Docstoc

Benign tumor

Document Sample
Benign tumor Powered By Docstoc
					    Benign tumor
     in Kidney
   Adenoma
   Oncocytoma
   Angiomyolipoma
   Leiomyoma
   Lipoma
   Hemangioma
   Juxtaglomerular tumor
      Renal adenoma


 most common benign tumor
 asymptomatic & incidentally
   at autopsy
 7 - 22 % at autopsy
Renal oncocytoma

   3 - 5 % of renal tumor
   M:F=2:1
   Solitary & unilateral
   tan & light brown
   spoke - wheel appearance
    Tx : radical nephrectomy
ONCOCYTOMA
     Angiomyolipoma (I)
     (Renal harmatoma)
   45 - 80 % in tuberous sclerosis
      (adenoma sebaceum,
       mental retardation, epilepsy)
   bilateral & asymptomatic
   3 major histologic components
            mature fat cell
            smooth muscle
            blood vessel
    Angiomyolipoma (II)


   DIAGNOSIS
    US & CT로 진단 가능
    US : very high intensity echo
    CT : -20~ -80 HU
    MRI : not considered
    Angiomyolipoma (III)

 Management  : by Sx & size
  1) < 4cm : yearly CT & MRI
  2) > 4cm & aSx or mild Sx
           : semi-annually F/U
  3) > 4cm & moderate or severe Sx
           : renal sparing or
             renal artery embolization
US of AML
CT of AML
Other rare benign
     tumor
 Leiomyoma
 Hemangioma
 Lipoma
 Juxtaglomerular   cell tumor
RENAL LIPOMA
  Adenocarcinoma of the
      kideny (RCC)

 3%   of adult cancer
 85% of all primary malignant renal tumor
 male : female = 2 : 1
 renal adenocarcinoma, hypernephroma,
  clear cell carcinoma, alveolar carcinoma
             RCC
 Etiology  : unknown
   1. cigarette smoking
   2. analgesic abuse : phenacetin
   3. occupation : shoe worker,
                     leather tanner etc
   4. coffee, diuretics, obesity, estrogen
   5. familial form : autosomal dominant
   6. ACDK : 4 - 9%
 Pathology of the RCC

 Proximal renal tubular epithelium
 Gross : yellow to orange
           hemorrhage, necrosis,
           calcification
 Micro. : clear cell
           granular cell
           sarcomatoid cell
Gross finding of RCC
Microscopic finding of RCC
   Pathogenesis of the RCC

 Vascular   tumor that tend to direct
 invasion & extension
 1/3   metastatic disease at presentation
 Lung,   liver, bone, ipsilateral lymph node,
 adrenal gland, opposite kidney
Staging of RCC
        Sx & Sign ( I )
         of the RCC

 incidentally  detected tumor :
               currently increasing
 Internist’s tumor
 Triad (10 -15%) : gross hematuria
                     flank pain
                     palpable mass
Sx & Sign(II) of the RCC

 Sx secondary to metastatic disease
       : dyspnea, cough, bone pain
 Paraneoplastic syndrome : 3 -10%
      erythrocytosis
      hypertension
      hypercalcemia
      non-metastatic hepatic dysfunction
 Dx of the RCC ( I )


 Laboratory finding
  – anemia ( 30% )
  – ESR increasing ( up to 75% )
  – hematuria ( up to 60% )
  – abnormal liver function test
Dx of the RCC ( II )

   X - ray findings
            IVP
            USG
            CT
            MRI
            Renal angiography
            Bone scan
IVP of RCC
US of RCC
CT of RCC
CT of RCC
Angiography of RCC
       DDx of the RCC

   Renal abscess
   Xanthogranulomatous PN
   Angiomyolipoma
   Renal pelvis tumor
   Extra-renal mass
DDx of cystic renal mass
      Tx of the RCC ( I )

   Localized disease ( stage I, II, IIIa )
    – radical nephrectomy
    – regional lymphadenectomy
    – preoperative renal A. embolization
Tx of the RCC (II)

   Disseminated disease
    – radical nephrectomy
    – RT
    – hormonal therapy
    – chemotherapy
    – B.R.M.
           B.R.M.
(Biologic Response Modifier)
   Interferon-a
   Tumor infiltrating lymphocyte(TIL)
   Interleukin
   Lymphocyte activating killer cell(LAK)
Follow - up of the RCC

 regular  interval
(수술 후 첫 1년 3개월, 5년은
  6개월 간격, 그 후 1년마다)
 history, P/E
 Chest X - ray
 CBC, LFT
 CT, Bone scan
Prognosis of the RCC


  T1   : 88 - 100%   5YSR
  T2 & T3a : 60%     5YSR
  T3b : 15 - 20%     5YSR
  T4 :     0 - 20%   5YSR
          김oo           F / 52

C.C.   Unable to void for 1 day
P.I.   입원 3년 전부터 blood clots을 동반한
        intermittent painless total gross hematuria (+)
       입원 1주일 전부터 gross hematuria 심해졌고
       입원 당일 AUR 발생
              Frequency(+), urgencty(+)
              Weight loss: 11kg/2yrs
Personal Hx. Smoking/alcohol (-/-)
P/E
  V/S: BP 110/70 PR 80 RR 20 BT
 36.6 0C
  HEENT: pale conjunctiva
  Abdomen: child head sized, non tender,
             firm movable mass (+) at RUQ
LAB
  CBC: 5500-4.6-267,000  ESR: 28mm/hr
  U/A: RBC many, WBC 2-3/HPF
  S/E: 137-4.3-107   BUN/Cr.: 10/0.6
  AST/ALT: 21/18
Chest PA

				
DOCUMENT INFO
Shared By:
Categories:
Tags:
Stats:
views:4
posted:12/4/2011
language:English
pages:50