Renal tumours Dr. Hawre Qadir Salih

Renal neoplasms Benign neoplasms ■ Adenoma ■ Angioma ■ Angiomyolipoma Malignant neoplasms ■ Wilms’ tumour (nephroblastoma in children) ■ Grawitz’s tumour (adenocarcinoma, hypernephroma) ■ Transitional cell carcinoma of the renal pelvis and collecting system ■ Squamous carcinoma of the renal pelvis

Adenoma cortical tumour asymptomatic Dx : incidentally, postmortem examination or US

Angioma profuse haematuria young adults Need renal angiography to Dx bleeding.

Angiomyolipoma Unusual tumour Often but not always associated with tuberous sclerosis CT typical appearance( high fat content ) Malignant elements in about one-quarter and may lead to metastasis

Wilms’ tumour (nephroblastoma) Usually Dx in the first 5 years of life Usually in one pole of one kidney. Bilateral tumors is a big problem Pathology : coffee coloured. Rapidly growing Soft and friable

Metastasis to the lungs (early) Big mass compared with the tiny patient. Some are hypertensive. Haematuria : extension to renal pelvis( poor prognosis ). US, CT or MRI: solid SOL with or without venous invasion, contralateral disease and distant spread. Metastasis to the lungs (early)

Treatment Best in specialist paediatric oncology units. Unilateral tumours : chemotherapy followed by nephrectomy. Bilateral disease: Partial nephrectomy

Bad prognosis: Metastasis Older children Bilateral diseases

Renal neoplasm in adults Hypernephroma (Grawitz’s tumour) Adenocarcinoma Most common (75% ) Arises from renal tubular cells. Usually in one pole of one kidney( mostly upper )

Spread renal vein Lungs ( cannonball) LN Bones

Clinical features Men > women Haematuria usually the presenting symptom, sometimes clot colic Pain Mass Rapid sudden varicocele in adult (rare) Atypical presentations fever, pain ,polycythemia

Dx

Treatment Radical nephrectomy : transabdominal,transperitoneal Partial nephrectomy : less than 7 cm polar tumour Poor response to chemo or radiotherapy

Poor prognosis Renal vein or IVC involvement Positive LN Extension beyond capsule

Transitional cell tumours of the renal pelvis resemble those of the UB but less common. May be multifocal About half will have tumours in the bladder at some stage. Follow-up cystoscopy with regular IVU is therefore necessary to detect recurrent tumours Haematuria most common symptom Mass

Treatment Nephroureterectomy. ureter must be disconnected with a cuff of bladder wall. If this is done by open surgery a second incision is needed to remove the kidney.

Squamous cell carcinoma of the renal pelvis rare chronic inflammation e.g. stone. radiosensitive prognosis is poor.

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