Treatment • Localized disease:

Radical nephrectomy.

• Metstatic disease:

Radiation therapy. Immunotherapy

• PROGNOSIS: stage1 80-100% 5yrs survival

stageII 60% 5yrs survival.

Urethelial tumor of the renal pelvis

• 4% of urethelial tumors. Male-Female ratio 4-1. High incidence of multicentric.• Etiology: Risk factor: smoking industrial

dye,solvent, analgesic such as phenacetin,aspirin,caffeine,

acetaminophen.. Pathology: Majority are Transitional cell carcinoma. Rarely squamous cell carcinoma,or adenocarcinoma.

Pathology of TCC.

Metastasis:Regional LNs,Lung,bone.

Staging: TNM:Ta.Tis: confined to mucosa. T1 Invasion of lamina propria. T2 Invasion of muscularis. T3a Invasion of deep muscles. T3b Extension into fat or renal parechyma. T4 Spread to adjacent organs. N+ LNs Metastasis. M+ Distant metastasis.

Clinical Findings:

• Symptoms&Signs: Gross Hematuria. Flank pain. Flank mass(Hydronephrosis). Weight loss anorexia.• Laboratory: Hematuria. Urine cytology(voided urine or ureteric catheter).

X-ray

• I.V.U.

Retrograde Pyelogram:

Ureteropyeloscopy : Ultrasonography:

C.T.

Treatment:

Localized Tumor :- Nephroureterectomy.

- Conservative :open or endoscopic excision + instillation of immuno-0r chemotherapeutic

Single kidney. Bilateral tumors.

Metastatic Tumor: Chemotherapy.

Adrenal gland:

Benign Tumors:- Adenoma.

Malignant: - Neuroblastoma.

Neuroblastoma of Adrenal Gland

-Origin:Neural crest.- Age:1st 2 ½ yrs.- Poor prognosis.

- Hereditary.- Rarely bilateral.

Clinical Findings: Symptoms:

Abdominal mass (parent). Symptoms related to metastases (failure to thrive,

Fever,malaise,bone pain,constipation,diarrhea.)

Signs:

- Palpable,visible abdominal mass.- In metastatic patient: enlarged nodular liver,mass in

bone,ocular protrusion. - Hypertension.

Laboratory Findings:- Anemia.

- Increase level of serum epinephrine , nor epinephrine, and urinary VMA.

X-ray Findings: U.S, I.V.P, CT, Angiography.

Treatment:

Localized Tumor:- Tumor Excision followed by radiotherapy to the tumor bed

- Very large tumor :Radiotherapy followed by excision.

Metastatic Tumor: Chemotherapy.