1. Renal tumours
Dr. Hawre Qadir Salih

2. 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

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

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

5. 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

6. 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

8. 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)

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

10. Bad prognosis:
Metastasis
Older children
Bilateral diseases

11. 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 )

13. Spread
renal vein
Lungs ( cannonball) LN
Bones

15. 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

16. Dx

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

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

20. 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

23. 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.

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

25. Thank u