1. Renal tissue tumors Urothelial tumors
Renal tumors
Renal tissue tumors
Urothelial tumors

2. pathology Benign adenoma angiomyolipoma oncocytoma Malignant : primary
secondary

3. Benign tumors renal adenoma
Small
Well defined
asymptomatic
usually diagnosed accidentally or at autopsy

4. Renal hamartoma (Angiomyolipoma)
Benign
bilateral with tuberous sclerosis
Unilateral in normal population
Usually Asymptomatic
Symptoms: Bleeding , Pain
Diagnosis:
US: ecchogenic
CT scan
High fat content Differentiate it from malignant tumors

5. Treatment in symptomatic cases
Embolization,
partial nephrectomy
total nephrectomy

6. Renal oncocytoma Generally benign Unifocal 5---6cm
Malignant elements may be detected
Clinically presents as other renal tumors
Spokewhele appearance on angiography
Treatment: radical nephrectomy is a safe decision

7. Malignant tumors Renal cell carcinoma Solid tumors Renal sarcoma
Tranc.cell carcinoma(TCC)

8. Renal cell carcinoma The most common malignant renal tumor(90%)
3% of all adult cancer
M:F = 2:1
Commonly affects year age group

9. Etiology
Unknow
Associated with: Adult polycystic renal disease, acquired renal cysts, horse shoe kidney
Risk factors: smoking, analgesic over use, caffeine, petroleum, asbestosis

11. Spread Direct: Perinephric fat & nearby viscera: renal vein extension
Blood : Liver, lung, bone , brain, suprarenal gland
Lymphatics .PARA AORTIC LN

12. Clinical presentation
Symptom less ,accidentally discovered(ABOUT 50 PERCENT)
Hematurea
Loin Pain
Mass
Wt loss
Features of metastasis
dyspnea,cough,headach,bone pain
Paraneoplastic syndrom

13. Paraneoplastic presentations
Polycythemia:Increase erythropoietin
Hypercalcaemia: Parathormone
Hepatic dysfunction
Hypertension : increased rennin
Polyneuropathy
Anemia

14. Diagnostic aids GUE : ? Haematuria
Hematology: Anaemia, Polycythemia, raised ESR.
Paraneoplastic features
Imaging: US. IVU. CT scan . MRI. Angiography
Bone scan
FNAC (fine needle aspiration cytology)

15. Staging To select the suitable therapy To provide the prognostic data
Staging systems:
Robson
TNM staging

16. Robson staging St1 T within the renal tissue
St2 T within gerotas fascia, perinephric fat invaded
St3a renal vein involved
St3b regional LN involved
St3c vessels & nodes involved
St4a near by organs involved
St4b Distant metastasis

18. Treatment Radical nephrectomy for localized tumor, T1,T2,T3a
Removal of the kidney ,perinepric fat,and gerota fascia alltogether
For T1 PARTIAL NEPHRECTOMY IS ANOTHER OPTION

20. For metastatic tumor Immunotherapy : BCG , Interferon, Interleukin_2
DXT Palliation of metastasis
Hormonal therapy
Chemotherapy
renal tumor is very chimoresistant

21. Indication of palliative nephrectomy in metastatic renal adenocarcinoma
Severe hemorrhage
Pain not respond to opiate
Debulking of tumor befor immunotherapy
When ther is resectable single pulmonary metastasis

22. Prognosis
5 years survival % in T1
60% T2—T3b
M %

23. Cystic disease of the kidney

24. Classification Genetic Nongenetic
Autosomal recessive (infantile) polycystic kidney disease.
Autosomal dominant (adult) polycystic kidney disease  .   )   
Nongenetic
  Multicystic kidney (multicystic dysplastic kidney).
Simple cysts .
Medullary sponge kidney.
Acquired renal cystic disease. 24

25. Adult polycystic renal disease

27. dysplasia

28. Acquired renal cystic disease
Usually occure in patient patient with end stage renal failure especially those on hemo or peritoneal dialysis

29. 1-SIMPLE (SOLITARY) CYST
Simple cyst of the kidney is usually unilateral and single but may be multiple and multilocular and, more rarely, bilateral.
It differs from polycystic kidneys both clinically and pathologically.
Congenital or acquired ?
Pathology
Simple cysts usually involve the lower pole of the kidney. Those that produce symptoms average about 10 cm in diameter, but a few are large enough to fill the entire flank. 29

30. Simple renal cyst

31. They usually contain a clear amber fluid.
Their walls are quite thin, and the cysts are “blue domed” in appearance.
Calcification of the sac is occasionally seen.
About 5% contain hemorrhagic fluid, and possibly one-half of these have papillary cancers on their walls.
Cysts do not communicate with r renal pelvis. 31

32. Clinical Findings 1usuqlly symptomless and discovered accedentally
- Pain in the flank or back, usually intermittent and dull. If bleeding suddenly distends the cyst wall, pain may come on abruptly and be severe.
2- Gastrointestinal symptoms .
3- a mass in the abdomen.
4- infected cyst, the patient usually complains of pain in the flank, malaise, and fever. 32

33. Diagnosis 1- LAB. INVESTIGATIONS GUE and KFT usually normal.
2- RENAL ULTRASONOGRAPHY: differentiates between a cyst and a solid mass.
usually the cyst have regular shape, thin walls ,no calcifications or internal echos.
3- CONTRASTED CT: appears to be the most accurate means of differentiating renal cyst and tumor.
4- ISOTOPE SCANNING: it appears as cold area ( avascular ). 5- 33

34. 34

35. Differential Diagnosis
1-Carcinoma of the kidney.
2- Polycystic kidney disease.
3- Renal cortical abscess.
4- Hydronephrosis.
5- Echinococcal (hydatid) Cyst.
6- Acquired cystic disease of the kidney. 35

36. Complications (Rare) 1- Infections. 2- Hemorrhage into the cyst.
3- Hydronephrosis.
4- Hypertention.
5- Severe Pain. ). 36

37. TREATMENT
Is usually expectant , unless complications developed which should be treated accordingley.( antibiotics , drainage , open or lap. Marcipulization (rovsing op.)