1. Neoplasias del tracto Urinario Superior Brian Campbell Guillermo Riley

4. Classification of Renal Tumors Adenocarcinoma Pararenal or perirenal cysts Table 47-1 -- Classification of Renal Tumors Adenocarcinoma Pararenal or perirenal cysts Tumors of the Renal Capsule Fibroma Leiomyoma Lipoma Mixed Tumors of the Mature Renal Parenchyma Adenoma Adenocarcinoma Hypernephroma Renal cell carcinoma Alveolar carcinoma Tumors of the Immature Renal Parenchyma Nephroblastoma (Wilms' tumor) Embryonic carcinoma Sarcoma Epithelial Tumors of the Renal Pelvis Transitional cell papilloma Transitional cell carcinoma Squamous cell carcinoma Adenocarcinoma Cysts Solitary Unilateral multiple Calyceal Pyogenic Calcified Tubular ectasia Tuberous sclerosis Cystadenoma Papillary cystadenoma Dermoid Lymphatic Wolffian Hydrocele renalis Lymphatic Wolffian Hydrocele renalis Lymphatic Wolffian

5. Cont.. Malignant Vascular Tumors Hemangioma Hamartoma Lymphangioma Neurogenic Tumors Neuroblastoma Sympathicoblastoma Schwannoma Heteroplastic Tissue Tumors Adipose Smooth muscle Adrenal rests Endometriosis Cartilage Bone Mesenchymal Derivatives Connective tissue Fibroma Fibrosarcoma Osteogenic sarcoma Adipose tissue Lipoma Liposarcoma Fibrosarcoma Muscle tissue Leiomyoma Leiomyosarcoma

8. Evaluación Radiológica de Masas Renales

9. Figure 47-2 A, CT scan without administration of contrast material shows solid, right posterior renal mass. B, After administration of the contrast agent, CT scan shows that the mass enhances more than 20 Hounsfield units and is thus highly suggestive of renal cell carcinoma. This mass was excised and confirmed to be a clear cell renal cell carcinoma. (Courtesy of Dr. Terrence Demos, Maywood, Illinois.)

10. Figure 47-4 A, Magnetic resonance scan of kidneys without administration of gadolinium suggests anterior right renal mass. B, After intravenous administration of gadolinium-labeled diethylenetriaminepentaacetic acid, MRI shows enhancement of this mass indicative of malignancy. (Courtesy of Dr. Terrence Demos, Maywood, Illinois.)

12. Figure 47-5 Bosniak's class II renal cysts. A, CT scan shows right renal cyst with thin internal septation. B, CT scan in another patient shows relatively thin, curvilinear calcification in the septa of the wall of right renal cyst. (Courtesy of Dr. Terrence Demos, Maywood, Illinois.)

14. Figure 47-7 Bosniak's class III cysts. A, CT scan shows complex right renal cyst with thick and irregular septa and inhomogeneous character. B, CT scan shows somewhat thick-walled, complex left renal cyst also exhibiting irregular calcification and moderate heterogeneity. (Courtesy of Dr. Terrence Demos, Maywood, Illinois.)

20. Figure 47-11 A, Bivalved renal oncocytoma demonstrating central scar. B, Oncocytoma with large eosinophilic cells arranged in distinct nests.

22. Figure 47-12 A, CT scan demonstrates large bilateral renal angiomyolipomas in a patient with tuberous sclerosis. B, Renal angiogram shows increased vascularity and aneurysmal dilation characteristic of angiomyolipoma. C, Typical microscopic appearance of angiomyolipoma with admixture of mature adipose tissue, smooth muscle, and thick-walled blood vessels.

26. Carcinoma de Células Renales Familiar y Genética Molecular

27. Patologia

28. Clasificación Histologica

32. Síndromes Paraneoplasicos

33. Poblaciones a estudio

35. Estadificación TNM

37. Estadificación de Robson

38. TNM + Robson

39. Pronostico

40. Tratamiento

42. Algoritmo Wein: Campbell-Walsh Urology, 9th ed

45. Table 47-16 -- Postoperative Surveillance after Radical Nephrectomy for Localized Renal Cell Carcinoma Wein: Campbell-Walsh Urology, 9th ed Pathologic Tumor Stage History, Examination, and Blood Tests Chest Radiograph Abdominal CT Scan T1 N0 M0 Yearly — — T2 N0 M0 Yearly Yearly Every 2 years T3a-c N0 M0 Every 6 months for 3 years, then yearly Every 6 months for 3 years, then yearly At 1 year, then every 2 years

51. Figure 47-28 Transfemoral venogram shows complete occlusion of the inferior vena cava in patient with renal tumor. Wein: Campbell-Walsh Urology, 9th ed

52. Figure 47-27 Contrast inferior venacavogram in patient with a right renal tumor shows involvement of the subdiaphragmatic vena cava. Wein: Campbell-Walsh Urology, 9th ed

56. Figure 47-31 Algorithm for management of advanced RCC. MSK, Memorial Sloan Kettering . Wein: Campbell-Walsh Urology, 9th ed

62. Figure 47-32 Overall response rates (complete and partial responses) in a review of therapy with various cytokines including interferon alfa (INF-α), interleukin-2 (IL-2), and the combination of interleukin-2 and interferon alfa. Patients included in prospective phase II and phase III trials receiving various doses and schedules of the cytokines are included Wein: Campbell-Walsh Urology, 9th ed

64. Figure 47-34 Illustration of the effects of various targeted agents (bevacizumab, sorafenib, SU011248) on endothelial and tumor cells. Bevacizumab binds and sequesters VEGF, and sorafenib and SU011248 inhibit the receptors for VEGF and PDGF. Wein: Campbell-Walsh Urology, 9th ed

65. Figure 47-35 Algorithm for multimodality therapy in patients with metastatic renal cell carcinoma (RCC). Wein: Campbell-Walsh Urology, 9th ed

66. ¿PrEgUnTaS?