〖医学〗Neoplasms of Genitourinary System 泌尿系肿瘤.pptVIP

Neoplasms of Genitourinary System泌尿系肿瘤 Adenocarcinoma of the Kidney （ Renal Cell Carcinoma, RCC, 肾细胞癌） RCC In US(1999), 30,000 new cases diagnosed, 11,900 deaths from this disease RCC accounts for 3% of adult cancers, 85% of all primary malignant renal tumors RCC occurs most commonly in 5th~6th decade, male-female ratio 2:1 Etiology Cause: unknown Risk Factors: cigarette smoking, exposure to asbestos （石棉）and tanning（鞣革）products Etiology RCC occurs in 2 forms: --inherited（遗传）：chromosome translocation, Von Hippel-Lindau disease --sporadic（散发） Pathology RCC originates from the proximal renal tubular epithelium. Types: Clear cell type Granular cell type Mixed cell type RCC is most often a mixed adenocarcinoma（腺癌）. Tumor Staging (Robson System) I: Tumor is confined within the kidney parenchyma. II: Tumor involves the perinephric fat but confined within Gerota’s fascia (including the adrenal). IIIA: Tumor involves the main renal vein/inferior vena cava. Tumor Staging (Robson System) IIIB: Tumor involves regional LN. IIIC: Tumor involves both local vessels and LN. IVA: Tumor involves adjacent organs other than the adrenal. IVB: Distant metastases. Clinical Findings Symptoms Signs A. Classical triad——gross hematuria, flank pain, palpable mass (only in 10~15% advanced cases) Symptoms secondary to metastatic disease: dysnea cough, seizure headache, bone pain Renal tumors are increasingly detected incidentally by CT or ultrasound Clinical Findings B. Paraneoplastic Syndromes: erythrocytosis（红细胞增多症）, hypercalcemia（高钙血症）, hypertension C. Lab Findings: anemia, hematuria(60%), ESR↑, Clinical Findings D. X-ray Findings: *Ultrasonography *Intravenous Urography (IVU): 75% accurate (used alone), calcification *CT scanning: more sensitive, mass +renal hilum, perinephric space and vena cava, adrenals, regional LN and adjacent organs *Renal Angiography IVU of right RCC CT scan of right RCC CT scan of left RCC RCC invading renal vein Left cy