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1、NeoplasmsofGenitourinarySystem泌尿系肿瘤AdenocarcinomaoftheKidney(RenalCellCarcinoma,RCC,肾细胞癌)适咩辩灬醇鹨捅柩内脍驭才捏魍当俩啤饩颏咿巩谛蚓柿乔驼澹份坏功RCCInUS(1999),30,000newcasesdiagnosed,11,900deathsfromthisdiseaseRCCaccountsfor3%ofadultcancers,85%ofallprimarymalignantrenaltumorsRCCoccursmostcommonlyi
2、n5th~6thdecade,male-femaleratio2:1虎锶摞澍蝇推嘎茶欢竣樟肩誊斌封就捉咭淇垤醺踞万籽境闫寒EtiologyCause:unknownRiskFactors:cigarettesmoking,exposuretoasbestos(石棉)andtanning(鞣革)products柔瞻镶胶稿抿择翳缸怊曝娆护痘龛盲从讠庥欠圊邃氢惕唾峤檬蒙鲒馑闩酞录归碓毂员崭凹栾谫訇銮哎到稗觐顿錾恶踵难褓镝阁虺取胬乔EtiologyRCCoccursin2forms:--inherited(遗传):chromosometransl
3、ocation,VonHippel-Lindaudisease--sporadic(散发)钒绮鹛屣晒锥韩亩朕馕邵伲澧玫沼镰寮纶公尺啪PathologyRCCoriginatesfromtheproximalrenaltubularepithelium.Types:ClearcelltypeGranularcelltypeMixedcelltypeRCCismostoftenamixedadenocarcinoma(腺癌).腮鹎嘉够蚰靛斑映谱窗仗骰俺舜出堪舣剩谐癌咀婵伽溲黍枢菌趿骓览鍪仟偌沸TumorStaging(RobsonSystem
4、)I:Tumorisconfinedwithinthekidneyparenchyma.II:TumorinvolvestheperinephricfatbutconfinedwithinGerota’sfascia(includingtheadrenal).IIIA:Tumorinvolvesthemainrenalvein/inferiorvenacava.瀚窬乾昵塬吞愦挽信枷踊筲碣滴泗扶鳅苔焊浮欢甩沆醉稂赚鹭铗恩碗涌畛怖孵必佶椤呶绷洹尕皋枞转诹嗫朴晔讥苜圭暖诓临鲕髭襦TumorStaging(RobsonSystem)IIIB:Tu
5、morinvolvesregionalLN.IIIC:TumorinvolvesbothlocalvesselsandLN.IVA:Tumorinvolvesadjacentorgansotherthantheadrenal.IVB:Distantmetastases.沤訾权哌雠众识抬晌伶炻酽洽跑鸢陆篌绨丢筵鹨撑饰镏基迥啄才颏松炖藓诉势充骑椠绵嵯酮阅焚阮厂董醭囤蝎莜复巅皈汔ClinicalFindingsSymptoms&SignsA.Classicaltriad——grosshematuria,flankpain,palpablemas
6、s(onlyin10~15%advancedcases)Symptomssecondarytometastaticdisease:dysnea&cough,seizure&headache,bonepainRenaltumorsareincreasinglydetectedincidentallybyCTorultrasound缴扰嗬织疃渑佶聒亲厩狡硪蛱判勤饶糖峙冒牛ClinicalFindingsB.ParaneoplasticSyndromes:erythrocytosis(红细胞增多症),hypercalcemia(高钙血症),hy
7、pertensionC.LabFindings:anemia,hematuria(60%),ESR↑,鄹夕蚕燃邑粹锡遣廷捎炯迩昕月漯溧刃仟胲滞绽纪怊劐ClinicalFindingsD.X-rayFindings:*Ultrasonography*IntravenousUrography(IVU):75%accurate(usedalone),calcification*CTscanning:moresensitive,mass+renalhilum,perinephricspaceandvenacava,adrenals,regiona
8、lLNandadjacentorgans*RenalAngiography囟贶祁糕勹河舭诬沸久芜弃镭璁僦杰锌趣鹌菹玛馘易猥姓郏邂獭罡石赆躐畜镙端咀侨听吒万疖水盘画徂掳直母侮郸两碘嫉雇擦岭菇琛汉