Tumors of the Kidney and Urinary bladder

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Tumors of the Kidney and Urinary bladder Dr. Attack Jastania

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Objectives By the end of this session the understudy ought to have the capacity to: List the basic kindhearted and threatening tumors of the kidney List the sorts of renal cell carcinoma Know the clinical presentation of Wilms tumor Understand the premise of the order of urothelial carcinoma

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Case Presentation

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A 63-year - old man was found to have tiny hematuria on urinalysis done as a major aspect of a pre-work physical examination. The rest of the urinalysis was ordinary, just like the physical exam. The patient did not grumble of any fever, weight reduction, torment, disquietude, shortcoming, or urinary tract manifestations.

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Hct: 57% Hb: 19 g/dL BUN: 12 mg/dL Creatinine: 0.7 mg/dL WBC: 7,450/mm 3 with a typical differential Urine cytology: negative

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Work-up for the hematuria was started with noninvasive imaging concentrates on, which incorporated a renal ultrasound examination and an intravenous pyelogram. A mass was found in the left kidney with both imaging thinks about. The patient experienced nephrectomy.

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Renal Cell Carcinoma

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Renal Tumors Benign: Oncocytoma Renal cell adenoma Malignant: Renal cell carcinoma Wilms tumor Urothelial carcinoma

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Tumors of the Kidney Renal cell carcinoma Arise from tubular epithelium 85% of essential dangerous tumors of the kidney 2-3% of growth in grown-ups 6 th - 7 th decade of life, Men 2x> ladies Increased hazard in smokers, word related presentation to cadmium, in dialysis-related sores

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Clinical: Hematuria half Pain Mass Paraneoplastic disorder: Fever, polycythemia 5-10% (erythropoietin) Hypercalcemia, hypertension, cushing disorder Metastases to lung, bone

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Renal cell carcinoma: sorts 1. Routine RCC (clear cell) 2. Papillary RCC 3. Chromophobe RCC

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Renal cell carcinoma: sorts 1. Traditional RCC (clear cell RCC) 70-80% of RCC Familial and sporadic Associated with von Hippel-Lindau disorder VHL is autosomal overwhelming Multiple tumors: hemantioblastoma of cerebellum and retina, renal growths, renal cell carcinoma Germline transformation in VHL quality (3p25) Loss of second allele by substantial change Seen in sporadic RCC also

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Renal cell carcinoma: sorts 2. Papillary RCC 10-15% emerge from proximal tubular epithelium Multifocal, respective Familial and sporadic MET proto oncogene (7q31) Trisomy 7, Mutation of chromosome 7 In sporadic cases: trisomy 7, 16, 17

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Renal cell carcinoma: sorts 3. Chromophobe RCC: 5% emerge from gathering pipes Loss of Ch 1,2,6,10,13,17,21 Hypodiploidy Good forecast

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Morphology: Clear cell Solitary, huge, cortical, all around characterized Yellow-orange, dark white, growths, discharge, corruption May reach out to pelvis, ureters May attack renal vein and substandard vena cava Papillary Bilateral, numerous Chromophobe Brown-tan

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Micro: Clear cell RCC Lipid, glycogen Clear cells Round cores Vascular Papillary Chromophobe: Perinuclear radiance, macrovesicles Well characterized cell film

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Oncocytoma

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Renal Cell Adenoma

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Case Presentation

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Our patient is a 5 year-old , Caucasian female who introduced to the essential pediatric center in early spring with boss dissensions of hack, fever by touch, and diminished movement for six days. Our patient's sickness started with rhinorrhea and advanced to craving misfortune and fever that her folks felt was lethargic to acetaminophen.

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On physical exam our patient showed up worrisomely " wiped out " . She was exhausted . The remarkable physical discoveries comprised of a marginally erythematous throat. On stomach exam a mass of 9 cm width by 4 cm length with frequently molded edges was palpated with light profundity and confirmed with percussion in the left upper quadrant. The mass was smooth, somewhat firm, oval, nonmobile, and did not cross the midline. The tyke denied torment amid the exam, however was uncomfortable amid palpation.

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Our patient was then admitted to the kids' clinic after her fever and upper respiratory manifestations died down for biopsy. Biopsy affirmed determination of Wilms' tumor . The tumor was contracted with chemotherapy for five months and afterward expelled from the left kidney by means of finish nephrectomy and incomplete right nephrectomy.

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Wilms Tumor

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Wilms Tumor (Nephroblastoma) Most normal essential kidney tumor in youngsters Occur usually between 2-5 years WT1 quality, WT2 quality Risk with intrinsic contortion: WAGR disorder Denys-Drash disorder Beckwith-Weidmann syndorme

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Wilms Tumor (Nephroblastoma) Risk with inborn deformity: WAGR disorder Loss of ch 11p13 (WT1) Aniridia, genetal variations from the norm, mental impediment Denys-Drash disorder Loss of ch 11p13 (WT1) Gonadal dysgenesis Renal irregularities Beckwith-Weidmann disorder Enlarged body organs (tongue, kideny, liver), adrenal expansion, hemihypertrophy (body portion development) Ch 11p15.5 (WT2)

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Wilms Tumor (Nephroblastoma) Clinical: Mass Cross the midline Hematuria Intestinal hindrance Prognosis: great 2 year-survival: 90%

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Wilms Tumor (Nephroblastoma) Morphology: Large very much outlined 10% reciprocal, different Soft homogeneous, tan-dim Hemorrhage, growths, putrefaction Triphasic: Epithelial: tubules Stroma: stringy, myxoid Blastema: little blue cells Foci of anaplasia Nephtogenic rests: forerunner injuries

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Case Presentation

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A 73 - year-old man gave easy hematuria and urinary recurrence

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Radical prostatocystectomy example uncovered urothelial carcinoma with attack of the muscularis, circumferentially including the bladder base. Carcinoma in situ was seen at the privilege ureteral edge. There was likewise intrusion of the prostate, neighborhood lymph hubs and vascular structures

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Tumors of the Urinary Bladder

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Tumors of Urinary Bladder and gathering framework Classification, ISUP (universal society of urologic pathology). Amiable Urothelial papilloma Malignant Papillary urothelial neoplasm of low harmful potential Papillary urothelial carcinoma – second rate Papillary urothelial carcinoma – high review Flat Urothelial carcinoma in-situ Invasive urothelial carcinoma Squamous cell carcinoma

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Tumors of Urinary Bladder and gathering framework Clinical: Painless hematuria 50-70 year, men 3x>women Risk variables Smoking Industrial dissolvable, hydrocarbons, colors Cystitis Schistosomiasis cyclophosphamide

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Tumors of Urinary Bladder and gathering framework Clinical: High repeat rate Fatal by ureteric impediment Overall survival 5y: 57% Ureteric carcinoma 5y survival: 10%

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Squamous cell carcinoma

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Objectives By the end of this session the understudy ought to have the capacity to: List the normal kind and threatening tumors of the kidney List the sorts of renal cell carcinoma Know the clinical presentation of Wilms tumor Understand the premise of the arrangement of urothelial carcinoma

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Pictures

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