L8: Renal Tumors Flashcards
Renal Tumors
- Outlines
Incidence of Renal Adenoma
- The Most common parenchymal lesion.
- 7-22% at autopsy.
Histology of Renal Adenoma
- Small, well differentiated glandular tumors of rwnal cortex
Diffrentiation of Renal Adenoma
- Difficult to be differentiated from RCC.
Incidence of Renal Oncocytoma
3-5% of renal tumors
Histology of Renal Oncocytoma
Composed of oncocytes “Large epithelial cells with fine granular eosinophilic cytoplasm”.
xIncidence of Renal Angiomyolipoma
< 1% of renal tumors.
Histology of Renal Angiomyolipoma
3 Major Components:
1) Angio: Blood vessels
2) Myo: Smooth ms.
3) Lipoma: Fat cells.
Renal Adenoma
- Dx
- TTT
Renal Oncocytoma
- NE
- Dx
- TTT
Renal Angiomyolipoma
- NE
- Dx
- TTT
Incidence of RCC
Incidence of RCC
- Percentage & Numbers
Incidence of RCC
- Age
5th to 6th decades of life.
Incidence of RCC
- Sex
Males (2) : Females (1)
Incidence of RCC
- Race
Hispanics
Etiology of RCC
- Hereditary
- Acquired Cystic Kidney Diseases
- Cigarettes
- Analgesic Abuse
- Occupational
Etiology of RCC
- Hereditary
Etiology of RCC
- VHL Syndrome
- Cerebellar hemangioblastora.
- Retinal angioma.
- Bilateral RCC.
Etiology of RCC
- Sporadic Vs Familial
Etiology of RCC
- Acquired Renal Cysteic Disease of the kidney
Etiology of RCC
- Cigarettes
At least 2-fold increase in risk.
Etiology of RCC
- Analgesic Abuse
Phenacitin-containing product → analgesic nephropathy → RCC.
Etiology of RCC
- Occupational
Pathology of RCC
Pathology of RCC
- Morphology
Pathology of RCC
- Histopathology
Pathology of RCC
- Most Common Histopathology
Conventional type (Clear cell renal cell carcinoma)
- 70%
- Clear cell + granula cell.
Spread of RCC
Spread of RCC
- Direct
Spread of RCC
- Lymphatic
…
Spread of RCC
- Heamtogenous
- 1/3 cf patients have metastasis at time of presentations.
- The most common site is the lung.
Staging of RCC
Staging of RCC
- Primary Tumor
Staging of RCC
- LN
Staging of RCC
- Distant Mets
Stage Grouping of RCC
Prognosis of RCC
Prognosis of RCC
- Anatomic Factors
Prognosis of RCC
- Histologic Factors
Prognosis of RCC
- Best Histology
Prognosis of RCC
- Clinical Factors
Prognosis of RCC
- Moleecula Factors
CP of RCC
Symptoms & Signs
CP of RCC
- Incidental
- Incidental (50%)
CP of RCC
- Symptomatic
CP of RCC
- Main Symptoms
Hematuria (50%) - Loin pain (40%) - Mass 30%.
CP of RCC
- Old CLassic Triad
- Old classic triad (pain, hematuria, and mass) in 10%.
CP of RCC
- Varicocele & Edema
Non-reducing varicocele or bilateral lower limb edema.
CP of RCC
- Mets
Metastatic symptoms (25%):
A. Lungs (75%).
B. Bones (20%).
C. Liver.
D. Brain.
CP of RCC
- Paraneoplatsic Syndrome
CP of RCC
- Internist or Radiologist?
- RCC used to be the internist’s tumor.
- May now be the radiologist’s tumor, as >60% are incidental.
Signs of RCC
- Abdominal Mass
Signs of RCC
INVx for RCC
INVx for RCC
- US & CT Scan
INVx for RCC
- MRI
INVx for RCC
- SRA
- Diagnostic.
- Therapeutic: Preoperative or Symptomatic embolization.
INVx for RCC
- Bone Scan, Brain CT or MRI
In symptomatic and advanced cases.
INVx for RCC
- Bx
- Metastatic, Lymphoma, survillence or ablative ttt, indeterminate lesion.
INVx for RCC
- 1st Step
US
INVx for RCC
- Gold Standard
CT Scan
INVx of RCC
- Exclusion or Mets
Surgical Management of RCC
- TTT (Not Palliation)
TTT of RCC
- Palliation
TTT of RCC
- Localized Renal Cancer
- Radical nephrectomy.
- Nephron-sparing surgery.
- Tumour ablation.
TTT of RCC
- Locally Advanced Renal Cancer
Radical nephrectomy + ….
TTT of RCC
- Metastatic Renal Cancer
- Role of nephrectomy
- metastatectomy
- targeted therapy.
TTT of Localized Renal Cancer
TTT of Localized Renal Cancer
- Radical Nephrectomy
TTT of Localized Renal Cancer
- NSS
NSS
- Absolute Indications
NSS
- Relative Indications
NSS
- Elective Indications
TTT of Locally Advanced RCC
- Indications of oprn surgery
Incidence of RCC with Venous Thrombus
- 4-10%
- More common on right side.
CP of RCC with Venous Thrombus
- 10- 25% extension above the hepatic veins.
- One third are metastatic.
TTT of RCC with Venous Thrombus
- Surgery can provide long tenn survival in suitable candidates with no metastas:
- Not difficult.
- Pull back the thrombus into RV and side clamp the IVC.
- Laparoscopically possible.
TTT of Metastatic RCC
- Chemo & Radio
NOOO
- RCC is chemo-refractory and radio-resistant!
TTT of Metastatic RCC
- Immunotherapy
TTT of Metastatic RCC
- Allogeneic stem cell transplantation
Has significant morbidity
“The standard of care for advanced RCC is the best available clinical trial”.
Ok Sir
VHL Biology in RCC
Targeted therapy for RCC
- Antiangiogenic Drugs
- mTOR Inhibitors
Antiangiogenic Drugs in RCC
Tyrosine kinase inhibitors (TKIs):
- block the intracellular domain of the VEGFR (e.g., Sunitinib, Sorafenib, Axitinib).
Monoclonal antibody:
- bind circulating VEGF and prevent it from activating the VEGFR (e.g., Bevacizurab).
mTOR Inhibitors in RCC
Temsirolimus
Another Name of Wilm’s Tumor
Nephroblastoma
Epidemeology of Wilm’s Tumor
Age in Wilm’s Tumor
peaks in 3rd Year of Life
Sex & Distribution of Wilm’s Tumor
Etiology of Wilm’s Tumor
Etiology of Wilm’s Tumor
- Familial
Pathology of Wilm’s Tumor
- NE
Spread of Wilm’s Tumor
Staging of Wilm’s Tumor
Staging of Wilm’s Tumor
- Stage I
Staging of Wilm’s Tumor
- Stage II
Staging of Wilm’s Tumor
- Stage III
Staging of Wilm’s Tumor
- Stage IV
Staging of Wilm’s Tumor
- Stage V
Management of Wilm’s Tumor
Epidemeology of Renal Pelvis Tumors
Etiology of Renal Pelvis Tumors
Occupational RF for Renal Pelvis Tumors
- Chemical.
- Leather.
- Printing.
- Gasworks.
- Rubber.
- Sewage works.
- Plastic
Pathology of Renal Pelvis Tumors
- Benign
Papilloma
Pathology of Renal Pelvis Tumors
- Malignant
- Transitional Cell Carcinoma (TCC) (The most common).
- Squamous Cell Carcinoma (SCC)-
- Adenocarcinoma.
Staging of Renal Pelvis Tumors
INVx for Renal Pelvis Tumors
TTT of Renal Pelvis Tumors
TTT of Renal Pelvis Tumors
- Surgical
- Kidney-sparing management.
- Radical rephroureterctomy and bladder cuff excision.
- Palliative nephrectomy and chemotherapy for metastatic dis.
TTT of Renal Pelvis Tumors
- Radiation
Postoperative or adjuvant
TTT of Renal Pelvis Tumors
- Systemic Chemo
MVAC:
M: Methotrexate
V: Vinblastine
A: doxorubicin (Adriamycin)
C: Cisplatin.
