A 60-year-old male presented with painless hematuria and an abdominal lump. On examination, a palpable lump was found. Differential diagnoses included renal cell carcinoma (RCC), given the patient's age and presenting symptoms of hematuria and abdominal lump. RCC is the most common type of kidney cancer in adults. It typically presents in individuals aged 40-60 years and is more common in males. Risk factors include smoking and occupational exposures like asbestos. On pathology, RCC appears as a homogenous yellow mass replacing the renal parenchyma, with microscopically visible clear and dark cells lining blood vessels - explaining its early metastatic potential.

1. 60 year old male came with
complains of painless hematuria
and a palpable abdominal lump

2. ANATOMY
- Retroperitoneal organ
- Right kidney L1-L3
- Left kidney T12-L2
Left kidney is little nearer to median plane than right
The kidneys are mobile organs that move vertically within
the retroperitoneum during normal respiration
external features
Shape:bean shaped
2 poles: upper & lower
2 Border: medial & lateral
2 Surface: anterior & posterior
Size: approx. 11–14 cm in length, 6 cm wide and 3cm thick
Weight: around 150 gm. in males & 135 gm. in females

3. RELATIONS
Anterior posterior

4. Coverings and Hilum of the kidney

5. Blood Supply
• Arterial supply by the renal arteries which are direct branches from abdominal aorta
• Entire arterial system is composed of end artries hence prone for infarction
• Venous drainage through the renal veins which drains into the inferior vena cava.
• veins anastomose freely
• Lymph Drainage
• The right kidney drains predominantly into the paracaval and interaortocaval lymph nodes
• left kidney drains exclusively to the para-aortic lymph nodes
• Nerve Supply:
• Through renal sympathetic plexus (T10 – L1) fibres, mainly vasomotor.
• Afferent nerves T10 to T12 thoracic nerves.
• Functions
• Excretion of wastes,
• Acid-base homeostasis,
• Osmolality regulation, Blood pressure regulation and Hormone secretion

6. INTERNAL STRUCTURES

7. DIFFERENTIAL DIAGNOSIS OF HEMATURIA
KEY POINT
-painless hematuria (papilloma and
carcinoma)
-Age –elederly (RCC)
-abdominal lump (polycyctic kidney ,
wilms tumor,
Renal cell carcinoma)

8. NEOPLAMS OF THE KIDNEY
• Benign
• Adenoma
• Papilloma arising from pelvis
• Hemangioma
• Malignant
• Renal Cell Carcinoma (Adenocarcinoma of Kidney)-MOST COMMON
• Transistional cell carcinoma
• Squamous cell carcinoma –EXTREMELY RARE

9. RENAL CELL CARCINOMA
• It is also called Hypernephroma or Grawitz tumor
• Commonly found in age group of 40 to 60 years
• Predominantly seen in males
• Aetiology :specific oncogenes are associated with different variants of
RCC
Clear cell
75%
Type
Incidence
Associated
mutations VHL
Papillary type 1
5%
c-Met
Papillary type 2
10%
FH
Chromophobe
5%
BHD
Oncocytoma
5%
BHD

10. Risk Factors
• Tobacco smoking
contributes to 24-30% of RCC cases
Tobacco results in a 2-fold increased risk
Environmental:
Cadmium, thorium-di-oxide,
petroleum
aresenic
phenacetin analgesics.
Occupational:
Leather workers
Asbestos workers
10

11. PATHOLOGY
• Nearly all renal cancers In adults are adenocarcinomas
• They arise from the proximal tubular epithelium
• Starts in one of the poles and usually ruptures outside
the capsule hence the reniform shape of the kidney is
maintained unlike wilms tumor.
• On the outer surface it is homogenous and yellow in
color
• Microscopically alternate clear cells and dark cells are
seen
• Tumor cells line the blood vessels which are
responsible for early blood spread.

12. THANK YOU
• Gauri Kulkarni