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CLASSIFICATION . BENIGNAdenomaAngiomaAngiomyolipomaMALIGNANTWilm's tumour/ NephroblastomaGrawitz's tumour/ Adenocarcinoma/ HypernephromaTransitional cell carcinomaSquamous cell carcinoma. . Of renal pelvis. www.similima.com. 2. RENAL CELL CARCINOMA. Also known as:HYPERNEPHROMAGRAWITZ'S TU
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2. CLASSIFICATION BENIGN
Adenoma
Angioma
Angiomyolipoma
MALIGNANT
Wilms tumour/ Nephroblastoma
Grawitzs tumour/ Adenocarcinoma/ Hypernephroma
Transitional cell carcinoma
Squamous cell carcinoma
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3. RENAL CELL CARCINOMA Also known as:
HYPERNEPHROMA
GRAWITZS TUMOUR
Common type of malignant renal neoplasm,arise from renal tubular cell
Incidence: 75%
Age group: 40-60yrs
Male:Female=2:1 www.similima.com 3
4. AETIOLOGY 6C:
Chromosomal defect
Cigarette smoking
Coffee drinking
Cadmium exposure
Chronic cystic disease
Congenital disease
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5. RISK FACTORS Diabetes Mellitus
Chronic dialysis www.similima.com 5
6. Cells of origin: Proximal renal tubular system
Starts in one of the poles; commonly upper pole
Reniform shape of kidney is maintained
Cut surface: Homogenous yellowish in colour due to lipid deposition,few haemorrhagic areas are common
Microscopy: Alternate clear & dark cells,Scanty stroma-richly vascular PATHOLOGY www.similima.com 6
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9. SPREAD Blood spread:
Tumour cells
Lymphatics
Lymph node in hilum
Distant metastasis to long bone (Secondary deposit) www.similima.com 9
10. CLINICAL FEATURES Triad of RCC
Pain: Dragging /Intermittent clot colic due to blood clot blocking the ureter
Intermittent hematuria
Palpable long mass www.similima.com 10
11. OTHER MANIFESTATIONS Bone:
Pathological fracture
Secondaries
Bony pain
Haematological
Anemia
Polycythemia
Hyperglobulinemia www.similima.com 11
12. Endocrinological
Hypertension
Hypercalcemia
Mild elevation of temperature:
37.8C-38.9C
Nephrotic syndrome: rare
Liver dysfunction www.similima.com 12
13. ROBSONS staging Stage 1: Limited to kidney
Stage 2: Invade perinephric tissue,doesnt extend beyond Gerotas fascia
Stage 3: Extend to major vein or lymph node
Stage 4: Distant metasatasis www.similima.com 13
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15. INVESTIGATIONS Urine examination done when the patient has hematuria to see malignant cells
Plain X-ray: Abnormal calcification in tumour
Intravenous urography: Hematuria
Ultrasonography
CT scan
MRI
Renal angiography
Venacavogram: To know extend of tumour in inferior venacava www.similima.com 15
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17. TREATMENT Radical nephrectomy
Radical nephrectomy with extraction of thrombus
Nephro sparing surgery
Therapeutic embolization
Radiotherapy
Immunotherapy www.similima.com 17
18. PROGNOSIS Removal of even the largest neoplasm may cure the patient
70% of the patients well after 3yr
60% after 5yr
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19. TRANSITIONAL CELL CARCINOMA It invade the ranal parenchyma
Have a tendency to multifocal & distant spread
Hematuria is the most common symptom
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22. INVESTIGATIONS Urine examination for presence of malignant cell
Intravenous urography
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23. TREATMENT Nephroureterectomy www.similima.com 23
24. SQUAMOUS CELL CARCINOMA Rare variety
Associated with chronic inflammation & leucoplakia resulting from stone
Radiosensitive but matastasis early www.similima.com 24
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