Аденокарцинома почки

Renal adenocarcinoma is a renal cell carcinoma originating from the renal tubule epithelium. Manifestations of kidney adenocarcinoma are lower back pain, hematuria, enlarged kidney, anemia, cachexia. It is possible metastasis of the tumor into the lungs, paracaval and paraaortic lymph nodes, bones, liver, adrenal glands, the opposite kidney. Adenocarcinoma is diagnosed by ultrasound of the kidneys, cystoscopy, excretory urography, ureteropyelography, and CT scan of the kidneys. Morphological verification of the diagnosis is carried out by puncture biopsy of the kidney and histological examination of the biopsy. Detection of kidney adenocarcinoma is an indication for nephrectomy followed by radiation therapy.

Kidney adenocarcinoma accounts for about 2.5% of the number of neoplasias of various locations. In urology, adenocarcinoma is the most common kidney cancer histotype in adults. Among all kidney tumors, adenocarcinoma accounts for 90% of cases. Kidney adenocarcinoma usually develops between the ages of 40-70; with the same frequency affects the left and right kidney; 2 times more often diagnosed in men.

Macroscopically, adenocarcinoma of the kidney looks like a node of soft-elastic consistency. When the incision is seen alternating areas of hemorrhage and necrosis, giving the tumor a mottled appearance. Tumor growth can be multidirectional - towards the renal capsule or the pyelocaliceal complex; rather quickly, adenocarcinoma sprouts the renal veins, inferior vena cava, adjacent tissues; metastases to the lymph nodes, lungs, bones, liver, brain.

The microscopic structure of kidney adenocarcinoma is represented by strands and clusters of polygonal cells having light protoplasm containing glycogen and lipids; tumor stroma is weakly expressed.

In case of kidney adenocarcinoma, it is optimal to conduct combined treatment, including radical kidney surgery and radiation therapy. In the early stages of kidney adenocarcinoma, partial nephrectomy can be performed. In a common process, total nephrectomy is performed by removal of the perirenal and retroperitoneal tissue with regional lymph nodes. Tumor germination by the inferior vena cava and even the presence of single distant metastases do not interfere with nephrectomy. With single metastases to the lungs, the second stage is the removal of the metastatic lesion. The combination of surgical treatment with radiation increases the survival of kidney adenocarcinoma.

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A total cancerous lesion of both kidneys may require a binectomy with a patient undergoing hemodialysis. A common form of kidney adenocarcinoma, characterized by extensive metastasis and tumor germination, involves symptomatic and palliative treatment with radiation and chemotherapy.

 

 

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Bangkok Pattaya Hospital, ПаттайяMedical Center KUIMS, Сеул
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