Benign tumor in Kidney

1
Benign tumor in Kidney

• Adenoma
• Oncocytoma
• Angiomyolipoma
• Leiomyoma
• Lipoma
• Hemangioma
• Juxtaglomerular tumor

2
Renal adenoma

• most common benign tumor
• asymptomatic incidentally
• at autopsy
• 7 - 22 at autopsy

3
Renal oncocytoma

• 3 - 5 of renal tumor
• M F 2 1
• Solitary unilateral
• tan light brown
• spoke - wheel appearance
• Tx radical nephrectomy

4
ONCOCYTOMA
5
Angiomyolipoma (I) (Renal harmatoma)

• 45 - 80 in tuberous sclerosis
• (adenoma sebaceum,
• mental retardation, epilepsy)
• bilateral asymptomatic
• 3 major histologic components
• mature fat cell
• smooth muscle
• blood vessel

6
Angiomyolipoma (II)

• DIAGNOSIS
• US CT? ?? ??
• US very high intensity echo
• CT -20 -80 HU
• MRI not considered

7
Angiomyolipoma (III)

• Management by Sx size
• 1) lt 4cm yearly CT MRI
• 2) gt 4cm aSx or mild Sx
• semi-annually F/U
• 3) gt 4cm moderate or severe Sx
• renal sparing or
• renal artery embolization
  

8
US of AML
9
CT of AML
10
Other rare benign tumor

• Leiomyoma
• Hemangioma
• Lipoma
• Juxtaglomerular cell tumor

11
RENAL LIPOMA
12
Adenocarcinoma of the kideny (RCC)

• 3 of adult cancer
• 85 of all primary malignant renal tumor
• male female 2 1
• renal adenocarcinoma, hypernephroma,
• clear cell carcinoma, alveolar carcinoma

13
RCC

• Etiology unknown
• 1. cigarette smoking
• 2. analgesic abuse phenacetin
• 3. occupation shoe worker,
• leather tanner etc
• 4. coffee, diuretics, obesity, estrogen
• 5. familial form autosomal dominant
• 6. ACDK 4 - 9

14
Pathology of the RCC

• Proximal renal tubular epithelium
• Gross yellow to orange
• hemorrhage, necrosis,
• calcification
• Micro. clear cell
• granular cell
• sarcomatoid cell

15
Gross finding of RCC
16
Microscopic finding of RCC
17
Pathogenesis of the RCC

• Vascular tumor that tend to direct
• invasion extension
• 1/3 metastatic disease at presentation
• Lung, liver, bone, ipsilateral lymph node,
• adrenal gland, opposite kidney

18
Staging of RCC
19
Sx Sign ( I ) of the RCC

• incidentally detected tumor
• currently increasing
• Internists tumor
• Triad (10 -15) gross hematuria
• flank pain
• palpable mass

20
Sx Sign(II) of the RCC

• Sx secondary to metastatic disease
• dyspnea, cough, bone pain
• Paraneoplastic syndrome 3 -10
• erythrocytosis
• hypertension
• hypercalcemia
• non-metastatic hepatic dysfunction

21
Dx of the RCC ( I )

• Laboratory finding
• anemia ( 30 )
• ESR increasing ( up to 75 )
• hematuria ( up to 60 )
• abnormal liver function test

22
Dx of the RCC ( II )

• X - ray findings
• IVP
• USG
• CT
• MRI
• Renal angiography
• Bone scan

23
IVP of RCC
24
US of RCC
25
CT of RCC
26
CT of RCC
27
Angiography of RCC
28
DDx of the RCC

• Renal abscess
• Xanthogranulomatous PN
• Angiomyolipoma
• Renal pelvis tumor
• Extra-renal mass

29
DDx of cystic renal mass
30
Tx of the RCC ( I )

• Localized disease ( stage I, II, IIIa )
• radical nephrectomy
• regional lymphadenectomy
• preoperative renal A. embolization

31
Tx of the RCC (II)

• Disseminated disease
• radical nephrectomy
• RT
• hormonal therapy
• chemotherapy
• B.R.M.

32
B.R.M.(Biologic Response Modifier)

• Interferon-a
• Tumor infiltrating lymphocyte(TIL)
• Interleukin
• Lymphocyte activating killer cell(LAK)

33
Follow - up of the RCC

• regular interval
• (?? ? ? 1? 3??, 5?? 6?? ??, ? ? 1???)
• history, P/E
• Chest X - ray
• CBC, LFT
• CT, Bone scan

34
Prognosis of the RCC

• T1 88 - 100 5YSR
• T2 T3a 60 5YSR
• T3b 15 - 20 5YSR
• T4 0 - 20 5YSR

35
? o o F / 52

• C.C. Unable to void for 1 day
• P.I. ?? 3? ??? blood clots? ???
• intermittent painless total gross
  hematuria ()
• ?? 1?? ??? gross hematuria ????
• ?? ?? AUR ??
• Frequency(),
  urgencty()
• Weight loss 11kg/2yrs
• Personal Hx. Smoking/alcohol (-/-)

36

• P/E
• V/S BP 110/70 PR 80 RR 20 BT
  36.6 0C
• HEENT pale conjunctiva
• Abdomen child head sized, non tender,
• firm movable mass ()
  at RUQ
• LAB
• CBC 5500-4.6-267,000 ESR 28mm/hr
• U/A RBC many, WBC 2-3/HPF
• S/E 137-4.3-107 BUN/Cr. 10/0.6
  
• AST/ALT 21/18

37
Chest PA
38
(No Transcript)
39
(No Transcript)
40
(No Transcript)
41
(No Transcript)
42
(No Transcript)
43
(No Transcript)
44
(No Transcript)
45
(No Transcript)
46
(No Transcript)
47
(No Transcript)
48
(No Transcript)
49
(No Transcript)
50
(No Transcript)