Transcript Renal Tumor

Tumors
of
Urinary Tract
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Urinary Tract Neoplasm
Kidney
Renal Cell Carcinoma [ adult],
Transitional cell carcinoma [ adult],
Wilms Tumor [children]
Ureter /
Urethra
Urinary
Bladder
Transitional Cell Carcinoma
Transitional Cell Carcinoma
(common)
Uncommon is Squamous cell
Carcinoma
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Renal Tumors
Tumors of kidney
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Renal Tumors
Benign
[Usually small]
Cortical Papillary Adenoma
[< .5 cm]
Common finding at autopsy.
Angiomyolipoma.
Malignant
Renal Cell Carcinoma
[ RCC ]
Nephroblastoma (Wilms
Tumor)
Primary tumor of calyces
and Pelvis
(TCC)
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Renal cell carcinoma
• Male > Female :: age 50-70 years.
• Risk :
– Smoking, cadmium ( food, battery or
plastic factory, Cigarettes)
– Acquired cystic disease, von- hippel
Lindau syndrome ( Ch 3) .
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Morphology
• Gross:
– Yellow, circumscribed mass in upper pole
– Invade renal vein→ vena cave and reach
right heart ( metastasis).
– Invade adrenal → Addison disease.
• Microscopic types:
– Clear cell carcinoma= MOST COMMON
– Papillary carcinoma
– Chromophobe carcinoma
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Key words ; Renal cell carcinoma
Clear Cell
Carcinoma
Associated with
Most common
Von Hippel- Lindau
(VHL) disease.
Papillary Renal
Cell Carcinoma
Associated with
Bilateral and
MET protoMultifocal
oncogene mutation
Chromophobe
Multiple loss of
Renal Carcinoma various
chromosome
Good
Prognosis
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RCC ( clear cell carcinoma)
Cancer cells with
clear cytoplasm.
It contain glycogen.
PAS +ve.
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RCC
• Metastasis: Lung and bone
• Bone: produce osteolytic lesion and cause
pathological fracture.
• Marker of bone mets.: ↑alkaline phosphatase
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Clinical for all RCC
• Silent
• Classic triad: Hematuria, mass, pain or fever.
• Paraneoplastic syndromes:
– Polycythemia ( erythropoietin):: Hct > 60%
– Hypercalcemia ( PTH like hormone)
– Cushing syndrome ( ACTH)
– Feminization / Musculinization (↑
gonadotrophin).
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Wilms tumor ( nephroblastoma)
Age: 2-5 y, present as abdominal mass
extended into the pelvis.
Syndromes:
WAGR syndrome
Denys-Drash Syndrome
Beckwith-widemann Syndrome
Genes:
WT 1 ( Ch11p13) and WT 2 (11p15).
(tumor suppressor gene)
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WAGR
syndrome
Denys-Drash
Syndrome
Beckwithwidemann
Syndrome
A = aniridia, G = genital
abnormality, R = mental
retardation
Gonadal Dysgenesis and
renal abnormality.
Enlargement of Individual
organ (macroglossia).
Enlargement of entire body
segment (hemihypertrophy).
Enlargement of adrenal
cortical gland.
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Morphology and prognosis
• Gross: lobulated, tan mass
• Micro:
– Blastemal cells
– Epithelial elements
– Stroma
• Prognosis:
– Excellent, long term survival 90%
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Morphology
Small blue
blastemal cells
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Transitional cell carcinoma in renal
pelvis.
Note: Papillary growth;
irregular cauliflower like
surface.
May follow
acetaminophen
poisoning.
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TUMORS OF THE URINARY BLADER
AND
COLLECTING SYSTEM
Usual Type -Transitional Cell Carcinoma
(TCC)
(Urothelial Neoplasm)
Tumors of the Lower urinary tract are about
twice as common as renal Cell
carcinomas.
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It frequently produces obstructive
features (common than metastasis).
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Types
• Transitional cell carcinoma
• Squamous cell carcinoma
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Transitional cell carcinoma
• Male > female :: Age: 40-60 years
• Risk (carcinogens)
– Smoking
– beta naphthylamine,
– Chronic cystitis
– Aniline dye.
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Types: superficial (non invasive) and deep.
Most TCC are Papillary tumor,
Produce cauliflower like mass
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Cauliflower like mass
Superficial Papillary tumor
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Genes
• Superficial neoplasm (tumors):
– deletion of Ch 9
• Invasive bladder neoplasm :
– Mutation of Rb and TP53 gene.
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Squamous cell carcinoma
Common in Middle east
Risk:
Schistosoma hematobium
(host is snail).
Micro: squamous cell
carcinoma
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Clinical of all bladder tumor
1. Pain less hematuria
2. Urine: atypical cells
3. Prognosis:
1. High incidence of recurrence.
2. Depends upon grade and stage
4. Bad prognosis
1. High pleomorphism ( anaplasia) of the
cells.
2. Invasion
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Angiomyolipoma.
• A hamartoma
• Micro: Blood vessels,
fat, smooth muscle
• Associated with:
tuberous sclerosis
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THANK
YOU
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