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TUMOURS OF KIDNEY RENAL CELL CARCINOMA. RENAL TUBULAR EPITHELIUM 80- 85% OF PRIMARY MALIGNANT TUMOURS OF KIDNEY 2- 3% 0F CANCERS IN ADULTS 6 TH - 7 TH DECADE M: F=2-1. TUMOURS OF KIDNEY RENAL CELL CARCINOMA. ETIOPATHOGENESIS SMOKING CADMIUM EXPOSURE
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TUMOURS OF KIDNEYRENAL CELL CARCINOMA RENAL TUBULAR EPITHELIUM 80- 85% OF PRIMARY MALIGNANT TUMOURS OF KIDNEY 2- 3% 0F CANCERS IN ADULTS 6TH - 7TH DECADE M: F=2-1
TUMOURS OF KIDNEYRENAL CELL CARCINOMA ETIOPATHOGENESIS SMOKING CADMIUM EXPOSURE AQUIRED POLYCYSTIC DISEASE-DIALYSIS
GENETIC BASIS OF RENAL CELL CARCINOMA 3 FORMS OF RCC 1.CLEAR CELL TYPE-70 - 80% -CLEAR CELLS & GRANULAR CELLS MAJORITY- SPORADIC FAMILIAL OR IN ASSOCIATION WITH von Hippel-lindu DISEASE-VARIETY OF NEOPLASMS-HAEMANGIOBLASTOMAS OF CEREBELLUM & RETINA
MOLECULAR BASIS OF CLEAR CELL RCC 40 -60%VHL DISEASE DEVELOP RENAL CYSTS BILATERAL OFTEN MULTIPLE ,CLEAR CELL RCC –GERMLINE MUTATION OF ONE ALLEL OF VHL GENE ON 3p25,THE SECOND ALLELE BY SOMATIC MUTATION ON 3p25 IN SPORADIC CASES ALSO VHL TUMOUR SUPPRESSOR GENE IS INVOLVED
MOLECULAR BASIS OF RCC LOSS OF CHROMOSOMAL SEGMENTS 3p14 TO 3p26 SEEN IN SPORADIC CASES
MOLECULAR BASIS OF RCC 2. PAPILLARY CARCINOMA-15% 0F ALL RCC FAMILIAL OR SPORADIC FREQUENTLY MULTIFOCAL & BILATERAL
MOLECULAR BASIS OF RCC MET PROTOONCOGENE ON 7q31 WHICH IS A TYROSINE KINASE RECEPTOR FOR GROWTH FACTOR KNOWN AS HEPATOCYTE GROWTH FACTOR(SCATTER FACTOR)- OVERDOSE OF MET-ABNORMAL GROWTH OF PROXIMAL TUBULAR EPITHELIUM
MOLECULAR BASIS OF RCC IN FAMILIAL CASES-ALONG WITH OVERDOSE THERE IS ACTIVATING MUTATION OF MET GENE IN SPORADIC CASES TRISOMY OF 7 CHROMOSOME,BUT THERE IS NO MUTATION OF MET,ALSO HAVE TRISOMIES OF 16,17& LOSS OF Y CHROMOSOMES
MOLECULAR BASIS OF RCC 3. CHROMOPHOBE RCC-5% OF RCC-CORTICAL COLLECTING DUCTS OR INTERCALATED DUCTS.CELLS STAIN DARKLY MULTIPLE LOSSES OF ENTIRE CHROMOSOMES- 1,2,6,1O,13 ,17- HAS A GOOD PROGNOSIS
MORPHOLOGY OF CLEAR CELL TYPE GROSS SOLITARY ,LARGE-3-15 cms, ANYWHERE IN THE CORTEX. YELLOW TO ORANGE TO GREYWHITE,HAEMORHAGE ,CYSTIC,WELL DEFINED.
MORPHOLOGY OF CLEAR CELL TYPE SMALL TUMOUR PROCESSES INTO ADJASCENT RENAL TISSUE,SATELLITE NODULES MAY EXTENTION TO CALYSES,PELVIS,URETER MAY BE SEEN.
MORPHOLOGY OF CLEAR CELL TYPE OCCATIONALLY DIRECT EXTENSION . LESS ORANGE YELLOWN EXTEND TO PERINEPHRIC FAT,ADRENAL GLAND.
MORPHOLOGY OF PAPILLARY TYPE PAPILLOARY TYPE TENDS TO BE BILATERAL & MULTIPLE NECROSIS ,HAEMORRHAGE & CYSTIC CHANGE MAY BE SEEN , LESS ORANGE YELLOW
MORPHOLOGY OF RCC - CHROMOPHOBE TYPE CHROMOPHOBE TYPE - TAN BROWN CUT SURFACE.THE CARCINOMA MAY BE CIRCUMSCRIBED, BUT VERY RARELY ENCAPSULATED. THE CUT SURFACE IS OFTEN HOMOGENEOUS PALE AND TAN
MORPHOLOGY OF RCC-MICROSCOPY -CLEAR CELL TYPE DEPENDING ON AMOUNT OF LIPID & GLYCOGEN- CYTOPLASM LOOKS CLEAR TO GRANULAR PINK NUCLEI ARE SMALL & ROUND
MORPHOLOGY OF RCC-MICROSCOPY-CLEAR CELL TYPE SOMETIMES MARKED ANAPLASIA,HIGH MITOTIC RATE ,MARKED PLEOMORPHISM WITH HYPERCHROMATIC NUCLEI ARE SEEN CELLS ARE ARRANGED IN CORDS , TUBULES ,DISORGANIZED MASSES SCANT VASCULARIZED STROMA
IHC OF RCC • MONOCLONAL ANTIBODIES TO RCC AND CD10 IN THE DIFFERENTIAL DIAGNOSIS OF COMMON RENAL TUMORS. EIGHTY-FIVE PERCENT OF CLEAR CELL CARCINOMAS (53 OF 62) HAD DETECTABLE SURFACE MEMBRANE STAINING FOR RCC, AND 94% (58 OF 62) WERE POSITIVE FOR CD10. (ACUTE LYMPHOCYTIC LEUKEMIA ANTIGEN( CALLA)
MORPHOLOGY OF RCC-MICROSCOPY-PAPILLARY TYPE PAPILLAE WITH FIBROVASCULAR CORE CELLS- CLEAR TO GRANULAR PINK TYPE
TYPE 1 AND TYPE 2 RENAL PAPILLARY CARCINOMA, EXPRESSING CYTOKERATIN 7 TYPE 1 PAPILLARY RCC HAS: A SINGLE LAYER OF CELLS ON THE BASEMENT MEMBRANE AND USUALLY HAS LOW GRADE NUCLEAR FEATURES, I.E. A LOW FUHRMAN GRADE.
TYPE 1 AND TYPE 2 RENAL PAPILLARY CARCINOMA, EXPRESSING CYTOKERATIN 7 TYPE 2 PAPILLARY RCC HAS PSEUDOSTRATIFICATION OF CELLS AND USUALLY HAS HIGH GRADE NUCLEAR FEATURES, A HIGH FUHRMAN GRADE.
MORPHOLOGY OF RCC-MICROSCOPY- CHROMOPHOBE RCC CLEAR FLOCCULENT CYTOPLASM WITH PROMINENT DISTINCT CELL MEMBRANE, PERINUCLEAR HALLO ELECTRON MICROSCOPY- MICROVESICALES ARE SEEN
MORPHOLOGY OF RCC –OTHER RARE TYPES 4. SARCOMATOID TYPE -1.5 % 5. COLLECTING DUCT TYPE-0.5%
7.COLLECTING DUCT TYPE ARISES FROM MEDULLARY COLLECTING DUCTS (BELLINI DUCT CARCINOMA)- 0.5% THOUGHT TO ARISE FROM OR DIFFERENTIATE TOWARDS COLLECTING (BELLINI’S) DUCTS
MORPHOLOGY OF RCC7.COLLECTING DUCT TYPE CENTERED IN THE MEDULLA TUBULOPAPILLARY ARCHITECTURE WITH DESMOPLASIA OF STROMA LINING CELLS ARE CUBOIDAL. ASSOCIATED WITH HYPERPLASTIC AND DYSPLASTIC EPITHELIAL LESIONS OF COLLECTING DUCTS IN THE VICINITY OF THE TUMOUR
7.COLLECTING DUCT TYPE RCC -BEHAVIOR AGGRESSIVE MANY OF THE PATIENTS HAVING DISTANT METASTASES AT THE TIME OF PRESENTATION
10. RENAL MEDULLARY CARCINOMA VERY RARE YOUNG BLACKS WITH SICKLE CELL ANAEMIA CENTERED IN THE MEDULLA
10. RENAL MEDULLARY CARCINOMA MICROSCOPICALLY- RETICULAR,YOLK SAC LIKE,ADENOID CYSTIC APPEARANCE OFTEN WITH POORLY DIFFERENTIATED AREAS IN A HIGHLY DESMOPLASTIC STROMA WITH NEUTROPHILS MARGINATED WITH LYMPHOCYTES
FUHRMAN GRADE NUCLEAR CHARACTERISTICS USED IN THE FUHRMAN SYSTEM OF GRADING 1. SIZE AND SHAPE OF THE NUCLEUS AS A WHOLE.