Download Renal pelvis mass

콩팥종양, 고환 및 기타 종양
상부요로종양, 방광종양
순천향대학교 비뇨기학교실 교수
양원재
2016년 1학기 신장요로생식학
2013년 국가암정보센터
강의계획
1. Renal cell carcinoma
2. Urothelial cancer
- Bladder
- Renal pelvis
- Ureter
3. Testis, Penis Cancer
Cystic renal masses
• A renal mass that is not clearly a simple cyst by strict
ultrasound criteria should be evaluated further with
computed tomography (CT).
• A dedicated (thin-slice) renal CT scan remains the single
most important radiographic test for delineating the nature
of a renal mass.
 Solid
Needle aspiration 시 cyst가 터지면 cancer cell seeding  Bx 불가..
Bosniak II
Bosniak III
Bosnik IV
Solid renal masses
Clinical Presentation
• Because of the sequestered location of the kidney within
the retroperitoneum, many renal masses remain
asymptomatic and nonpalpable until they are advanced.
• With the more pervasive use of noninvasive imaging for
the evaluation of a variety of nonspecific symptom
complexes, more than 50% of RCCs are now detected
incidentally.
Symptomatic renal mass
• 동영상
Symptomatic renal mass
• 동영상
Tx for localized RCC
Radical or partial nephrectomy
72점
40점
28점
Postoperative nomogram
predicting recurrence of clear cell renal cell
carcinoma after nephrectomy
Tx for mRCC
Surgical Management of mRCC
-Debulking or Cytoreductive Nephrectomy-
Targeted molecular agents in Clear Cell mRCC
-Antagonists of the Vascular Endothelial Growth
Factor Pathway-
Motzer RJ, et al. N Engl J Med 2007;356:115–24
요약
• 초음파에서 단순 낭종 이외의 신종물이 관찰될 때에는 조영증
강 CT를 시행해야 한다.
• 낭성 신종물에 대한 Bosniak 분류에서 그룹 III 이상은 외과적
적출이 필요한 대상이다.
• 국소 신세포암은 외과적 절제가 최선이며 크기가 작을 경우 콩
팥 전체를 제거하지 않고 암종만 제거해도 된다.
• 전이 신세포암에서 가능한 원발암을 제거하는 것이 추후 전신
치료에 대한 반응을 높혀준다.
• 전이 신세포암은 기존의 고식적인 항암, 방사선 치료에 반응하
지 않고 표적치료가 표준적인 치료이다.
Urothelial Cancer: Bladder
Endoscopic surgery, BCG instillation
Radical surgery
Detection of Urothelial Carcinoma
• Gross, painless hematuria is the primary symptom in 85%
of patients with a newly diagnosed bladder tumor, and
microscopic hematuria occurs in virtually all patients.
• The hematuria is usually intermittent; therefore any
episode of gross hematuria should be evaluated even if
subsequent urinalysis is negative.
• Fifty percent of patients with gross hematuria will have a
demonstrable cause, 20% will have a urologic malignancy,
and 12% will have a bladder tumor.
A full hematuria evaluation
• Cystoscopy
• Urine cytology
• Upper-tract imaging (primarily a CT scan of the abdomen
and pelvis)
• PSA blood test
TransUrethral Resection of Bladder
tumor –TURBt (1) remove all visible tumors
(2) provide specimens for pathologic examination to
determine stage and grade.
Single papillary mass
• 동영상
Multiple papillary mass
• 동영상
Multiple solid mass
• 동영상
Advanced Bladder Urothelial cancer
• 동영상
Radical cystoprostatectomy
Included;
Bladder
Perivesical fat
Peritoneum
Lower ureters
Prostate
Seminal vesicle
Bilateral Pelvic Lymph Nodes Dissection
- Therapeutic procedure -
Ileal conduit, Urostomy, 요루
Orthotopic Neobladder
Orthotopic
ileal
neobladder
substitution:
Studer
neobladder
Urothelial Cancer:
Renal pelvis
Incidentally found Rt hydronephrosis, GIII
Retrograde pyelography:
Renal pelvis mass
• 동영상
CT: Renal pelvis tumor
• 동영상
Urothelial Cancer: Ureter
• 동영상
Testis cancer
• Germ cell tumor
• Lymphoid and Hematopoietic Tumors
Lymphoma
Plasmacytoma
Leukemia
Testis Cancer: Germ Cell Tumor
Initial presentation
• Painless testicular mass
• A firm intratesticular mass should be considered cancer
until proven otherwise and should be evaluated further
with scrotal ultrasonography.
• Prior studies show that up to one third of testicular tumors
are initially misdiagnosed as epididymitis or hydrocele.
Diagnosis
• In men presenting with a testicular mass, hydrocele, or unexplained
scrotal symptoms or signs, scrotal ultrasonography should be
considered an extension of the physical examination because it
is widely available, inexpensive, and noninvasive.
• Testicular cancer is one of the few malignancies associated with
accurate serum tumor markers (LDH, AFP, and hCG), a finding that
is essential in its diagnosis, prognosis, treatment, and monitoring.
• Serum tumor marker levels should be obtained at diagnosis, after
orchiectomy, to monitor for response to chemotherapy, and to
monitor for relapse in patients on surveillance and after completion
of therapy.
Scrotal sonography
• 동영상
Tx: Seminomatous GCT
Tx: Non-Seminomatous GCT
RetroPeritoneal Lymph Node Dissection: RPLND
John P. Donohue 1932-2008
Lawrence Einhorn 1940-
Their works led to an increase in cure rate of
testicular cancer from 5% to 90%.
Penile Cancer