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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
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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
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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.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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