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Renal tumours

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

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Renal tumours

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  1. Renal tumours Dr. Hawre Qadir Salih

  2. 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 collecting system ■ Squamous carcinoma of the renal pelvis

  3. Adenoma • cortical tumour • asymptomatic • Dx : incidentally, postmortem examination or US

  4. Angioma • profuse haematuria • young adults • Need renal angiography to Dx bleeding.

  5. 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

  6. 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

  7. 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)

  8. Treatment • Best in specialist paediatric oncology units. • Unilateral tumours : chemotherapy followed by nephrectomy. • Bilateral disease: Partial nephrectomy

  9. Bad prognosis: • Metastasis • Older children • Bilateral diseases

  10. 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 )

  11. Spread • renal vein • Lungs ( cannonball) • LN • Bones

  12. 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

  13. Dx

  14. Treatment • Radical nephrectomy : transabdominal,transperitoneal • Partial nephrectomy : less than 7 cm polar tumour • Poor response to chemo or radiotherapy

  15. Poor prognosis • Renal vein or IVC involvement • Positive LN • Extension beyond capsule

  16. 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

  17. 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.

  18. Squamous cell carcinoma of the renal pelvis • rare • chronic inflammation e.g. stone. • radiosensitive • prognosis is poor.

  19. Thank u

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