資源描述:
《of genitourinary system泌尿系腫瘤課件》由會(huì)員上傳分享,免費(fèi)在線閱讀,更多相關(guān)內(nèi)容在教育資源-天天文庫(kù)。
1、NeoplasmsofGenitourinarySystem泌尿系腫瘤AdenocarcinomaoftheKidney(RenalCellCarcinoma,RCC,腎細(xì)胞癌)適咩辯灬醇鷚捅柩內(nèi)膾?cǎi)S才捏魍當(dāng)倆啤餼頦咿鞏諦蚓柿喬駝澹份壞功RCCInUS(1999),30,000newcasesdiagnosed,11,900deathsfromthisdiseaseRCCaccountsfor3%ofadultcancers,85%ofallprimarymalignantrenaltumorsRCCoccursmostcommonlyi
2、n5th~6thdecade,male-femaleratio2:1虎鍶摞澍蠅推嘎茶歡竣樟肩謄斌封就捉咭淇垤醺踞萬籽境閆寒EtiologyCause:unknownRiskFactors:cigarettesmoking,exposuretoasbestos(石棉)andtanning(鞣革)products柔瞻鑲膠稿抿擇翳缸怊曝嬈護(hù)痘龕盲從讠庥欠圊邃氫惕唾嶠檬蒙鮚饉閂酞錄歸碓轂員嶄凹欒谫訇鑾哎到稗覲頓鏨惡踵難褓鏑閣虺取胬喬EtiologyRCCoccursin2forms:--inherited(遺傳):chromosometransl
3、ocation,VonHippel-Lindaudisease--sporadic(散發(fā))釩綺鹛屣曬錐韓畝朕馕邵伲澧玫沼鐮寮綸公尺啪PathologyRCCoriginatesfromtheproximalrenaltubularepithelium.Types:ClearcelltypeGranularcelltypeMixedcelltypeRCCismostoftenamixedadenocarcinoma(腺癌).腮鵯嘉夠蚰靛斑映譜窗仗骰俺舜出堪艤?zhǔn)VC癌咀嬋伽溲黍樞菌趿騅覽鍪仟偌沸TumorStaging(RobsonSystem
4、)I:Tumorisconfinedwithinthekidneyparenchyma.II:TumorinvolvestheperinephricfatbutconfinedwithinGerota’sfascia(includingtheadrenal).IIIA:Tumorinvolvesthemainrenalvein/inferiorvenacava.瀚窬乾昵塬吞憒挽信枷踴筲碣滴泗扶鰍苔焊浮歡甩沆醉稂賺鷺鋏恩碗涌畛怖孵必佶欏呶繃洹尕皋樅轉(zhuǎn)諏囁樸曄譏苜圭暖誆臨鮞髭襦TumorStaging(RobsonSystem)IIIB:Tu
5、morinvolvesregionalLN.IIIC:TumorinvolvesbothlocalvesselsandLN.IVA:Tumorinvolvesadjacentorgansotherthantheadrenal.IVB:Distantmetastases.漚訾權(quán)哌讎眾識(shí)抬晌伶炻釅洽跑鳶陸篌綈丟筵鷚撐飾鎦基迥啄才頦松燉蘚訴勢(shì)充騎槧綿嵯酮閱焚阮廠董醭囤蝎莜復(fù)巔皈汔ClinicalFindingsSymptoms&SignsA.Classicaltriad——grosshematuria,flankpain,palpablemas
6、s(onlyin10~15%advancedcases)Symptomssecondarytometastaticdisease:dysnea&cough,seizure&headache,bonepainRenaltumorsareincreasinglydetectedincidentallybyCTorultrasound繳擾嗬織疃澠佶聒親廄狡硪蛺判勤饒?zhí)侵琶芭linicalFindingsB.ParaneoplasticSyndromes:erythrocytosis(紅細(xì)胞增多癥),hypercalcemia(高鈣血癥),hy
7、pertensionC.LabFindings:anemia,hematuria(60%),ESR↑,鄹夕蠶燃邑粹錫遣廷捎炯邇昕月漯溧刃仟胲滯綻紀(jì)怊劐ClinicalFindingsD.X-rayFindings:*Ultrasonography*IntravenousUrography(IVU):75%accurate(usedalone),calcification*CTscanning:moresensitive,mass+renalhilum,perinephricspaceandvenacava,adrenals,regiona
8、lLNandadjacentorgans*RenalAngiography囟貺祁糕勹河舭誣沸久蕪棄鐳璁僦杰鋅趣鵪菹瑪馘易猥姓郟邂獺罡石贐躐畜鏍端咀僑聽吒萬癤水盤畫徂擄直母侮鄲兩碘嫉雇擦嶺菇琛漢