neoplasms of renal system

8/13/2019 Neoplasms of Renal System

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Neoplasmsof

Renal system

Dr. MOHAMED IQBAL MUSANI

& Dr.SOHEIR SAAD


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Renal cell carcinoma (Clear cell type) :

Tumor consists of groups of cells with clearcytoplasm and slightly enlarged nuclei.

The stroma consists of delicate vascularconnective tissue


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Nephroblastoma1. Kidney tissue is seen at the right side

2. Tumor tissue at left consists of spindle sarcomatous backgroundwith abortive glomeruli and abortive tubules


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The multiple irregular bilateral masses (many of which show central indentations, or

"umbilications", from necrosis)

here represent metastases of carcinoma to thekidneys. Kidney is not a usual site for metastases.


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Benign Adenoma, oncocytoma, angiomyolipoma,

fibroma (rare!)

Malignant:

Renal cell carcinoma (common adults)

Wilms tumor (childhood)

Transitional cell carcinoma of renal pelvis

Renal tumors


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Renal Papillary Adenoma

Papillary Common

Histopathology similarto renal CellCarcinoma.

< 3cmbenign

> 3cm - malignant

All tumors consideredmalignant until provedotherwise.


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Lobulated tumors mass encapsulated

Histology: mixture of immature cells

metanephric, stromal, tubular

Chemotherapy + surgery = 5 years = 90%

Children < 2 years better prognosis

Wilms Tumor Features:


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Childhood tumor (2-5y) 98%< 10 years Most common tumor in childhood

Sporadic, unilateral (90%)

Bilateral more common in familial cases (20%)

Familial syndromic (5%), nonsyndromic (5%)

WAGR sy

Aniridia, genital abn, Mental Ret.WT1

Beckwith Wiedemann sy - Hemihypertrophy WT2

Wilms tumor


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Introduction

Incidence:

Etiology:

Clinical

Features:

Lab:

Path:

Clinical

Course:

Embryonic renal tissue (metanephric

blastema). Genetic abnormalities.

Palpable abdominal mass. Abdominal

pain, fever, anorexia, nausea/vomiting.

Hematuria.

No specific clinical laboratory findings.

Diagnosis by radiographic techniques.

5-yr. Survival 80%. Metastases to lung,

liver, bone, brain.

Gross: Solitary/multiple cystic mass,

sharply delineated. Soft, bulging, gray-

white with focal hemorrhage and necrosis.

Micro: Triphasic mesenchymal stroma,

tubules, and solid areas (blastema).Primitive glomeruli, skeletal muscle,

cartilage, bone, etc. (embryonic tissues)

Most common renal tumor ofchildhood. Peak age - 2.5 - 3.5 years.

Treatment: Prompt resection with chemotherapy

radiotherapy.

Synonyms: Nephroblastoma.

Wilms Tumor


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Wilms Tumor:1. An illdefined

noncapsulated tumormass.

2. The mass is lobulated.3. Cut section is fleshy,

tan-white mass


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Most common renal tumor

Peak age 60y M:F = 3:1

Incidence increasing world wide

Tobacco; Obesity, genetics (VHLgene,familial cases)

Von Hippel-Lindau syndrome

Hemangioblastoma cerebellum retina

Bilateral renal cysts,

Clear cell type RCC common.

Renal Cell Carcinoma


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Yellow orange tumor Hypernephroma.

Partially encapsulated

Extends into renal vein

tubular clear cell (77%)

papillary (15%)

granular, chromophobe, sarcomatoid (5%)

RCC - Pathology


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Hypernephroma :

1. Tumor arises from lowerpole of the kidney.

2. Tumor forms an illdefinednoncapsulated mass.

3. Cut section shows areas ofhemorrhage and necrosis

as well as golden yellowareas.

4. Kidney forms a crescentabove the tumor


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Renal cell carcinoma(Invasion of renal vein) :

Kidney shows an illdefinednoncapsulated tumor mass with

the cut section showing goldenyellow areas.Tumor tissue is seen invadingrenal vein (Prognostic significane)


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Renal Cell Carcinoma:


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Classical triad (hematuria, flank pain, mass)

(


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Introduction

Incidence:

Etiology:

Clinical

Features:

Lab:

Path:

Clinical

Course:

Cells of proximal convoluted tubule. Risk

factors are smoking, obesity, analgesic

abuse, APCKD.

Hematuria*, flank pain, palpable mass.

Frequently metastasize (lungs, bone, skin,

liver, brain).

Gross or microscopic hematuria.

Specific Dx by radiographic techniques.

5-yr. survival 40%. Poor prognosis with

metastases.

Gross: Large yellow mass with hemorrhage

and necrosis. Invade renal vein.

Micro: Usually clear or granular cells with

little anaplasia. Other histologic variants

(great mimicker).

5thand 6thdecades, most commonprimary renal malignancy.

Treatment: Chemotherapy, surgery, immunotherapy.

Synonyms: Hypernephroma, clear cell carcinoma.

Renal Cell Carcinoma:


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Transitional Cell Carcinoma:

5-10% of adult renal ca.

Etiology: Analgesic abuse, dye, rubber

etc.. Multiple common.

Malignant cells in urine

Desquamated tissue may cause

obstruction.

Hematuria & pain.


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Transitional cell Carcinoma:


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neoplasms of renal system

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