L8: Renal Tumors Flashcards
1
Q
Renal Tumors
- Outlines
A
2
Q
Incidence of Renal Adenoma
A
- The Most common parenchymal lesion.
- 7-22% at autopsy.
3
Q
Histology of Renal Adenoma
A
- Small, well differentiated glandular tumors of rwnal cortex
4
Q
Diffrentiation of Renal Adenoma
A
- Difficult to be differentiated from RCC.
5
Q
Incidence of Renal Oncocytoma
A
3-5% of renal tumors
6
Q
Histology of Renal Oncocytoma
A
Composed of oncocytes “Large epithelial cells with fine granular eosinophilic cytoplasm”.
7
Q
xIncidence of Renal Angiomyolipoma
A
< 1% of renal tumors.
8
Q
Histology of Renal Angiomyolipoma
A
3 Major Components:
1) Angio: Blood vessels
2) Myo: Smooth ms.
3) Lipoma: Fat cells.
9
Q
Renal Adenoma
- Dx
- TTT
A
10
Q
Renal Oncocytoma
- NE
- Dx
- TTT
A
11
Q
Renal Angiomyolipoma
- NE
- Dx
- TTT
A
12
Q
Incidence of RCC
A
13
Q
Incidence of RCC
- Percentage & Numbers
A
14
Q
Incidence of RCC
- Age
A
5th to 6th decades of life.
15
Q
Incidence of RCC
- Sex
A
Males (2) : Females (1)
16
Q
Incidence of RCC
- Race
A
Hispanics
17
Q
Etiology of RCC
A
- Hereditary
- Acquired Cystic Kidney Diseases
- Cigarettes
- Analgesic Abuse
- Occupational
18
Q
Etiology of RCC
- Hereditary
A
19
Q
Etiology of RCC
- VHL Syndrome
A
- Cerebellar hemangioblastora.
- Retinal angioma.
- Bilateral RCC.
20
Q
Etiology of RCC
- Sporadic Vs Familial
A
21
Q
Etiology of RCC
- Acquired Renal Cysteic Disease of the kidney
A
22
Q
Etiology of RCC
- Cigarettes
A
At least 2-fold increase in risk.
23
Q
Etiology of RCC
- Analgesic Abuse
A
Phenacitin-containing product → analgesic nephropathy → RCC.
24
Q
Etiology of RCC
- Occupational
A
25
Pathology of **RCC**
26
Pathology of **RCC**
- Morphology
27
Pathology of **RCC**
- Histopathology
28
Pathology of **RCC**
- Most Common Histopathology
Conventional type (Clear cell renal cell carcinoma)
- 70%
- Clear cell + granula cell.
29
Spread of **RCC**
30
Spread of **RCC**
- Direct
31
Spread of **RCC**
- Lymphatic
...
32
Spread of **RCC**
- Heamtogenous
- 1/3 cf patients have metastasis at time of presentations.
- The most common site is the lung.
33
Staging of **RCC**
34
Staging of **RCC**
- Primary Tumor
35
Staging of **RCC**
- LN
36
Staging of **RCC**
- Distant Mets
37
Stage Grouping of **RCC**
38
Prognosis of **RCC**
39
Prognosis of **RCC**
- Anatomic Factors
40
Prognosis of **RCC**
- Histologic Factors
41
Prognosis of **RCC**
- Best Histology
42
Prognosis of **RCC**
- Clinical Factors
43
Prognosis of **RCC**
- Moleecula Factors
44
CP of **RCC**
Symptoms & Signs
45
CP of **RCC**
- Incidental
- Incidental (50%)
46
CP of **RCC**
- Symptomatic
47
CP of **RCC**
- Main Symptoms
Hematuria (50%) - Loin pain (40%) - Mass 30%.
48
CP of **RCC**
- Old CLassic Triad
- Old classic triad (pain, hematuria, and mass) in 10%.
49
CP of **RCC**
- Varicocele & Edema
Non-reducing varicocele or bilateral lower limb edema.
50
CP of **RCC**
- Mets
Metastatic symptoms (25%):
A. Lungs (75%).
B. Bones (20%).
C. Liver.
D. Brain.
51
CP of **RCC**
- Paraneoplatsic Syndrome
52
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.
53
Signs of **RCC**
- Abdominal Mass
53
Signs of **RCC**
54
INVx for **RCC**
55
INVx for **RCC**
- US & CT Scan
56
INVx for **RCC**
- MRI
57
INVx for **RCC**
- SRA
- Diagnostic.
- Therapeutic: Preoperative or Symptomatic embolization.
58
INVx for **RCC**
- Bone Scan, Brain CT or MRI
In symptomatic and advanced cases.
59
INVx for **RCC**
- Bx
- Metastatic, Lymphoma, survillence or ablative ttt, indeterminate lesion.
60
INVx for **RCC**
- 1st Step
US
61
INVx for **RCC**
- Gold Standard
CT Scan
62
INVx of **RCC**
- Exclusion or Mets
63
Surgical Management of **RCC**
- TTT (Not Palliation)
64
TTT of **RCC**
- Palliation
65
TTT of **RCC**
- Localized Renal Cancer
1. Radical nephrectomy.
2. Nephron-sparing surgery.
3. Tumour ablation.
66
TTT of **RCC**
- Locally Advanced Renal Cancer
Radical nephrectomy + ....
67
TTT of **RCC**
- Metastatic Renal Cancer
- Role of nephrectomy
- metastatectomy
- targeted therapy.
68
TTT of **Localized Renal Cancer**
69
TTT of **Localized Renal Cancer**
- Radical Nephrectomy
70
TTT of **Localized Renal Cancer**
- NSS
71
NSS
- Absolute Indications
72
NSS
- Relative Indications
73
NSS
- Elective Indications
74
TTT of **Locally Advanced RCC**
- Indications of oprn surgery
75
Incidence of **RCC with Venous Thrombus**
- 4-10%
- More common on right side.
76
CP of **RCC with Venous Thrombus**
- 10- 25% extension above the hepatic veins.
- One third are metastatic.
77
TTT of **RCC with Venous Thrombus**
- Surgery can provide long tenn survival in suitable candidates with no metastas:
1. Not difficult.
2. Pull back the thrombus into RV and side clamp the IVC.
3. Laparoscopically possible.
78
TTT of **Metastatic RCC**
- Chemo & Radio
NOOO
- RCC is chemo-refractory and radio-resistant!
79
TTT of **Metastatic RCC**
- Immunotherapy
80
TTT of **Metastatic RCC**
- Allogeneic stem cell transplantation
Has significant morbidity
81
"The standard of care for advanced RCC is the best available clinical trial".
Ok Sir
82
VHL Biology in RCC
83
**Targeted therapy** for RCC
- Antiangiogenic Drugs
- mTOR Inhibitors
84
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).
85
mTOR Inhibitors in RCC
Temsirolimus
86
Another Name of **Wilm's Tumor**
Nephroblastoma
87
Epidemeology of **Wilm's Tumor**
88
Age in **Wilm's Tumor**
peaks in 3rd Year of Life
89
Sex & Distribution of **Wilm's Tumor**
90
Etiology of **Wilm's Tumor**
91
Etiology of **Wilm's Tumor**
- Familial
92
Pathology of **Wilm's Tumor**
- NE
93
Spread of **Wilm's Tumor**
94
Staging of **Wilm's Tumor**
95
Staging of **Wilm's Tumor**
- Stage I
96
Staging of **Wilm's Tumor**
- Stage II
97
Staging of **Wilm's Tumor**
- Stage III
98
Staging of **Wilm's Tumor**
- Stage IV
99
Staging of **Wilm's Tumor**
- Stage V
100
Management of **Wilm's Tumor**
101
Epidemeology of **Renal Pelvis Tumors**
102
Etiology of **Renal Pelvis Tumors**
103
Occupational RF for **Renal Pelvis Tumors**
* Chemical.
* Leather.
* Printing.
* Gasworks.
* Rubber.
* Sewage works.
* Plastic
104
Pathology of **Renal Pelvis Tumors**
- Benign
Papilloma
105
Pathology of **Renal Pelvis Tumors**
- Malignant
* Transitional Cell Carcinoma (TCC) (The most common).
* Squamous Cell Carcinoma (SCC)-
* Adenocarcinoma.
106
Staging of **Renal Pelvis Tumors**
107
INVx for **Renal Pelvis Tumors**
108
TTT of **Renal Pelvis Tumors**
109
TTT of **Renal Pelvis Tumors**
- Surgical
- Kidney-sparing management.
- Radical rephroureterctomy and bladder cuff excision.
- Palliative nephrectomy and chemotherapy for metastatic dis.
110
TTT of **Renal Pelvis Tumors**
- Radiation
Postoperative or adjuvant
111
TTT of **Renal Pelvis Tumors**
- Systemic Chemo
MVAC:
M: Methotrexate
V: Vinblastine
A: doxorubicin (Adriamycin)
C: Cisplatin.
