Transcript PROGRESS IN RENAL CELL CARCINOMA

Renal tumors-1
Dr. Abdelaty Shawky
Assistant professor of pathology
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* Classification of Renal tumors:
I. Benign tumors:
• Cortical adenoma.
• Oncocytoma.
II. Malignant tumors:
• Renal cell carcinoma.
• Wilms tumor.
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• With the exception of oncocytoma, benign tumors
rarely cause clinical problems.
• Malignant tumors, on the other hand, are of great
importance clinically and deserve considerable
emphasis.
• By far the most common of these malignant tumors is
renal cell carcinoma that affects adults, followed by
Wilms tumor, which is found in children
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Renal cortical adenoma
* Clinical Features:
• Usually an incidental finding.
• Often seen in patients receiving long-term
hemodialysis, also more common in kidneys
scarred from chronic pyelonephritis.
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* Gross examination:
• The tumor is smaller than 5 mm.
• Soft, well-circumscribed mass with yellow to
gray cut surface surrounded by compressed
adjacent kidney parenchyma
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* Microscopic examination:
• They are composed of complex, branching,
papillomatous structures. The cells may also
grow as tubules, glands, and cords.
• The cells are cuboidal to polygonal in shape and
have regular, small central nuclei, scanty
cytoplasm, and no atypia.
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Renal adenoma
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Renal oncocytoma
* Clinical Features:
• Most are asymptomatic, although flank pain
may be a presenting complaint; hematuria
may be seen.
• CT or MRI may identify a central scar.
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* Gross Pathology:
• Well-circumscribed, homogeneous cortical tumor
• Mahogany-brown cut surface.
• Often shows a central, irregular fibrous scar (in about
40% of cases).
• Bilateral or multicentric in 2% to 3% of cases
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Renal
oncocytoma
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• On microscopic examination: the
tumor consists of large, eosinophilic cells
having small, round, benign-appearing nuclei
that have large nucleoli. The cells are arranged
in nests separated by edematous and
hyalinized fibrous stroma.
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Renal oncocytoma
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Renal cell carcinoma
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* Epidemiology:
• Renal cell carcinomas represent about 1% to 3%
of all visceral cancers and account for 85% of
renal malignancy in adults.
• The tumors occur most often in older
individuals, usually in the sixth and seventh
decades of life, showing a male preponderance
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in the ratio of 3:1.
• 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. It is now clear that all
these tumors arise from tubular epithelium
and are therefore renal adenocarcinomas.
• Most renal cancer is sporadic, but unusual
forms of autosomal-dominant familial cancers
occur, usually in younger individuals.
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* Risk factors for RCC:
1. Cigarette smoking is the most significant risk
factor.
2. Obesity (particularly in women).
3. Hypertension.
4. Unopposed estrogen therapy.
5. Exposure to asbestos, petroleum products,
and heavy metals.
6. Acquired polycystic kidney disease secondary
to dialysis
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* Clinical presentation of RCC:
1. Hematuria.
2. Flank pain.
3. Flank lump.
• This triad is seen in only 10% of cases. The most reliable
of the three is hematuria, but it is usually intermittent
and may be microscopic; thus, the tumor may remain
silent until it attains a large size.
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• Renal cell carcinoma tends to produce a diversity
of systemic symptoms not related to the kidney
termed paraneoplastic syndromes, ascribed to
abnormal hormone production including;
– Polycythemia.
– Hypercalcemia.
– Hypertension.
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– Hepatic dysfunction.
– Feminization or masculinization.
– Cushing syndrome.
– Leukemoid reactions.
– Amyloidosis.
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• One of the common characteristics of this tumor
is its tendency to metastasize widely before
giving rise to any local symptoms or signs.
• In 25% of patients with renal cell carcinoma,
there is radiologic evidence of metastases at the
time of presentation.
• The most common locations of metastasis are
the lungs (more than 50%) and bones (33%),
followed in order by the regional lymph nodes,
liver and adrenals, and brain.
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* Classification of Renal Cell Carcinoma:
1. Clear cell RCC.
2. Papillary RCC.
3. Chromophobe RCC.
4. Collecting duct carcinoma.
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1. Clear cell RCC.
• This is the most common type, accounting for
70% to 80% of RCC.
* Gross Pathology:
• Solitary renal cortical mass
• Bilaterality and multifocality more common in
familial cases.
• Well-circumscribed, lobulated with goldenyellow cut surface.
• Cystic change, hemorrhage, necrosis, and
calcification often present
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* Histopathology:
• Nests of clear cells interspersed by delicate
vascular network.
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References:
Robbins and Cotran’s:
Pathologic Basis of Disease.
Seventh edition.
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