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Chapter: Medicine Study Notes : Renal and Genitourinary

Renal Tumours - Kidney Disease

Renal Oncocytoma: Have oncocytes: cells with abundant mitochondria (pink and granular) – tired epithelial cells. Grossly form a stalate scar

Renal Tumours

 

Renal Adenoma/Papillary Adenoma

 

·        Most people have one or two

·        Associated with renal scarring

·        < 5 mm diameter

·        Papillary architecture 

·        No clear cells (if there were then malignant)

 

 Other benign renal tumours

 

·        Renal Oncocytoma: Have oncocytes: cells with abundant mitochondria (pink and granular) – tired epithelial cells. Grossly form a stalate scar 

·        Renal fibroma 

·        Aniomyolipoma: composed of fat, smooth muscle and thick blood vessels. Associated with Tuberous Sclerosis

 

Renal Cell Carcinoma

 

·        75% of renal epithelial tumours in adults

·        Annual incidence 3/100,000

·        Risk factors: smoking, obesity, hypertension, unopposed oestrogen

·        3% familial, Von Hippel-Lindau disease

·        Clinical features: haematuria, back pain, abdominal mass.  Often metastasised before diagnosis

·        Histology:

o  Clear Cell Renal Cell Carcinoma – most common 

§  Metastasise up the renal vein to the heart ® emboli ® cannon ball metastasis of the lung

§  Sheets of clear cells

§  3 p25 deletion diagnostic feature

o  Papillary RCC: Better prognosis

o  Chromophobe RCC: Better prognosis, large cells, abundant cytoplasm, small dark nucleus

o  Sarcomatoid RCC: Highly malignant, highly anaplastic

 

Transitional Papillary Cell Carcinoma

 

·        Present with painless haematuria

·        Can cause hydronephrosis, flank pain, and renal colic from clots

·        Peak in 6th – 7th decade, M > F

·        Derived from epithelium of renal pelvis

·        Associated with smoking, analgesic abuse, azo dyes

·        Often associated with transitional cell carcinoma of the bladder and ureter

 

Nephroblastoma (Wilms’ Tumour)

 

·        Very aggressive, presents with abdominal mass with or without haematuria. Pain and intestinal obstruction can occur

·        50% present < 3 years, 90% < 10 years, rare in adults

·        Derived from metanephric blastema

o  Dark with scant cytoplasm

o  Triphasic histology: epithelial cells, stromal cells, blastema

·        Now around 80% cure

·        Associated with syndromes:

o  WAGR: Wilms, aniridia, genital anomalies and mental retardation

o  Denys Drash Syndrome: Gonadal dysgenesis, nephropathy

o  Beckwith-Wiedemann syndrome

 

Other Renal Tumours

 

·        Angiomyolipoma: Benign – but grow and haemorrhage. Composed of fat, smooth muscle and dilated blood vessels

·        Juxtaglomerular Cell Tumour:  Very rare, benign but causes malignant hypertension

 

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Medicine Study Notes : Renal and Genitourinary : Renal Tumours - Kidney Disease |


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