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    Renal Tumors

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    drham
    1. Renal cell carcinoma is the most common type of kidney cancer, accounting for 80-85% of cases. The three main types are clear cell carcinoma (most common), papillary renal cell carcinoma, and chromophobe renal cell carcinoma. 2. Clear cell carcinoma typically presents as a solitary, large yellow-orange mass in the renal cortex. It can invade the renal vein and spread to other organs. Papillary renal cell carcinoma is often multifocal and bilateral, associated with mutations in the MET protooncogene. 3. Common symptoms of renal cell carcinoma include hematuria, flank pain, and fever. If metastatic, it can spread to the lungs and bones. Prognosis depends on tumor

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    Renal Tumors

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    drham
    188 views4 pages
    1. Renal cell carcinoma is the most common type of kidney cancer, accounting for 80-85% of cases. The three main types are clear cell carcinoma (most common), papillary renal cell carcinoma, and chromophobe renal cell carcinoma. 2. Clear cell carcinoma typically presents as a solitary, large yellow-orange mass in the renal cortex. It can invade the renal vein and spread to other organs. Papillary renal cell carcinoma is often multifocal and bilateral, associated with mutations in the MET protooncogene. 3. Common symptoms of renal cell carcinoma include hematuria, flank pain, and fever. If metastatic, it can spread to the lungs and bones. Prognosis depends on tumor

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    1. Renal cell carcinoma is the most common type of kidney cancer, accounting for 80-85% of cases. The three main types are clear cell carcinoma (most common), papillary renal cell carcinoma, and chromophobe renal cell carcinoma. 2. Clear cell carcinoma typically presents as a solitary, large yellow-orange mass in the renal cortex. It can invade the renal vein and spread to other organs. Papillary renal cell carcinoma is often multifocal and bilateral, associated with mutations in the MET protooncogene. 3. Common symptoms of renal cell carcinoma include hematuria, flank pain, and fever. If metastatic, it can spread to the lungs and bones. Prognosis depends on tumor

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    Download as DOC, PDF, TXT or read online from Scribd
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    188 views4 pages

    Renal Tumors

    Uploaded by

    drham
    1. Renal cell carcinoma is the most common type of kidney cancer, accounting for 80-85% of cases. The three main types are clear cell carcinoma (most common), papillary renal cell carcinoma, and chromophobe renal cell carcinoma. 2. Clear cell carcinoma typically presents as a solitary, large yellow-orange mass in the renal cortex. It can invade the renal vein and spread to other organs. Papillary renal cell carcinoma is often multifocal and bilateral, associated with mutations in the MET protooncogene. 3. Common symptoms of renal cell carcinoma include hematuria, flank pain, and fever. If metastatic, it can spread to the lungs and bones. Prognosis depends on tumor

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    Renal Tumors

    A. Renal Cell Carcinoma


    1- Derived from renal tubular epithelium
    2- Located predominately in the cortex
    3- 80-85% of all primary malignant tumors of the kidney
    4- 2-3% of all cancers in adults
    5- 30,000 cases/year
    6- 40% of patients die from the disease
    7- Most common in the 6th-7th decades of life
    8- Men affected twice as common as women
    9- Increased risk:
    0o Smokers
    1o Occupational exposure to cadmium
    2o Acquired polycystic disease secondary to chronic dialysis (30 fold
    increased risk)
    3
    10 Renal cell carcinoma classifications
    11. Clear cell carcinoma
    22. Papillary renal cell carcinoma
    33. Chromophobe renal cell carcinoma
    1
    21. Clear cell carcinoma:
    1- Most common type of renal cell carcinoma (70-80%)
    2- Morphology:
    1o Usually solitary and large
    2o Grossly is yellow to orange to gray-white with areas of cystic
    softening and hemorrhage
    3o Well defined margins
    4o Some may develop satellite nodules
    5o Can invade into the renal vein (may extend into the IVC to the
    heart)
    6o Can directly invade into the perinephric fat
    7o Microscopically: cells appear vacuolated or may be solid…depends
    on the amount of lipid and glycogen present
    8o Nuclei are small and round
    3- Majority = sporadic
    4- Also occur in familial forms or in association with von Hippel-Lindau
    disease (VHL)
    1o VHL Disease:
    2 Autosomal dominant
    3 Predisposition to a variety of neoplasms:
    hemangioblastomas of the cerebellum and retina
    4 Hundreds of bilateral renal cysts and bilateral, often multiple
    clear cell carcinomas develop in 40-60% of the cases
    5 Patients with VHL inherit a germ line mutation of the VHL
    gene (3p25, a tumor suppressor gene) and lose the second
    allele by a somatic mutation
    6 Loss of both copies can give rise to clear cell carcinoma
    7 Loss of chromosomal segment of 3p14 to 3p26 is often seen
    in sporadic clear cell carcinoma

    12. Papillary Renal Cell Carcinoma


    1- 10-15% of all renal cell carcinomas
    2- Frequently multifocal and bilateral
    3- Familial and sporadic forms
    4- Chromosome involved: 7q31 = MET protooncogene
    1o MET gene = tyrosine kinase receptor
    2o An "overdose" of the MET gene (2-3 fold gain) in chromosome 7
    can spur abnormal growth of tubular epithelial cell precursors of
    papillary renal cell carcinoma
    3o Trisomy of chromosome 7 along with mutations of the MET gene
    are seen commonly in familial papillary renal cell carcinoma
    5- Morphology:
    1o Papillary formations with fibrovascular cores
    2o Can have clear cells or more commonly cells with a pink cytoplasm

    13. Chromophobe Renal Cell Carcinoma


    1- Least common type (5%)
    2- Cells stain more darkly than clear cell type
    3- Tumor cells have multiple losses of entire chromosomes hypodiploidy
    4- Good prognosis (in general)

    Renal Cell Carcinoma Clinical Course


    1- Most frequent presenting manifestation = hematuria (>50% of cases)
    2- If tumor is large = flank pain and a palpable mass
    3- Nonspecific extrarenal effects of tumor = fever and polycythemia
    1o Polycythemia from erythropoietin produced by tumor cells (5-10% of
    cases)
    4- In many cases, the primary tumor remains silent…only to be diagnosed
    after it metastasizes
    5- Prevalent metastatic sites: lungs and bone
    6- Tumor presents in many fashions, but the following triad is characteristic:
    1o PAINLESS HEMATURIA
    2o LONG-STANDING FEVER
    3o DULL FLANK PAIN

    B. Wilms Tumor
    1- 3rd most common organ cancer in children < 10 years old
    2- Infrequent in adults
    3- Variety of cell and tissue components which are all derived from mesoderm
    4
    0III. Tumors of the Urinary Bladder and
    1Collecting System
    2
    5- Transitional epithelium lines the collecting system
    6- Collecting system tumors above the bladder = relatively uncommon
    7- Dominant clinical presentation = painless hematuria

    Bladder Tumors
    1- Bladder tumors = more frequent cause of death than kidney tumors
    2- Bladder tumors range from benign papillomas to invasive cancers

    Benign Papillomas
    1 Rare
    2 Frond like structures with a delicate fibrovascular core that
    are covered by multiple layers of well- differentiated transitional
    epithelium
    3 Usually solitary and rarely recur after removal

    Malignant tumors
    1 Used to be called transitional cell carcinomas
    2 New terminology: urothelial carcinoma
    3 Range from flat to papillary, from noninvasive to invasive,
    and from well differentiated to highly anaplastic
    4 Grading of tumors
    0o Grade I: well differentiated
    1o Grade II
    2o Grade III: highly anaplastic and aggressive
    1- Bladder Cancer Clinical Course:
    1o Men 3x as frequent as women
    2o 50-70 years old
    3o 50x more common in those exposed to B-naphthylamine
    4o Increased incidence with: smoking, chronic cystitis,
    schistosomiasis, and certain drugs (cyclophosphamide)
    5o Clinical significance of bladder cancer depends on:
    6 Histologic grade and differentiation of tumor
    7 Depth of invasion (**most important**)
    2o Deep bladder wall infiltration = 5 year survival rate < 20%
    3o Overall survival rate: 57%

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