Lecture 4: Renal Disorders & Tumors PDF

Lecture 4 Renovascular disorders Renal tumors Prof. Marwa Shakweer Head of pathology dep.BUC Professor of pathology , Ain Shams Univeristy  Kidney Glomeruli Tubules Blood vessels Inter...

Lecture 4 Renovascular disorders Renal tumors Prof. Marwa Shakweer Head of pathology dep.BUC Professor of pathology , Ain Shams Univeristy  Kidney Glomeruli Tubules Blood vessels Interstitial tissue MM.shakweer  ILOs Identify types of renovascular disorders, causes, pathogenesis, and clinicopathologic features Classify tumors of the kidney, describe its pathologic features and list its complications MM.shakweer  Vascular diseases of the kidney Renal artery stenosis Benign nephrosclerosis (on top of benign hypertnesion) Malignant nephrosclerosis (on top of malignant hypertension) MM.shakweer  Renal artery stenosis Atherosclerosis Fibromuscular dysplasia Vasculitis Effect: leads to secondary hypertentsion MM.shakweer  Benign nephrosclerosis It is the term used for abnormalities of the kidney induced by benign hypertension Gross: both kidneys are reduced in size The outer surface is finely granular The cut surface shows irregular atrophy of the cortex with loss of differentiation between cortex and medulla Microscopic: a) Large arteries: fibromuscular hyperplasia b) Arteriols: thickening and hyalinization of the walls and narrow lumens leading to diffuse ischemic atrophy of the nephrons MM.shakweer MM.shakweer  Malignant nephrosclerosis May arise without preexisting hypertension. May occur on top of malignant hypertension Gross: petechial hemorrhages on cortical surface (flee bitten kidney) Microscopic : fibrinoid necrosis, hyperplastic arteriolosclerosis (onion skin appearance), necrotizing glomerulitis MM.shakweer  Hyperplastic arterioloscleroiss, fibrinoid necrosis MM.shakweer  Clinical course It is characterised by papilledema, encephalopathy, renal failure Increased intracranial pressure causes headache, nausea, vomiting and visual impairment 90% of deaths are caused by uremia and 10% by cerebral hemorrhage and cardiac failure MM.shakweer  Tumors of the kidney Tumors of Tumors of pelvicalyceal kidney tissue system Benign: papilloma, Benign: adenoma, fibroma, lipoma, oncoctyoma fibroma, hemangioma Malignant: a) primary: renal cell carcinoma, Wilm’s tumor Malignant: b) secondary: metastatic from lung breast prostate transitional cell Sarcoma (osteosarcoma) carcinoma Malignant melanoma, choriocarcinoma MM.shakweer  Renal cell carcinoma It arises from epithelial cells of renal tubules Age: 60-70 Male to female: 2:1 Risk factors: Smoking Polycystic kidney on top of chronic dialysis Genetic factors: - Clear RCC: von hippel lindau disease (AD) VHL gene is TSG - Papillary RCC: MET protooncogene MM.shakweer  Gross Well demarkated and centered in the cortex The cut surface is solid, golden yellow with areas of HNC Extension to the renal pelvis is early and extension to the capsule is late MM.shakweer  Microscopic 1- clear cell RCC: clear cells arranged in solid masses, cords, tubules or cysts with papillary structures. The stroma is scanty and very vascular with areas of hemorrhage and necrosis 2- papillary RCC: branching papillae covered by single layer of cells with large nuclei and small amount of cytoplasm 3- chromophobe RCC: large cells with granular esinophilic cytoplasm MM.shakweer MM.shakweer  Spread Local: early infiltrate the pelvis , later iinfiltrate the capsule and perinephric fat Blood : lung , bone , brain (due to renal vein invasion) N.B invasion of left renal vein leads to varicocele Lymphatic spread: to lumber group of lymph nodes MM.shakweer  Clinical manifestations 1- painless hematuria 2- flank pain and mass in the region of the kidney in late cases 3- manifestations dt metastasis to lung and bones 4- anemia, fever, weight loss 5- Paraneoplastic syndrome: a) Polycythemia due to secretion of erythropoetic stimulating substance b) Hypercalcemia dt production of PT like hormone c) Gynecomastia as result of gonadotrophin and placental lactogen production MM.shakweer  Wilm’s tumor Age: children (2-5y) Arise from embryonic cells Gross: rapidly growing tumor destroying kidney tissue and infiltrating renal capsule Infiltration of the renal pelvis and ureter is rare and late MM.shakweer  Microscopic (three components) Blastematous areas: small rounded cells with very scanty cytoplasm Mesenchymal elements: spindle cells and may show differentiation to smooth muscles, skeletal muscle, cartilage Epithelial component: anaplastic masses of malignant epithelial cells and may show glandular, tubular or glomerular formations MM.shakweer MM.shakweer MM.shakweer  Clinical presentation Large abdominal mass Hematuria Abdominal pain Intestinal obstruction MM.shakweer  Spread Local: renal tissue destruction, invasion of renal capsule, adrenal cortex, bowl, liver, vertebrea Blood: lung liver brain Lymphatics : to regional lymph nodes MM.shakweer Thank you