4. Are non-cancerous growths of the kidney that do
not metastasize to other sites in the body .
They are not life-threatening but they can
cause complaints if they exert pressure
effects on adjacent structures.
As there is universal increase in the use of
radiological imaging, benign renal masses
are being detected more frequently .
5. Most common benign renal parenchymal tumor.
Discovered occasionaly at postmortem or incidentally
during radiological imaging .
Asymptomatic .
Despite the classification of adenoma as a
benign tumor, difficult to differentiate from
renal carcinoma.
Unknown etiology . Small
and slow growing .
Look very much like malignant RCCs.
Previously, all renal tumors <3 cm were considered
adenomas. However, even such small tumors
can be of high grade .
7. Benign, unifocal renal tumor that averages 5 to 8 cm in
diameter but can reach larger sizes; however, the
presence of malignant elements has been known to
occur.
More often in men than women .
Unknown etiology .
Found incidentally .
Partial or radical nephrectomy is the safest method of
treatment because of unreliability of differentiating it
from RCC preoperatively. .
8.
9. Unusual tumors of the kidney .
Often but not always associated with TUBEROUS
SCLEROSIS .
Histologically, they are composed of fat cells,
blood vessels, and sheets of smooth
muscle cells.
Profuse internal hemorrhage can occur.
10. Malignant elements are present in about one-
quarter of them and may lead to metastasis
.
Asymptomatic lesions smaller than 4 cm should be
followed with yearly ultrasounds.
Larger tumors should be considered for
embolization or renal-sparing surgery.
Conservative surgical therapy is necessary
because of frequent bilaterality and multiplicity.
11. Rare .
Small .
Typically found in smooth muscle –containing
areas of the kidney including renal capsule and
renal pelvis .
13. Seen in middle aged females
.
Best detected radio-logically by CT scan
. ( due to high fat content .)
14. Very small in size ( average 0.5 cm ) or less
Asymptomatic .
More commonly found in women than men.
Usually occur on the rim of the kidney
May reach large size before being detected
.
Because they can’t be distinguished from malignant growths, they
are often removed through partial or complete nephrectomy .
15. This small round white nodule in the medulla is
an incidental autopsy finding. They are
generally 0.5 cm in size or less.
fibroma
19. EPIDEMIOLOGY
-The most common neoplasm of the kidney
(75%) or up to 85% .
- Arises from renal tubular cells .
- ( 2 – 3 ) % of all adulthood cancers .
- ( 40 % ) of patients die of cancer .
- Most common in 6th& 7thdecades .
- Male : Female ratio 2:1
20. RISK FACTORS
Male gender .
Race ( African Americans > Caucasians
) Age ( 40 – 60 )
Smoking ( increase risk by 40%
) Obesity
High caloric diet
Lack of physical activity.
Occupational exposure ( asbestose ,cadmium
) Family history of RCC .
Specific treatments like dialysis – drugs
certain pain relievers - like Phenacetin, diuretics
23. Renal cell carcinoma arising in the middle pole of the kidney. Fairly circumscribed, The cut surface
demonstrates a yellowish areas, white areas, brown areas, and hemorrhagic red areas.
RCC
24. Occur anywhere in the urinary tract, but they are
most common in the bladder.
Smoking, exposure to analine or azo dyes,
and napthylamine exposure are known to
be associated with urothelial cancers.
Urothelial tumors often are multicentric .
These patients need careful follow-up.
27. - Rare .
-Often associated with chronic inflammation
resulting from stones.
- Metastasize early and the prognosis is poor
.
-Radiosensitive
28. - More than 50% of these tumors are
asymptomatic.
Classic triad: pain, hematuria, and flank mass occur only rarely and indicate
advanced disease.
More frequent sign and symptoms are:
Pain
Hematuria
Flank mass
Weight loss
Hypertension
Hypercalcemia
Erythrocytosis
Varicocele, usually left sided, due to obstruction of the
testicular vein.
29. Paraneoplastic syndromes may occur as a result of renal tumor production of
1,25 dihydroxycholecalciferol, rennin, erythropoietin, and other hormone
substances
RCC is known to produce biologically active products
that result in clinically significant syndromes, including;
Adrenocorticotropic hormone (Cushing’s syndrome),
Prolactin (galactorrhea),
Insulin (hypoglycemia),
Gonadotropins (gynecomastia and decreased libido; or
hirsutism, amenorrhea, and male pattern balding).
A paraneoplastic syndrome confer a poor prognosis.
Patients whose paraneoplastic metabolic disturbances
fail to normalize after nephrectomy suggests presence of
clinically undetectable metastatic disease and have very
poor prognosis.
30. Stauffer’s syndrome is a reversible syndrome
of hepatic dysfunction in the absence of hepatic
metastases associated with RCC and can occur
in up to 20% of patients.
Hepatic function abnormalities include elevation
of alkaline phosphatase and bilirubin,
hypoalbuminemia, prolonged prothrombin time,
and hypergammaglobulinemia.
Stauffer’s syndrome tends to occur in
association with fever, fatigue, and weight loss
and typically resolves after nephrectomy. It may
be due to overproduction of granulocyte-
macrophage colony stimulating factor by the
tumor.
31. Hypertension, supraclavicular adenopathy, and flank or
abdominal mass with bruit.
Approximately 30% of patients with renal carcinoma
present with metastatic disease.
Metastatic disease involve organs ;
Lung (75%)
Soft tissues (36%)
Bone (20%)
Liver (18%)
Cutaneous sites (8%)
Central nervous system
(8%)
Varicocele and findings of paraneoplastic syndromes
raise clinical suspicion for this diagnosis.
.
32. Laboratory studies in the evaluation of renal cell carcinoma should
include a workup for paraneoplastic syndromes. Initial studies
- Complete Urine analysis
-CBC
-Electrolytes
-Renal profile
Liver function tests
Calcium
ERS
PT
APTT
Other tests indicated by presenting symptoms
33. IMAGING ; IVU ; to fully evaluate upper & lower UT
CT
- A CT scan without and with intravenous (IV) contrast (renal protocol) is the
method of choice to evaluate a renal mass .
- Any mass that enhances with IV contrast should be considered an RCC until
proven otherwise.
- CT provides information on renal vein and inferior vena cava
involvement, lymph node metastases, and perirenal involvment of
the adjacent organs.
MRI, help differentiate solid and cystic renal masses and is
particularly useful in patients who cannot receive IV contrast
agents.
MRI has become the best study to evaluate the IVC
for tumor thrombus.
34. Metastatic
Workup
Metastatic workup should include routine chest
radiograph, IVU, CT, liver function tests, and
serum calcium. A bone scan should be
obtained in any patient with skeletal pain or
other evidence of metastatic disease ..
35. 1 . Surgery :
Simple enculation
Partial nephrectomy .
Radical nephrectomy
.
Radical nephrectomy ; removal of kidney , perinephric fat,
fascia gerota,suprarenal gland, upper half of the ureter.
(lymph nodes not part pf radical nephrectomy).
Minimal invasive .
open/laparoscope
2. Chemo/radiotherapy .
36. Radical nephrectomy includes the
removal of the tumour-bearing kidney.
It remains the gold standard curative
therapy for patients with localised renal
cell carcinoma (RCC)
Nephron-sparing surgery considered for
patients with a localised tumour less than
4 cm in diameter.
It involves partial nephrectomy with
preservation of as much functioning
kidney tissue as possible.
37. Palliative
nephrectomy
In patients with Metastatic disease for alleviation of symptoms
such as pain, hemorrhage, malaise, hypocalcaemia,
erythrocytosis,
or hypertension.
Several randomized studies are now showing improved overall
survival in patients presenting with Metastatic kidney cancer
who have nephrectomy followed by either interferon or IL-2.
38. Patient who are not suitable candidates for surgery
Ablation:
Kidney tumors be removed (ablated) with intense heat or cold, in which
special needles are inserted through the skin, guided by imaging from a CT
scan and ultrasound.
Percutaneous cryoablation — Cryoprobes freeze the tumor with intense
cold. The treatment lasts about 30 minutes.
Percutaneous radiofrequency ablation — Electrodes deliver
radiofrequency energy to the tumor, and the intense heat destroys the
tumor in five to 15 minutes.
Angioemoblization
39. Unfortunately, RCC is very resistant to chemotherapy
and there is no standard effective treatment of RCC
with present-day chemotherapy drugs. Some drugs,
such as vinblastine, floxuridine, and 5-fluorouracil are
mildly effective.
Immune therapy; (interferon alpha , IL2)
Anti-angiogenesis therapies; to reduce the blood
supply to the tumor, slowing or stopping growth of
the tumor
Targeted therapies; to growth of the cancer
41. For stage I and II disease:
Complete history, physical examination, chest radiographs,
LFTs, BUN , serum creatinine, and calcium are recommended
every 6 months for 2 years and then annually for 5 years.
Abdominal CT scan is recommended once at 4-6 months .
For stage III renal cell carcinoma,
Physical examination, chest radiographs, LFTs, BUN, serum
creatinine, and calcium are recommended every 4 months for 2
years, then every 6 months for 3 years, and then annually for 5
years.
Abdominal CT scan should be performed at 4-6 months,
then annually or as indicated.
Careful surveillance of patients with end-stage renal disease
by ultrasonography and CT scan is recommended.
43. Epidemiology
Second most common pediatric abdominal tumor and
most common renal malignancy
Incidence of Wilms tumor is 8 cases per million
children under age 15
About 500 new cases per year
Accounts for 6% of all childhood malignant tumors
Presents between age 1-5; most commonly age 3
66% before age 5
95% before age 10
44. No tumor-specific symptoms
1/3rd patients may have anorexia, vomiting, malaise
Most common presentation is painless abdominal
mass
Physical Exam
Smooth, palpable large abdominal
mass May reveal HTN
Hematuria
Associated congenital abnormalities
Check labs – associated with Von Willebrand’s
Disease in up to 10% of cases
45. Is thought to rise from
foci of persistent
metanephric cells
called nephrogenic
rests
These normally occur in
1% of newborn kidneys
and regress in early
childhood
Multiple foci of
nephrogenic rests is
called
nephroblastomatosis
46. Wilms’ tumor consists of
three cell types
(a) Tubular
(b) Blastemal
(c) Stromal
All three are present in
Wilms’ tumor and
considered Favorable
Histology
47. Despite malignancy, excellent results if it can be
treated aggressively with combination of
radiotherapy, surgery and chemotherapy
Pts who receive pre-op chemo and those who
have primary resection have an equal rate of
complications, but more complications are seen in
the primary resection group.
48. A 3-year-old child has become more irritable over the past
two months and does not want to eat much at meals. On
physical examination the pediatrician notes an enlarged
abdomen and can palpate a mass on the right. An abdominal
CT scan reveals a 10 cm solid mass involving the right
kidney. The resected mass has a microscopic appearance
with sheets of small blue cells along with primitive tubular
structures. The child receives chemotherapy and radiation
therapy, and there is no recurrence.
Which of the following neoplasms is this child most likely to
have had?
A Angiomyolipoma
B Renal cell carcinoma
C Urothelial carcinoma
D Wilms tumor
49. A 50-year-old man has noted passing darker urine for
the past week. On physical examination there are no
abnormal findings. A urinalysis shows pH 5.5, specific
gravity 1.013, 2+ blood, no protein, and no glucose. A
urine cytology is performed and there are atypical
uroepithelial cells seen. A urologist performs a
cystoscopy, but no mucosal lesions are noted. He has
a 60 pack year history of smoking cigarettes.
Which of the following is the most likely diagnosis?
A Adenocarcinoma of prostate
B Urothelial carcinoma of renal pelvis
C Acute interstitial nephritis
D Nodular glomerulosclerosis
E Squamous cell carcinoma of penis
