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Benign tumor in Kidney

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

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Benign tumor in Kidney

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  1. Benign tumor in Kidney • Adenoma • Oncocytoma • Angiomyolipoma • Leiomyoma • Lipoma • Hemangioma • Juxtaglomerular tumor

  2. Renal adenoma • most common benign tumor • asymptomatic & incidentally at autopsy • 7 - 22 % at autopsy

  3. Renal oncocytoma • 3 - 5 % of renal tumor • M : F = 2 : 1 • Solitary & unilateral • tan & light brown • spoke - wheel appearance • Tx : radical nephrectomy

  4. ONCOCYTOMA

  5. 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

  6. Angiomyolipoma (II) • DIAGNOSIS US & CT로 진단 가능 US : very high intensity echo CT : -20~ -80 HU MRI : not considered

  7. 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

  8. US of AML

  9. CT of AML

  10. Other rare benign tumor • Leiomyoma • Hemangioma • Lipoma • Juxtaglomerular cell tumor

  11. RENAL LIPOMA

  12. 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

  13. 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%

  14. Pathology of the RCC • Proximal renal tubular epithelium • Gross : yellow to orange hemorrhage, necrosis, calcification • Micro. : clear cell granular cell sarcomatoid cell

  15. Gross finding of RCC

  16. Microscopic finding of RCC

  17. 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

  18. Staging of RCC

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

  20. 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

  21. Dx of the RCC ( I ) • Laboratory finding • anemia ( 30% ) • ESR increasing ( up to 75% ) • hematuria ( up to 60% ) • abnormal liver function test

  22. Dx of the RCC ( II ) • X - ray findings IVP USG CT MRI Renal angiography Bone scan

  23. IVP of RCC

  24. US of RCC

  25. CT of RCC

  26. CT of RCC

  27. Angiography of RCC

  28. DDx of the RCC • Renal abscess • Xanthogranulomatous PN • Angiomyolipoma • Renal pelvis tumor • Extra-renal mass

  29. DDx of cystic renal mass

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

  31. Tx of the RCC (II) • Disseminated disease • radical nephrectomy • RT • hormonal therapy • chemotherapy • B.R.M.

  32. B.R.M.(Biologic Response Modifier) • Interferon-a • Tumor infiltrating lymphocyte(TIL) • Interleukin • Lymphocyte activating killer cell(LAK)

  33. 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

  34. Prognosis of the RCC • T1 : 88 - 100% 5YSR • T2 & T3a : 60% 5YSR • T3b : 15 - 20% 5YSR • T4 : 0 - 20% 5YSR

  35. 김o o 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 (-/-)

  36. 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

  37. Chest PA

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