2. Renal cell carcinomas
Definition
• Malignant tumours derived from the renal epithelium.
• It is the most common malignant renal tumour,
• with a variety of radiographic appearances.
3. Epidemiology
• Patients are
typically 50-70 years of age at presentation ,
male female ratio 2:1 .
Renal cell carcinomas are thought to be the 8th most common adult
malignancy,
representing 2% of all cancers,
and account for 80-90% of primary malignant adult renal neoplasms
.
4. Cont..
Majority of RCC occurs sporadically
Tobacco smoking contributes to 24-30% of RCC cases
- Tobacco results in a 2-fold increased risk
Occupational exposure to cadmium, asbestos, petroleum
Obesity
Chronic phenacetin or aspirin use
Acquired polycystic kidney disease due to dialysis results in 30%
increase risk
5. Clinical manifestations
macroscopic haematuria: 60%
flank pain: 40%
palpable flank mass: 30-40%
Symptoms secondary to metastatic disease: dysnea & cough, seizure & headache, bone
pain
Other Signs And Symptoms
Weight loss (33%)
Fever (20%)
Night sweats
Malaise
Varicocele,
usually left sided, due to obstruction of the testicular vein (2% of males)
7. Metastasis
The tendency of metastasize widely before giving rise to any local
symptoms and signs.
25% of RCC had metastasis Most common location:-
1. lung(more than 50%)
2. bone(33%)
3. Regional lymph nodes
4. Liver, adrenal, and brain
8. Classification of RCC
• CLEAR CELL RENAL CARCINOMA (conventional): 70-80% large uniform cells with clear . highly vascular
• CLEAR CELL MULTILOCULAR RENAL CELL CARCINOMA
• PAPILLARY RENAL CELL CARCINOMA: 13-20%
• type I: sporadic, generally good prognosis
• type II: inherited, bilateral and multi focal
• CHROMOPHOBE RENAL CELL CARCINOMA: 5%
• similar histologically to renal oncocytomas
• best prognosis
• COLLECTING DUCT RENAL CELL CARCINOMA (Bellini duct): <1%
• often younger patients
• worst prognosis
• RENAL MEDULLARY CARCINOMA: rare
• seen primarily in patients with sickle cell disease or sickle cell trait
9.
10.
11. Etiopathogenesis of RC
Tobacco, exposure to Asbestos,heavy Metals,
petroleum products,OestrogenTherapy,heredity &HTN
Leads to tumor growth in the renal cortex
Uninterrupted growth tends to compress adjacent
organs (RC)
Lead to metastasis to liver,bone,skin,spleen& brain
12. Pathological Changes
• The tumour is usually large,golden yellow and circumscribed.
• Cut section shows large areas of ischemic necroses and foci of haemorrhages.
• Invasion of renal vein is evident.
• Acidophilic cytoplasm well differentiated.
15. • Eatiology
• Bacterial cystitis :
• 1. E.coli
• 2. Proteus
• 3. Klebsiella
• • Tuberculous cystitis
• • Fungal cystitis ( candida albicans) Immunesuppressed and those on
long term ABCs
• • Schistosomal cystitis
• • Viruses , chlamydia , mycoplasma
• • Other non infectious causes : drugs (cyclophosphamide) and
radiation ( radiation cystitis)
16.
17. Clinical manifestations
Frequency
Dysuria
Urgency
Bacteruria
Gross hematuria
Chronic UTI
They may complain of voiding mucus
Less frequently: ureteral obstruction and subsequently
hydronephrosis.
18. Etiopathogenesis of cystitis
Nephrotoxins infections,chemical agents,antibiotics,heavey
metals,poisons,drugslike cytophosphamide,radiation
therapy&autoimmune responses
Inflammation of the bladder due to change in
permeability of the layer of the bladder mucosa
cystits
19. Pathological changes
• Bladder mucosa is red,swollen and hemorrhagic
• Patchy ulceration of the mucosa with formation of granulation tissue
• Intense neutrophilic exudate admixed with lymphocytes and macrophage.
• Presence of edema and congestion of bladder
20. Diagnostic methods
Cystoscopy
appearance looks like
cobblestone pattern.
The bladder neck and trigone
are the areas most frequently
involved.
Followed by the lateral walls
and the dome of the bladder.
22. Treatment
treat the source of chronic bladder irritation if it is present i.e. treat UTI
and stones, replace indwelling catheters with CIC.
Transurethral resection of bladder lesions.
Intravesical steroids injection.
Nephrostomy tubes may be initially necessary for severe ureteral
obstruction before definitive therapy.
Bladder augmentation and cystectomy have been described in severe
intractable cases who fail initial therapy and progressed into bladder
contracture and renal failure.