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《(医学)Neoplasms of Genitourinary System 泌尿系肿瘤》由会员上传分享，免费在线阅读，更多相关内容在教育资源-天天文库。
1、NeoplasmsofGenitourinarySystem泌尿系肿瘤AdenocarcinomaoftheKidney（RenalCellCarcinoma,RCC,肾细胞癌）RCCInUS(1999),30,000newcasesdiagnosed,11,900deathsfromthisdiseaseRCCaccountsfor3%ofadultcancers,85%ofallprimarymalignantrenaltumorsRCCoccursmostcommonlyin5th~6thdecade,male-femaleratio2:1Etiology
2、Cause:unknownRiskFactors:cigarettesmoking,exposuretoasbestos（石棉）andtanning（鞣革）productsEtiologyRCCoccursin2forms:--inherited（遗传）：chromosometranslocation,VonHippel-Lindaudisease--sporadic（散发）PathologyRCCoriginatesfromtheproximalrenaltubularepithelium.Types:ClearcelltypeGranularcelltype
3、MixedcelltypeRCCismostoftenamixedadenocarcinoma（腺癌）.TumorStaging(RobsonSystem)I:Tumorisconfinedwithinthekidneyparenchyma.II:TumorinvolvestheperinephricfatbutconfinedwithinGerota’sfascia(includingtheadrenal).IIIA:Tumorinvolvesthemainrenalvein/inferiorvenacava.TumorStaging(RobsonSystem
4、)IIIB:TumorinvolvesregionalLN.IIIC:TumorinvolvesbothlocalvesselsandLN.IVA:Tumorinvolvesadjacentorgansotherthantheadrenal.IVB:Distantmetastases.ClinicalFindingsSymptoms&SignsA.Classicaltriad——grosshematuria,flankpain,palpablemass(onlyin10~15%advancedcases)Symptomssecondarytometastatic
5、disease:dysnea&cough,seizure&headache,bonepainRenaltumorsareincreasinglydetectedincidentallybyCTorultrasoundClinicalFindingsB.ParaneoplasticSyndromes:erythrocytosis（红细胞增多症）,hypercalcemia（高钙血症）,hypertensionC.LabFindings:anemia,hematuria(60%),ESR↑,ClinicalFindingsD.X-rayFindings:*Ultra
6、sonography*IntravenousUrography(IVU):75%accurate(usedalone),calcification*CTscanning:moresensitive,mass+renalhilum,perinephricspaceandvenacava,adrenals,regionalLNandadjacentorgans*RenalAngiographyIVUofrightRCCCTscanofrightRCCCTscanofleftRCCRCCinvadingrenalveinLeftcysticRCCLeftcysticR
7、CCDifferentialDiagnosisBenignrenaltumors:Angiomyolipoma（血管平滑肌脂肪瘤,错构瘤)Treatment1.Localizeddisease:Surgicalremoval---onlypotentiallycurativetherapyRadicalNephrectomy(enblocremovalofthekidneyandGerota’sfasciaincludingipsilateraladrenal,proximal½ureter,regionallymphadenectomy(淋巴结清扫)Treat
8、ment2.Dissem
