This document discusses renal cell carcinoma (RCC), which accounts for 85% of renal tumors. RCC most commonly affects men between 50-70 years old. Pathology shows tumors originating from tubular epithelium that can be cystic or solid. Bilateral and multicentric RCC can occur in patients with certain conditions. RCC spreads locally and to distant sites like lungs and bones. Presenting symptoms include hematuria, flank pain, or incidental discovery on imaging. Diagnosis involves imaging like CT, MRI, ultrasound and biopsy to identify tumors and metastases.

1. Genito-Urinary
Tumors
Episode 4 “The Malignant Evil”

2. Genito-Urinary Tumors
Renal Cell Carcinoma
(RCC)

3. Renal Cell Carcinoma
Incidence:
• 85% of renal tumors.
• ♂:♀ = 2:1
• Age: 50-70 Yrs.

4. Renal Cell Carcinoma
Pathology:
• Tubular epithelium.

5. Renal Cell Carcinoma
Pathology:
• Vary from being nearly
completely cystic to being
completely solid.

6. Renal Cell Carcinoma
Pathology:
Bilateral RCCs:
1. Von Hippel-Lindau syndrome
2. Tuberous sclerosis.
3. Chronic dialysis.
4. 2% of sporadic cases.
Multicentric RCC:
- 25% of patients.

7. Renal Cell Carcinoma
Pathology:
Spread:
1. Direct local invasion of adjacent structures.
2. Local regional lymph node metastases.
3. Extend into the renal vein and, subsequently,
into the inferior vena cava.
4. The lungs are the most common sites of distant
metastases.
NB: Typically, skeletal metastases are purely lytic.

8. Renal Cell Carcinoma
Clinical:
• Hematuria, flank pain, or less frequently a flank mass.
• Incidentally during imaging.
• Occasionally, patients present with systemic symptoms
such as fever, nausea, anorexia, and weight loss.
• Rarely, patients have symptoms related to humoral
factors such as parathormone, prolactin, erythropoietin,
or renin.

9. Renal Cell Carcinoma
Plain X-Ray:
• Normal.
• Distort the normal renal contour.
• Calcifications.
• Metastasis.

10. Renal Cell Carcinoma
IVU:
• Normal.
• Mass effect on the collecting system.
• Distortion of the renal contour.
• Enlargement of a portion of the kidney.
• Poor or absent contrast material
excretion
• Calcifications.

11. Renal Cell Carcinoma
US:
• Variable solid or cystic.
• RCC can be isoechoic, hypoechoic,
or hyperechoic.

12. Renal Cell Carcinoma
CT:
NECT:
• Isodense, hypodense, or
hyperdense.
• Calcifications may be present and
are usually amorphous and internal.
• Metastasis.

13. Renal Cell Carcinoma
CT:
NECT:
• Isodense, hypodense, or
hyperdense.
• Calcifications may be present and
are usually amorphous and internal.
• Metastasis.

14. Renal Cell Carcinoma
CT:
NECT:
• Isodense, hypodense, or
hyperdense.
• Calcifications may be present and
are usually amorphous and internal.
• Metastasis.

15. Renal Cell Carcinoma
CT:
NECT:
• Isodense, hypodense, or
hyperdense.
• Calcifications may be present and
are usually amorphous and internal.
• Metastasis.

16. Renal Cell Carcinoma
CT:
CECT:
• Solid, and evidence of necrosis is
often present.

17. Renal Cell Carcinoma
CT:
CECT:
• Predominantly cystic mass, with
thick septa and wall nodularity.

18. Renal Cell Carcinoma
CT:
CECT:
• Predominantly cystic mass, with
thick septa and wall nodularity.

19. Renal Cell Carcinoma
CT:
CECT:
• Completely solid enhancing mass.

20. Renal Cell Carcinoma
CT:
CECT:
• Metastasis.

21. Renal Cell Carcinoma
CT:
CECT:
• Metastasis.

22. Renal Cell Carcinoma
CT:
CECT:
• Metastasis.

23. Renal Cell Carcinoma
MRI:
Masses ranging from predominantly
cystic with septa or nodularity to solid
with enhancement

24. Renal Cell Carcinoma
MRI:
T1WI:
• Isointense or hypointense.
• The presence of necrosis or
hemorrhage may alter these signal
intensity characteristics.

25. Renal Cell Carcinoma
MRI:
T2WI:
• Hyperintense & heterogeneous

26. Renal Cell Carcinoma
MRI:
• Metastasis.

27. Test