tract tumors judoctors泌尿系肿瘤课件

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1、UrinaryTractTumors2%-3%ofallcancersinadults.Themostcommonmalignanttumorofthekidneyisrenalcellcarcinoma.followedinfrequencybynephroblastoma(Wilmstumor)andbyprimarytumorsofthecalycesandpelvis.Tumorsofthelowerurinarytractareabouttwiceascommonasrenalcellcarcinomas.Renal

2、CellCarcinoma(RCC)arederivedfromtherenaltubularepithelium.locatedpredominantlyinthecortex.2%-3%ofallcancersinadults.80%-85%ofallprimarymalignanttumorsofthekidney.30,000casesperyear.40%ofpatientsdieofthedisease.6th-7thdecades.M:F2:1Predisposingfactors1-smoking2-hyper

3、tension3-obesity4-occupationalexposuretocadmium.Smokerswhoareexposedtocadmiumhaveaparticularlyhighincidenceofrenalcellcarcinomas.5-chronicdialysis&acquiredpolycysticdisease-Theriskofdevelopingrenalcellcancerisincreased30-foldNewclassificationbasedonthemolecularorigi

4、nsofthesetumors1-ClearCellCarcinomas2-PapillaryRenalCellCarcinomas3-ChromophobeRenalCarcinomas1-ClearCellCarcinomasarethemostcommontype(70%-80%ofRCC).Histologically,theyaremadeupofcellswithclearorgranularcytoplasm.Formsofclearcellrenalcarcinoma:1-Sporadic2-Familial3

5、-inassociationwithvonHippel-Lindau(VHL)diseaseVHLdiseaseVHLgeneistumorsuppressorgeneinvolvedinlimitingtheangiogenicresponsetohypoxia;thus,itsabsencemayleadtoincreasedangiogenesisandtumorgrowthisautosomaldominantandischaracterizedbypredispositiontoavarietyofneoplasms

6、:1-hemangioblastomasofthecerebellumandretinalangiomas.2-bilateralrenalcysts3-bilateral&multipleclearcellcarcinomas(40%-60%ofindividuals).4-PheochromocytomaThosewithVHLsyndromeinheritagerm-linemutationoftheVHLgeneonchromosome3p25andlosethesecondallelebysomaticmutatio

7、n.TheVHLgeneisalsoinvolvedinthemajorityofsporadicclearcellcarcinomas(60%).homozygouslossoftheVHLgeneseemstobethecommonunderlyingmolecularabnormalityinbothsporadicandfamilialformsofclearcellcarcinomas2-PapillaryRenalCellCarcinomas10%to15%ofallrenalcancers.showapapill

8、arygrowthpattern.arefrequentlymultifocalandbilateralandappearasearly-stagetumors.familialandsporadicforms.papillaryrenalcancershavenoabnor