This specimen is from a radical nephrectomy performed for a renal cell carcinoma. It shows a partially cystic
lesion replacing much of the inferior pole of the kidney. Renal cell carcinomas are also known as hypernephromas
(They were once believed to arise from the adrenal gland), clear cell carcinomas (because of their small nuclei
and abundant clear cytoplasm) and Gravitz tumours.
The classic presentation of a renal cell carcinoma is with haematuria, loin pain and mass. This triad of
symptoms occurs only in those who present late and today is seen in only 10% of patients. Renal cell carcinomas
can present with 'clot' colic similar in nature to ureteric colic due to renal calculus. They are also able to
produce quite marked systemic symptoms. They can present as a pyrexia of unknown origin or hypertension. They
can present with polycythaemia due to the production of erythropoietin, or hypercalcaemia due to the ectopic
production of PTH-like hormone.
renal tumours are rare. All renal neoplasms should be regarded as potentially malignant. They can spread both
directly into surround tissues and organs and can also spread via the renal vein and inferior vena cava. Caval
spread is seen in about 10% of cases. Blood borne spread can result in 'cannon-ball' pulmonary metastases. The
diagnosis can often be confirmed with an ultrasound scan. Abdominal CT scanning will allow identification of
renal vein and caval spread. If caval spread occurs above the level of the diaphragm an echocardiogram should be
obtained. Unless there is evidence of extensive metastatic disease treatment almost invariably requires a
radical nephrectomy. the kidney is approached through either a loin or transabdominal approach. The renal vein
is ligated early to reduce tumour spread. Resection should involve adjacent tissue and organs including the
perinephric fat and adrenal. Radiotherapy and chemotherapy have little proven benefit in patients with renal
cell carcinoma. Occasionally surgical resection of isolated solitary distant metastases (usually lung) offers
the prospect of prolonged long-term survival.
Russco P. Renal cell carcinoma:
presentation, staging and surgical treatment. Semin Oncol
2000; 27: 106-176.