A912: Kidney, Renal cell carcinoma

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1 A912: Kidney, Renal cell carcinoma General facts of kidney cancer Renal cell carcinoma, a form of kidney cancer that involves cancerous changes in the cells of the renal tubule, is the most common type of kidney cancer in adults Renal cell carcinoma affects about 3 in 10,000 people, resulting in about 31,000 new cases in the US per year. Every year, about 12,000 people in the US die from renal cell carcinoma. It is more common in men than women, usually affecting men older than 55. Why the cells become cancerous is not known. A history of smoking greatly increases the risk for developing renal cell carcinoma. Some people may also have inherited an increased risk to develop renal cell carcinoma, and a family history of kidney cancer increases the risk. People with von Hippel-Lindau disease, a hereditary disease that affects the capillaries of the brain, commonly also develop renal cell carcinoma. Kidney disorders that require dialysis for treatment also increase the risk for developing renal cell carcinoma. The first symptom is usually blood in the urine. Sometimes both kidneys are involved. The cancer metastasizes (spreads) easily, most often to the lungs and other organs, and about one-third of patients have metastasis at the time of diagnosis. Symptoms & Signs Blood in the urine / Abnormal urine color (dark, rusty, or brown) Flank pain /Back pain /Abdominal pain Weight loss, more than 5% of body weight Emaciated, thin, malnourished appearance Enlargement of one testicle Swelling or enlargement of the abdomen Additional symptoms that may be associated with this disease: Vision abnormalities /Paleness Excessive hair grown (females) /Constipation /Cold intolerance Diagnosis & Tests Palpation of the abdomen may show a mass or organ enlargement, particularly of the kidney or liver. There may be a testicular varicocele. A CBC may show increased red blood cells (RBC) caused by stimulation of RBC production by the tumor. More commonly, though, it shows a decrease in RBC count. The RBC in urine is increased. Serum calcium levels may increase because of hormonal changes resulting from the tumor. The SGPT and alkaline phosphatase may be elevated. A urine cytology examination may show carcinoma cells. Liver function tests may show involvement of the liver from metastasis, or may be abnormal without metastasis. An ultrasound of the abdomen and kidney may show the tumor. Kidney X-ray may indicate a tumor or calcification. IVP may indicate obstruction by the tumor. Renal arteriography may show the tumor if it is highly vascular. Because metastasis is common, the following tests to look for metastasis may be performed: An abdominal CT scan shows the kidney tumor and may show a liver mass. Sometimes an abdominal MRI has to be done to determine if the tumor involves any surrounding blood vessels and to determine whether it can be surgically removed. A chest X-ray may show mass in the chest. A bone scan may show involvement of the bones. Renal Cell Carcinoma Prognosis (Expectations) The outcome varies depending on the amount of metastasis. The 5-year survival rate is around 60% to 75% if the tumor is in the early stages and has not spread outside the kidney. If it has metastasized to the lymph nodes, the 5-year survival is around 5% to 15%. If it has spread to other organs, the 5-year survival at less than 5%.

2 Staging of Renal cell carcinoma Primary tumor (T) T0 there is no evidence of a primary tumour in the kidney the tumour is no more than 7cm across and is completely inside the kidney T2 the tumour is more than 7cm across, but is still completely inside the kidney T3 the cancer has spread through the kidney capsule, to a major vein, the adrenal gland or other tissues immediately surrounding the kidney T4 the cancer has spread further than the tissues immediately surrounding the kidney Nodal involvement (N) N0 No cancer in any lymph nodes Cancer spread to one nearby lymph node only N2 Cancer spread to more than one nearby lymph node Distant metastasis (M) MX: Minimum requirements to assess the presence of distant metastasis cannot be met M0: No (known) distant metastasis M1: Distant metastasis present 1. Urinary bladder. In: American Joint Committee on Cancer.: AJCC Cancer Staging Manual. 6th ed. New York, NY: Springer, 2002 Stage I, N0, M0 Stage II T2, N0, M0 Stage III or T2,, M0 T3, N0, M0 Stage IV T3,, M0 T3a, N0, M0 T3a,, M0 T3b, N0, M0 T3b,, M0 T3c, N0, M0 T3c,, M0 T4, N0, M0 T4,, M0 Any T, N2, M0 Any T, Any N, M1

3 Lot. No : Ureter Adrenal Adrenal Fig2. RT-PCR for GAP3DH Sample : Serial 10 sections of Ureter Adrenal / AGE: 59 Stage: T2N0M0 1.Kidney, left, radical nephrectomy: Renal cell carcinoma, 1) clear cell type, Fuhrman grade III 2) confined to the capsule. 2.Resection margins, ureter and vascular: Free of tumor. 3.Lymph nodes, hilar (0/1) and paraaortic (0/18): Free of tumor. 3.Adrenal gland: No pathological diagnosis. EM> Ultrastructural features are compatible with renal cell carcinoma

4 Lot. No : Adrenal Ureter Adrenal Ureter Fig2. RT-PCR for GAP3DH Sample : Serial 10 sections of Adrenal Ureter / AGE: 61 Stage: N0M0 1.Kidney, left, radical nephrectomy: Renal cell carcinoma 1) clear cell type, Fuhrman grade II 2) confined to the capsule. 2.Simple cysts. 3.Resection margins, ureteral and vascular: Free of tumor. 1) lymph nodes, paraaortic (0/35) and regional hilar (0/2) : (0/37) : Free of tumor. 4.Adrenal gland: No pathological diagnosis. * preoperation conservative theraphy

5 Lot. No : Fig2. RT-PCR for GAP3DH Sample : Serial 10 sections of / AGE: 61 Sex: Female Stage: N0M0 1.Kidney, adrenal gland and perirenal fatty tissue, left, radical nephrectomy: Renal cell carcinoma, clear cell type, in mid portion 1) size: 6x3.3x3cm 2) Fuhrman grade II 3) invasion to renal capsule but limited to the kidney 4) intact renal artery and vein from tumor 5) intact ureter from tumor 6) intact perinephric tissue and Gerota's fascia from tumor 7) no metastasis to hilar lymph nodes (0/2) 2.Adrenal gland: Free from tumor extension. * Preoperation conservative theraphy * Comments: Diabefes mellitus, Hypertension

6 Lot. No : Fig2. RT-PCR for GAP3DH Sample : Serial 10 sections of / AGE: 34 Stage: N0M0 1.Kidney, left radical nephrectomy: Renal cell carcinoma, 1) conventional (clear cell) type, Fuhrman's 2) nuclear grade II, confined to renal capsule. 2.Ureter, resection margin: Free of tumor. 3.Blood vessels: Free of tumor. 4.Adrenal gland: Free of tumor. 1) lymph node, paraoartic(0/1): Free of tumor. * Comments: with lung TB, hepatitis B

7 Lot. No : N TN Fig2. RT-PCR for GAP3DH Sample : Serial 10 sections of TN / AGE: 58 Stage: an0m1 1.Kidney, left, partial nephrectomy: Renal cell carcinoma, conventional (clear cell type) 1) confined to the renal capsule, 2) Fuhrman's nuclear grade IV. 3) resection margin, ureter: Free of tumor. 2.Renal vein: Free of tumor. 3.Adrenal gland: Free of tumor.

8 A912: kidney: renal cell carcinoma Lot. No : N2 N3 T2 for H&E stained slides * Post operation: radiotheraphy,immunotheraphy Fig2. RT-PCR for GAP3DH Sample : Serial 10 sections of T / N2 N AGE: / Stage: N0M1 1.Kidney, right, nephrectomy: Renal cell carcinoma, conventional type, with 1) Fuhrman's nuclear grade: lll. 2) limited within renal capsule. 3) no vascular invasion. 4) no pelvis invasion. 5) resection margins, ureter and renal vessels: Free of tumor. 2.Adrenal gland: Free of tumor. 1) lymph nodes, aortocaval (0/3): Free of tumor metastasis in all 3 nodes.

9 A912: kidney: renal cell carcinoma Lot. No : T Fig2. RT-PCR for GAP3DH Sample : Serial 10 sections of for H&E stained slides / AGE: 37 Stage: an0m0 1.Kidney, right, radical nephrectomy: Renal cell carcinoma, conventional (clear cell) type, 1) confined to the renal capsule, Fuhrman's nuclear grade II. 2.Ureter, resection margin: Free of tumor. 3.Blood vessels: Free of tumor. 4.Adrenal gland: Free of tumor.

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