renal tumors-1 dr. abdelaty shawky assistant professor of pathology 1
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Renal tumors-1 Renal tumors-1 Dr. Abdelaty ShawkyDr. Abdelaty Shawky
Assistant professor of pathologyAssistant professor of pathology
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* Classification of Renal tumors:
I. Benign tumors:I. Benign tumors:
•Cortical adenoma.
•Oncocytoma.
II. Malignant tumors: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 adenomaRenal 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 papillomatous structures,
tubules, and glands.
•The cells are cuboidal in shape and have small
central nuclei, scanty cytoplasm, and no atypia.
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Renal adenoma
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Renal oncocytoma
* Clinical Features:
•Most cases 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.
•Bilateral or multicentric in 2% to 3% of cases
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Renal Renal oncocytomaoncocytoma
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• On microscopic examination: the
tumor consists of large, eosinophilic cells
having small nuclei that have large nucleoli.
The cells are arranged in nests separated by
edematous and hyalinized fibrous stroma.
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Renal oncocytomaRenal oncocytoma
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Renal cell carcinomaRenal 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 in the ratio of 3:1.
•Most renal cancer is sporadic, but unusual forms are a
familial. 14
* 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 dialysis15
* 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.1. Clear cell RCC.
2. Papillary RCC.2. Papillary RCC.
3. Chromophobe RCC. 3. Chromophobe RCC.
4. Collecting duct carcinoma.4. Collecting duct carcinoma.
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1. Clear cell RCC.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 golden-yellow
cut surface.• Cystic change, hemorrhage, necrosis, and
calcification often present21
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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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