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Renal cell carcinoma for students

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Causes, …

Causes,
pathogenesis,
Morphology, stages and prognosis

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  • 1. Renal Cell Carcinoma Lecturer 53 Tumors of the Kidney Adenocarcinoma of the Kidney Hypernephroma
  • 2. HYPERNEPHROMA- RCC • Because of their gross yellow color and the resemblance of the tumor cells to clear cells of the adrenal cortex, they were at one time called Hypernephroma.
  • 3. Renal Adenocarcinoma • It is now clear that all these tumors arise from tubular epithelium and are therefore RENAL ADENOCARCINOMAS.
  • 4. Epidemiology • Male predominance (1.6:1.0 M:F) • Highest incidence between age 60-80 -Median age of diagnosis is 66 years -Median age of death 70 years • Highest incidence in Scandinavia and North America, lowest in Africa
  • 5. Risk Factors
  • 6. Causes/ Risk Factors • There is also an increased incidence in patients with chronic renal failure and acquired cystic disease and in tuberous sclerosis.
  • 7. RCC • Most renal cancer is sporadic, but unusual forms of autosomal dominant familial cancers occur, usually in youngerindividuals.
  • 8. Classification of RCC The major types of RCC are as follows: • 1. Clear cell carcinoma -70-80%, 95% Sporadic • 2. Papillary carcinoma- 10-15% • 3. Chromophobe renal carcinoma- 5% • 4. Collecting duct (Bellini duct) carcinoma- 1% 0r less
  • 9. Pathogenesis of VHL • Von Hippel-Lindau protein, product of VHL gene, is a tumor suppressor • VHL inhibits hypoxia-inducible genes involved in angiogenesis such as VEGF, TGF-a, GLUT-1 • VHL destabilizes and promotes ubiquination of HIF-a (hypoxia-inducible factor) • Loss of VHL results in tumor angiogenesis, tumor-cell proliferation, epithelial cell proliferation Glucose transporter 1 Ubiquination: a small polypeptide, found in most eukaryotic cells, that combines with other proteins to make them susceptible to degradation
  • 10. Morphology •Renal cell carcinomas may arise in any portion of the kidney, but more commonly affects the poles.
  • 11. RCC Morphology • One of the striking characteristics of renal cell carcinoma is its tendency to invade the renal vein and grow as a solid column of cells within this vessel.
  • 12. Clear cell Carcinomas
  • 13. Morphology- Papillary Carcinomas • Papillary carcinomas are the most common type of renal cancer in patients who develop dialysis-associated cystic disease.
  • 14. Microscopy- Papillary Carcinoma • Papillary carcinoma is composed of cuboidal or low columnar cells arranged in papillary formations. • Interstitial foam cells are common in the papillary cores. • Psammoma bodies may be present. • The stroma is usually scanty but highly vascularized.
  • 15. Chromophobe renal carcinoma • Chromophobe renal carcinoma is made up of pale eosinophilic cells, often with a perinuclear halo, arranged in solid sheets with a concentration of the largest cells around blood vessels.
  • 16. Collecting duct carcinoma • Collecting duct carcinoma is a rare variant showing irregular channels lined by highly atypical epithelium with a hobnail pattern.
  • 17. RCC •Sarcomatoid changes arise infrequently in all types of renal cell carcinoma and are a decidedly ominous feature.
  • 18. Renal cell carcinoma. Typical cross-section of yellowish, spherical neoplasm in one pole of the kidney. Note the tumor in the dilated thrombosed renal vein.
  • 19. Paraneoplastic Syndromes 1. Polycythemia, 2. Hypercalcemia, 3. Hypertension, 4. Hepatic dysfunction, 5. Feminization or masculinization, 6. Cushing syndrome, 7. Eosinophilia, 8. Leukemoid reactions, and 9. Amyloidosis.
  • 20. RCC
  • 21. Clinical Presentation • Most asymptomatic • Hematuria present 40% of patients • Classic triad: flank pain, hematuria, palpable abdominal mass occur in 9% of patients • 45% present with localized disease, • 25% with locally advanced disease, • 30% with metastatic disease
  • 22. Treatment •Nephrectomyhas been the treatment of choice, but •Partial nephrectomy to preserve renal function is being done with increasing frequency and similar outcome.