Renal cell CA
60, white M,
heavy smoker x 24y, c/o R flank pain & hematuria.
Lost 5 lb x 1m (not on diet).
V/S: low
fever, mod HTN, pallor; palpable mass in R flank.
↑RBC (polycythemia), ↑ESR.
CBC/PBS:
normocytic normochromic anemia.
UA: gross
hematuria. IVP/CT/US: mass in upper pole of R
kidney.
MR: no
invasion of renal vein or IVC.
Patho: (yellowish
area of necrotic tiss w/ focal areas of hge w/in renal parenchyma) clear cells
(containing glycogen) w/ atypia
Invading renal
parenchyma.
-mc
renal tumor.↑in von Hippel-Lindau synd,
acquired polycystic Kidney Dz (PKD).)
-freq
invade renal vein & IVC.
-Mets (lung, bone)
via hematogenous.
-Can
cause paraneoplastic synd. (EPO, PTH, ACTH, renin)
Tx:
R nephrectomy.
Renal sparing
partial nephrectomy (consider)
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