renal cell carcinoma for students
DESCRIPTION
Causes, pathogenesis, Morphology, stages and prognosisTRANSCRIPT
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Renal Cell Carcinoma
Lecturer 53
Tumors of the Kidney
Adenocarcinoma of the Kidney
Hypernephroma
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HYPERNEPHROMA- RCC• 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.
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Renal Adenocarcinoma
• It is now clear that all these tumors arise from tubular epithelium and are therefore
RENAL ADENOCARCINOMAS.
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Epidemiology• Male predominance (1.6:1.0 M:F)• Highest incidence between age 60-80-Median age of diagnosis is 66 years-Median age of death 70 years• Highest incidence in Scandinavia and North
America, lowest in Africa
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Risk Factors
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Causes/ Risk Factors
• There is also an increased incidence in
patients with chronic renal failure and acquired cystic disease and in
tuberous sclerosis.
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RCC•Most renal cancer is
sporadic, but unusual forms of
autosomal dominant familial cancers occur, usually in
younger individuals.
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Classification of RCCThe major types of RCC are as follows:• 1. Clear cell carcinoma -70-80%, 95%
Sporadic• 2. Papillary carcinoma- 10-15%• 3. Chromophobe renal carcinoma- 5%• 4. Collecting duct (Bellini duct) carcinoma-
1% 0r less
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Pathogenesis of VHL• Von Hippel-Lindau protein, product of VHL gene,
is a tumor suppressor • VHL inhibits hypoxia-inducible genes involved in
angiogenesis such as VEGF, TGF-a, GLUT-1• VHL destabilizes and promotes ubiquination of
HIF-a (hypoxia-inducible factor) • Loss of VHL results in tumor angiogenesis, tumor-
cell proliferation, epithelial cell proliferationGlucose transporter 1Ubiquination: a small polypeptide, found in most eukaryotic cells, that combines with other proteins to
make them susceptible to degradation
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Morphology•Renal cell carcinomas may
arise in any portion of the kidney, but more commonly affects the
poles.
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RCC Morphology• One of the striking
characteristics of renal cell carcinoma is its tendency to invade the renal vein and grow as a solid column of cells within this vessel.
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Clear cell Carcinomas
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Morphology- Papillary Carcinomas
• Papillary carcinomas are the most common type of renal cancer in patients who develop dialysis-associated cystic disease.
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Microscopy- Papillary Carcinoma
• Papillary carcinoma is composed of cuboidal or low columnar cells arranged in papillary formations.
• Interstitial foam cells are common in the papillary cores.
• Psammoma bodies may be present. • The stroma is usually scanty but highly
vascularized.
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Chromophobe renal carcinoma• Chromophobe renal carcinoma is made up of
pale eosinophilic cells, often with a
perinuclear halo, arranged in
solid sheets with a concentration of
the largest cells around blood vessels.
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Collecting duct carcinoma
• Collecting duct carcinoma is a rare variant showing irregular channels lined by highly atypical epithelium with a hobnail pattern.
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RCC•Sarcomatoid changes
arise infrequently in all types of renal cell carcinoma and are a decidedly
ominous feature.
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Renal cell carcinoma. Typical cross-section of yellowish, spherical neoplasm in one pole of the kidney. Note the tumor in the dilated thrombosed renal vein.
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Paraneoplastic Syndromes
1. Polycythemia, 2. Hypercalcemia,3. Hypertension,4. Hepatic dysfunction, 5. Feminization or masculinization, 6. Cushing syndrome, 7. Eosinophilia, 8. Leukemoid reactions, and9. Amyloidosis.
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RCC
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Clinical Presentation• Most asymptomatic • Hematuria present 40% of patients• Classic triad: flank pain, hematuria, palpable
abdominal mass occur in 9% of patients• 45% present with localized disease, • 25% with locally advanced disease,• 30% with metastatic disease
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Treatment•Nephrectomy has been the
treatment of choice, but
•Partial nephrectomy to preserve renal function is being done with increasing frequency and similar outcome.
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