RENAL CELL CARCINOMA

1. RENAL CELL
CARCINOMA
By
Mukti Indwar Jacob
Associate professor
GRDCON

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)

6. Cont…
Paraneoplastic syndrome
1. Polycythemia
2. Hypercalcemia
3. Hypertension
4. Hepatic dysfunction
5. Feminization
6. Masculinization
7. Cushing syndrome
8. Eosinophilia
9. Leukemoid reaction
10. Amyloidosis

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

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.

13. Diagnostic methods
• CT scan.
• Intravenous retrograde pyclography.
• USG
• Cystoscopy
• Renal angiography.
• LFT
• CBC (shows anemia

14. CYSTITIS
• Inflammation of the urinary bladder
is called cystitis

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)

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.

21. Cont..
• Urine culture
• Urine flow study

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.