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Renal Cell Carcinoma

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Topic updated on 11/09/17 8:14pm

Overview
  • 65-year-old man with a 40 pack-year history of smoking presents with right costovertebral angle pain, hematuria, fever, and a palpable mass in the right lower quadrant. A chest radiograph reveals multiple nodular masses in the lungs. A biopsy is performed.
Introduction
  • Malignancy of proximal renal tubular cells
    • are the most metabolically active cells of the kidney predisposing them to oxidative damage
    • usually involves upper poles of the kidney
  • Most common renal malignancy 
  • Affects more men than women
  • Usually arises in the sixth-seventh decade of life
  • Risk factors
    • smoking
    • obesity
    • exposure to petroleum products
  • Associated with
    • von Hippel-Lindau
      • autosomal dominant
      • gene deletion in chromosome 3
      • bilateral tumors in half of cases
    • paraneoplastic syndromes
      • ectopic EPO, ACTH, PTHrP, and prolactin
Presentation
  • Symptoms 
    • hematuria (90%)
    • pain (45%)
    • fever (20%)
      • related to chemical released by the tumor rather than by infection.
    • weight loss
  • Physical exam
    • palpable mass (30%)
    • left-sided varicocele
      • due to blockage of left testicular vein, which drains into left renal vein
Evaluation
  • Serology 
    • polycythemia
      • paraneoplastic syndrome due to EPO release
    • hypercalcemia
      • paraneoplastic syndrome due to PTH-related hormone
    • hypercortisolism
      • due to ACTH
    • hypertension
      • due to renin
  • Histology
    • clear cells filled with glycogen and lipid
Prognosis, Prevention, and Complications
  • Involvement of the renal vein or renal capsid is very important in prognosis
    • allows for hematogenous spread
  • Cannonball metastasis to the lungs
    • can also spread to nodes and bone


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(M1.ON.87) A 71-year-old male presents to your office with painless hematuria and left costovertebral angle pain. His body mass index is 33 kg/m^2. A renal biopsy is shown in Figure A. The patient’s mass is most likely a malignancy of which of the following:
Topic Review Topic
FIGURES: A          

1. Tubular epithelial cells
2. Perirenal adipose cells
3. Metastatic adrenocortical carcinoma
4. Mesangial cells
5. Visceral epithelial cells

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