Benign Renal Tumours
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on Aug 13, 2012 Says :
@khusbhu Tnx a lot.
on Jul 17, 2012 Says :
informative and striking ppt on Benign renal tumors.
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Slide 1 :
BENIGN RENAL TUMORS BY DR.SINGARAVELU M.S.,(GEN.SURGERY) V.M.M.C & H KARAIKAL
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BENIGN RENAL TUMORS Benign renal tumors includes 1. Adenoma. 2. Oncocytoma. 3. Angiomyolipoma. 4. Leiomyoma. 5. Lipoma. 6. Hemangioma. 7. Juxtaglomerular tumors.
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RENAL ADENOMA Most common benign renal tumors. Small, well- differentiated, glandular tumours of renal cortex . These are typically asymptomatic but are identified incidentally. Despite this been classified in benign tumor, no clinical, histological, or immunohistochemical criteria differentiate this from renal carcinoma. Previously tumors <3cms are considered as adenomas.
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RENAL ONCOCYTOMA Composed of large epithelial cells with finely granular eosinophilic cytoplasm. Can occur in various organs and organ system including salivary glands, adrenal gland, thyroid, parathyroid as well as in kidney. 3-5 % of renal tumors are oncocytoma. Men are affected often than women.
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RENAL ONCOCYTOMA Generally occur within in the well defined fibrous capsule, with tumor tissue rarely penetrating renal pelvis, cortex amd collecting system. Metastasis is extremely rare. On cut section the surface of tumor is usually tan or light brown color with a central statelite scar. Tumor is usually solitary and unilateral.
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RENAL ONCOCYTOMA The Familial Oncocytoma syndrome has also been described. These patients have their characteristic genetic abnormality involving the gene located on 17p encoding the protein name Folliculin. Cellular origin of renal oncocytoma is not fully elucidated, although some evidence suggest the origin may be a precursor of stem cell or intercalated cells of collecting tubes.
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RENAL ONCOCYTOMA Diagnosis is predominantly pathological as there is no reliable distinguishing clinical charecterstics. Gross hematuria and flank pain occur in < 20% of patients. No charecterstic findings appear in CT, USG & IVU 0r MRI. Angiographic features include SPOKE WHEEL appearance of tumor arterioles, LUCENT RIM SIGN of capsule and a homogeneous capillary nephrogarm phase.
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ANGIOMYOLIPOMA Also known as renal hamartoma. Is a rare benign tumor seen in 2 distinct populations. Occurs in 45-80% of patients with tuberous sclerosis and are typically bilateral and asymptomatic. Occurs in other rare condition termed as lymphangioleiomyomatosis may have multiple renal and hepatic angiomyolipomata, multiple pulmonary cysts, enlarged abdominal lymph nodes, lymphangiomyomas.
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ANGIOMYOLIPOMA Tuberous sclerosis is a familial inherited disorder comprising adenoma sebaceum, mental retardation & epilepsy. In patients without tuberous sclerosis angiomyolipoma can be unilateral and tend to be larger than associated with tuberous sclerosis. 25% of cases presents with spontaneous rupture and subsequent hemorrhage to retro peritoneum.(Wunderlich’s syndrome)
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ANGIOMYOLIPOMA These are uncapsulated yellow to gray lesion, round to oval, that elevate the renal pelvis producing a bulging smooth mass. Characterized by 3 histological components: mature fat cells, smooth muscle and blood vessels. Presence of renal hamartomas in extra renal sites is a manifestation of multicentricity rather than metastatic potential.
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ANGIOMYOLIPOMA Diagnosis has evolved with widespread use of CT and Ultrasound. Arteriography can reveal Neovascularity similar to renal cancer and hence its not useful. Ultrasonography and CT are frequently used as diagnostic tool. Fat visualized in USG appears as very high intensity echoes. Fat imaged by CT has negative density.
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ANGIOMYOLIPOMA MANAGEMENT Isolated lesions < 4cms can be followed with yearly CT or ultrasound. Patients with asymptomatic or mildly symptomatic lesions > 4 cms should be followed up with semiannual ultrasound. Patients with lesions > 4cms with moderate or severe symptoms(bleeding or pain) should undergo renal sparing surgery or renal artery embolization.
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ANGIOMYOLIPOMA MANAGEMENT Pregnancy may also increase the risk of growth and bleeding from large renal hamartoma. Such patients should be managed by embolization prior or in early pregnancy.
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LEIOMYOMAS Rare small tumors found in smooth muscle containing area of kidney such as renal capsule and renal pelvis. Two groups of patients has been described. The most common group comprises cortical tumors that are < 2cms and are multiple. These tumors are typically found at autopsy and are clinically not significant.
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HEMANGIOMAS These are small vascular tumors ocurring in kidney. Multiple lesions in one kidney occur in about 12% of cases. Rarely bilateral. Diagnosis is by CT angiography or MR angiography or by direct visualization by endoscope.
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RENAL LIPOMAS These are very uncommon deposits of mature adipose tissues without evident mitotic that arise from the renal capsule or perirenal tissue. Seen primarily in middle aged females. Best diagnosed by CT.
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JUXTAGLOMERULAR CELL TUMOR Most significant in benign tumor as it causes significant hypertension which can be cured by surgical treatment. Occurs more commonly in womens in 20’s and 30’s. Tumor originates in pericytes of afferent arterioles in juxtaglomerular apparatus and can be shown to contain renin secretory granules. These are typically encapsulated and are located in cortical area.
Slide 19 :
JUXTAGLOMERULAR CELL TUMOR Diagnosis can be suspected by secondary hyperaldosteronism and is confirmed by selected renal vein sampling. Complete nephrectomy is advocated in the past,several recent reports indicate partial nephrectomy can be equally effective.
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