Mx
REserved for pts. with poor prognosis
Temsirolimus (mTOP inhibitor)
Renal cell carcinoma/Hypernephroma Mx surgical
Radical nephrectomy
Consider partial if small tumour of 1 kidney
Transitional cell Carcinoma Epi
2nd commonest renal cancer
Age: 50-55yrs
Sex: M>F=4:1
Transitional cell Carcinoma RF
Smoking
Amine exposure (rubber industry)
Cyclophosphamide
Transitional cell Carcinoma Pathology
Hihgly malignant Locations -bladder 50% Ureter REnal pelvis
Transitional cell Carcinoma Presentation
Painless haematuria
Freqeuncy, urgency, dysuria
Urinary tract obstruction
Transitional cell Carcinoma Investigations
Urine cytology
CT/MRI
IVU: pelvicael filing defect
Transitional cell Carcinoma MA
Nephrouretctomy
REgular f/up: 50% develop bladder tumours
Nephroblastoma: Wilms tumour
Childhood tuour of primitve renal tubules and mesenchymal cells
May be association with Chr 11 mutation
May be association with WAGR syndrome - wilms, aniridia, GU abnormalities, REtardation
Nephroblastoma: Wilms tumour Presentation
2-5 yrs 5-10% bilateral Abdo mass (doesnt cross the midline) Haematuria Abdo pain GTN
Benign neoplasms
Cysts: very common
Renal papillary adenomas
Oncocytoma: eosinophilic cells with numerous mitochondria
Angiomyolipoma: seen in tuberous sclerosis
Malignant neoplasms
SCC: associations with chronic infected staghom calculi
Benign tumours note
Commonly require nephrectomy to exclude malignancy
