Urology

Renal tumors

Renal tissue tumors Urothelial tumors

pathology

Benign adenoma angiomyolipoma oncocytoma Malignant : primary secondary

Benign tumorsrenal adenoma

Small Well defined asymptomatic usually diagnosed accidentally or at autopsy

Renal hamartoma(Angiomyolipoma)

Benign bilateral with tuberous sclerosis Unilateral in normal population Usually Asymptomatic Symptoms: Bleeding , Pain Diagnosis: US: ecchogenic CT scan High fat content Differentiate it from malignant tumors

 Treatment in symptomatic cases

Embolization, partial nephrectomy total nephrectomy

Renal oncocytoma

Generally benign Unifocal 5---6cm Malignant elements may be detected Clinically presents as other renal tumors Spokewhele appearance on angiography Treatment: radical nephrectomy is a safe decision


Malignant tumors
Solid tumors Renal cell carcinoma Renal sarcoma Tranc.cell carcinoma(TCC)

Renal cell carcinoma

The most common malignant renal tumor(90%) 3% of all adult cancer M:F = 2:1 Commonly affects 40-60 year age group

Etiology

Unknow Associated with: Adult polycystic renal disease, acquired renal cysts, horse shoe kidney Risk factors: smoking, analgesic over use, caffeine, petroleum, asbestosis

Spread

Direct: Perinephric fat & nearby viscera: renal vein extension Blood : Liver, lung, bone , brain, suprarenal gland Lymphatics .PARA AORTIC LN

Clinical presentation

Symptom less ,accidentally discovered(ABOUT 50 PERCENT) Hematurea Loin Pain Mass Wt loss Features of metastasis dyspnea,cough,headach,bone pain Paraneoplastic syndrom

Paraneoplastic presentations

Polycythemia:Increase erythropoietin Hypercalcaemia: Parathormone Hepatic dysfunction Hypertension : increased rennin Polyneuropathy Anemia

Diagnostic aids

GUE : ? Haematuria Hematology: Anaemia, Polycythemia, raised ESR. Paraneoplastic features Imaging: US. IVU. CT scan . MRI. Angiography Bone scan FNAC (fine needle aspiration cytology)

Staging

To select the suitable therapy To provide the prognostic data Staging systems: Robson TNM staging

Robson staging

St1 T within the renal tissue St2 T within gerotas fascia, perinephric fat invaded St3a renal vein involved St3b regional LN involved St3c vessels & nodes involved St4a near by organs involved St4b Distant metastasis

Treatment

for localized tumor, T1,T2,T3a Radical nephrectomy Removal of the kidney ,perinepric fat,and gerota fascia alltogether For T1 PARTIAL NEPHRECTOMY IS ANOTHER OPTION

For metastatic tumor

Immunotherapy : BCG , Interferon, Interleukin_2 DXT Palliation of metastasis Hormonal therapy Chemotherapy renal tumor is very chimoresistant

Indication of palliative nephrectomy in metastatic renal adenocarcinoma

Severe hemorrhage Pain not respond to opiate Debulking of tumor befor immunotherapy When ther is resectable single pulmonary metastasis

Prognosis

5 years survival 80---100% in T1 60% T2—T3bM1 0----15%

Cystic disease of the kidney

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Adult polycystic renal disease

dysplasia

Acquired renal cystic disease

Usually occure in patient patient with end stage renal failure especially those on hemo or peritoneal dialysis

Simple cyst of the kidney is usually unilateral and single but may be multiple and multilocular and, more rarely, bilateral. It differs from polycystic kidneys both clinically and pathologically. Congenital or acquired ? Pathology Simple cysts usually involve the lower pole of the kidney. Those that produce symptoms average about 10 cm in diameter, but a few are large enough to fill the entire flank.

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Simple renal cyst


They usually contain a clear amber fluid.Their walls are quite thin, and the cysts are “blue domed” in appearance. Calcification of the sac is occasionally seen.About 5% contain hemorrhagic fluid, and possibly one-half of these have papillary cancers on their walls. Cysts do not communicate with r renal pelvis. *

1usuqlly symptomless and discovered accedentally - Pain in the flank or back, usually intermittent and dull. If bleeding suddenly distends the cyst wall, pain may come on abruptly and be severe. 2- Gastrointestinal symptoms . 3- a mass in the abdomen. 4- infected cyst, the patient usually complains of pain in the flank, malaise, and fever.

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1- LAB. INVESTIGATIONS GUE and KFT usually normal. 2- RENAL ULTRASONOGRAPHY: differentiates between a cyst and a solid mass. usually the cyst have regular shape, thin walls ,no calcifications or internal echos. 3- CONTRASTED CT: appears to be the most accurate means of differentiating renal cyst and tumor. 4- ISOTOPE SCANNING: it appears as cold area ( avascular ). 5-
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1-Carcinoma of the kidney. 2- Polycystic kidney disease. 3- Renal cortical abscess. 4- Hydronephrosis. 5- Echinococcal (hydatid) Cyst. 6- Acquired cystic disease of the kidney.
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1- Infections. 2- Hemorrhage into the cyst. 3- Hydronephrosis. 4- Hypertention. 5- Severe Pain. ).
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TREATMENT Is usually expectant , unless complications developed which should be treated accordingley.( antibiotics , drainage , open or lap. Marcipulization (rovsing op.)