Karcinom ledviny

Longitudinal section of the kidney - carcinoma

Histological preparation of chromophobic renal carcinoma

Adenocarcinoma of the kidney spreads per continuitat (into surrounding structures, angioinvasion - IVC), lymphogenically few (lumbar nodes) and especially hematogenously (lungs, bones, liver). It is based on tubule cells.

Forms of cancer

• Light cell - makes up about 70%

bright cells, thanks to glycogen and lipids

• Papillary - 10-15%

papillary structure, contains psamomatous bodies.

• Granular - 8%

acidophilic cytoplasm, cellular atypia.

• Chromophobic - 5%

contains clear cells with perinuclear halo + granular cells

• Sarcomid - 1.5%

vortex atypical spindle cells.

• From collecting channels - 0.5%

structure with tubular and papillary pattern

Clinical manifestations

• Up to 60% of patients are asymptomatic, the tumor is diagnosed as an incident (accidental finding on a sonography),
• trias (in advanced tumor) - macrohematuria, lumbalgia, palpable tumor - in about 6–10% of diagnosed tumors,
• acute varicocele,
• renal colic (clot, tumor mass),
• pathological fracture.

Diagnostics

• When an expansive kidney process is found:

• excretory urography,
• Ultrasound, CT examination with contrast of the abdomen and chest (staging),
• angiography, cavography (injection of the inferior vena cava with a contrast agent - a tumor thrombus is being sought, now replaced by MRI).

Treatment

1. Surgical – nephrectomy,
   • nephrectomy (preferably transabdominal approach, laparoscopically and openly transperitoneal) radical - including fat sheath and Gerot's fascia, in tumors over 5 cm in the upper pole in adrenalectomy, regional lymphadenectomy is no longer performed as standard (kidney cancer metastasizes mainly hematogenously, not lymphoscopically), operate on tumors up to 8−10 cm, without invasion of perirenal structures and tumor thrombus,
   • conservation surgery - resection of the pole (tumor up to 5 cm) or excision of the tumor from lumbotomy or laparoscopically, (indications of conservation surgery: anatomically or functionally solitary kidney, bilateral tumor and hereditary forms of tumors),
   • advanced carcinoma - resection of solitary metastasis, in massive hematuria embolization, in bone pain palliative radiation,
2. chemo-radiotherapy - the tumor is chemo- and radioresistant, the effect is vinblastine,
3. imunoterapie (IFNα, IL-2) - since the 90s, effect on metastasis treatment, partial remission in 15% of patients (IL-2),
4. biologic therapy (since 2006) - sunitinib, sorafenib, doubled patient survival, angiogenesis inhibitors bevacizumab.

Tumor thrombus

Kidney cancer grows into the veins:

• renal vein - nephrectomy,
• inferior vena cava below the level of the diaphragm - cavotomy,
• inferior vena cava above the level of the diaphragm - a two-cavity procedure with extracorporeal circulation and assisted by a cardiac surgeon.

Links

Related articles

• Clear cell renal cell carcinoma (histology slide)
• Benign kidney tumors