Renal tumours
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Transcript of Renal tumours
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RENAL TUMOURS Dr. Hawre Qadir Salih
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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
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Adenoma
cortical tumour asymptomatic Dx : incidentally, postmortem
examination or US
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Angioma
profuse haematuria young adults Need renal angiography to Dx bleeding.
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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
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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
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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)
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Treatment Best in specialist paediatric oncology units. Unilateral tumours : chemotherapy followed by
nephrectomy. Bilateral disease: Partial nephrectomy
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Bad prognosis: Metastasis Older children Bilateral diseases
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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 )
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Spread renal vein Lungs ( cannonball) LN Bones
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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
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Dx
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Treatment Radical nephrectomy :
transabdominal,transperitoneal Partial nephrectomy : less than 7 cm
polar tumour Poor response to chemo or radiotherapy
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Poor prognosis Renal vein or IVC involvement Positive LN Extension beyond capsule
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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
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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.
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Squamous cell carcinoma of the renal pelvis
rare chronic inflammation e.g. stone. radiosensitive prognosis is poor.
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Thank u