renal tumours
DESCRIPTION
Renal tumours . Dr. Hawre Qadir Salih. Renal neoplasms. Benign neoplasms ■ Adenoma ■ Angioma ■ Angiomyolipoma Malignant neoplasms ■ Wilms’ tumour (nephroblastoma in children) ■ Grawitz’s tumour (adenocarcinoma, hypernephroma) ■ Transitional cell carcinoma of the renal pelvis and - PowerPoint PPT PresentationTRANSCRIPT
RENAL TUMOURS Dr. Hawre Qadir Salih
Renal neoplasms
Benign neoplasms■ Adenoma■ Angioma■ AngiomyolipomaMalignant neoplasms■ Wilms’ tumour (nephroblastoma in children)■ Grawitz’s tumour (adenocarcinoma,
hypernephroma)■ Transitional cell carcinoma of the renal pelvis andcollecting system■ Squamous carcinoma of the renal pelvis
Adenoma
cortical tumour asymptomatic Dx : incidentally, postmortem
examination or US
Angioma
profuse haematuria young adults Need renal angiography to Dx bleeding.
Angiomyolipoma
Unusual tumour Often but not always associated with
tuberous sclerosis CT typical appearance( high fat content ) Malignant elements in about one-quarter
and may lead to metastasis
Wilms’ tumour (nephroblastoma)
Usually Dx in the first 5 years of life Usually in one pole of one kidney. Bilateral tumors is a big problem Pathology : coffee coloured. Rapidly growing Soft and friable
Big mass compared with the tiny patient. Some are hypertensive. Haematuria : extension to renal pelvis( poor
prognosis ). US, CT or MRI: solid SOL with or without
venous invasion, contralateral disease and distant spread.
Metastasis to the lungs (early)
Treatment Best in specialist paediatric oncology units. Unilateral tumours : chemotherapy followed by
nephrectomy. Bilateral disease: Partial nephrectomy
Bad prognosis: Metastasis Older children Bilateral diseases
Renal neoplasm in adults
Hypernephroma (Grawitz’s tumour) Adenocarcinoma Most common (75% ) Arises from renal tubular cells. Usually in one pole of one kidney( mostly
upper )
Spread renal vein Lungs ( cannonball) LN Bones
Clinical features Men > women Haematuria usually the presenting
symptom, sometimes clot colic Pain Mass Rapid sudden varicocele in adult (rare) Atypical presentations fever,
pain ,polycythemia
Dx
Treatment Radical nephrectomy :
transabdominal,transperitoneal Partial nephrectomy : less than 7 cm
polar tumour Poor response to chemo or radiotherapy
Poor prognosis Renal vein or IVC involvement Positive LN Extension beyond capsule
Transitional cell tumours of the renal pelvis
resemble those of the UB but less common.
May be multifocal About half will have tumours in the
bladder at some stage. Follow-up cystoscopy with regular IVU is therefore necessary to detect recurrent tumours
Haematuria most common symptom Mass
Treatment Nephroureterectomy. ureter must be
disconnected with a cuff of bladder wall. If this is done by open surgery a second incision is needed to remove the kidney.
Squamous cell carcinoma of the renal pelvis
rare chronic inflammation e.g. stone. radiosensitive prognosis is poor.
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