D R A . M A R I A A N T O N I E T A R A M O SK A R E N M E Z A

CARCINOMA DE CÉLULAS RENALES (CCR)

Grupo 5.4matrícula: 259943

RRC

RRC

malignant tumours derived from the renal

epithelium

most common malignant renal

tumour

variety of radiographic appearances

Epidemiology

50-70 years of age at

presentation

male predilection

of 2:1

Clinical presentation

macroscopic hematuria:

60%

flank pain: 40%

palpable flank mass:

30-40%

This triad is however only found in 10-15% of patients

RISK FACTORS

obesity

dialysis

cigarette smoking

PARANEOPLASIC SYNDROMES

Polycythaemia

Hypercalcaemia

Stauffer syndrome

Robson staging: *stage I - limited to kidney*stage II - involvement of perinephric fat but remains limited to Gerota's fascia*stage III IIIa - renal vein involvement IIIb - nodal involvement IIIc - both IIIa and IIIb*stage IV IVa - direct invasion of adjacent organs / structures IVb - distant metastases

CTUSED TO BOTH DIAGNOSE AND STAGE RENAL CELL CARCINOMAS

On non-contrast CT the lesions appear of soft

tissue attenuation

Approximately 30% demonstrate some calcification

In general small lesions enhance homogeneously

Larger lesions have irregular

enhancement due to areas of necrosis

MRIIS ALSO ABLE TO SUGGEST THE LIKELY HISTOLOGY, ON THE GROUNDS OF

T2 DIFFERENCES

MR

IT1 - often heterogeneous due to necrosis, haemorrhage and solid

components

T2 - appearances depend on histology 6

clear cell RCC - hyper intensepapillary RCC - hypo intense

MRI

Tumour pseudocapsule appears as an

hypointense rim between the tumor and

the adjacent parenchyma

Useful at imaging renal vein and IVC tumour

thrombus

Presence of enhancement in the thrombus is able to distinguish between bland and tumour

thrombus

CASE REPORT

A 61 year old female patient presented to the Emergency Department with feeling unwell, pyrexia, nausea and headache. She gave a history of fever for the past three weeks with three episodes of rigors. She also gave a history of recent loss of appetite and some weight loss. She had no urinary problems.On examination she looked pale. A mass was palpable in the right lower quadrant and lumbar region. Liver and spleen were not palpable. There were no signs of peritonitis.Her pulse rate was 125/minute, BP 120/85 and temp 39.6 degree Centigrade. She had blood tests in the Emergency Department which revealed the following : Hb 12.0 g/dL, WCC 11.6 × 10(9)/litre and Platelets 237 × 10(9)/litre. Electrolytes and urea were as follows: Na 133 mmol/litre, K+ 4.2 mmol/litre, Urea 5.1 mmol/litre and Creatinine 78 micromol/litre. Chest X ray did not reveal any abnormality.The patient had a CT which showed mass in the right Kidney.

DIFERENTIAL DIAGNOSIS

Renal adenoma

Renal oncocytoma

Angiomyolipoma

RENAL ONCOCYTOMA

5% of resected primary adult

epithelial renal neoplasms

6th to 7th decades with a peak incidence

at 55 years of age

Up to three quarters of patients are asymptomatic

Large massPseudocapsule,

necrosis is usually absent

sharp central stellate scar

The only reliable feature is evidence of

metastasis or aggressive infiltration

small tumours may enhance

homogeneously, but usually enhancement is heterogenous and the mass is larger

tumour thrombus is absent

Angiography: spoke wheel pattern, during

the capillary phase the tumour demonstrates a

homogenous blush, lu acent avascular rim may be seen

due to the compressed pseudocapsule

ANGIOMYOLIPOMA

composed of vascular, smooth muscle and fat

elements

typically identified in adults (mean age of

presentation 43 years)F:M of 4:1

The remaining 20% are seen in association with phakomatoses,

the vast majority in the setting of tuberous

sclerosis

Retroperitoneal haemorrhage;

Wunderlich syndrome

palpable mass, flank pain, urinary tract

infections, haematuria, renal failure, hypertension

cornerstone of diagnosis on all modalities is the demonstration of macroscopic fat

in the setting of haemorrhage, or when

lesions contain little fat, appearances may

be difficult to distinguish

Most lesions involve the cortex and demonstrate

macroscopic fat (< - 20HU)

A proportion of angiomyolipomas are

fat-poor. This is especially the case in

the setting of tuberous sclerosis

Calcification is rare.

MRI: at saturated techniques

demonstrate high signal on non-fat

saturated sequences, and loss of signal

following fat saturation

india ink artifact at the interface between fat

and non-fat components

DSA - angiographyAngiomyolipomas are hypervascular

lesions demonstrating often characteristic features:

micro or macro aneurysms sharply marginateddense early arterial networklate whorled appearance

RENAL ADENOMA

>3 cm in patients of 50-70 years of age

Male predilection

CRR potential It´s benign if it´s >2cm

You can´t diferentiate it

from RRC