renal pelvis tumor
Introduction
Introduction to renal pelvic tumor Renal pelvic tumor is an epithelial tumor that occurs from the renal pelvis mucosa. The age of onset is the same as that of kidney cancer. More men than women, the prevalence of both kidneys is the same, and the incidence of both kidneys is extremely rare. basic knowledge Sickness ratio: 0.0012% Susceptible people: no special people Mode of infection: non-infectious Complications: anemia
Cause
Causes of renal pelvic tumor
(1) Causes of the disease
The collecting duct, renal pelvis, renal pelvis, ureter, bladder and urethra mucosa belong to the same source in embryonic development, collectively referred to as "urine epithelium". Because of the common transitional epithelium, renal pelvis and ureteral tumors will be considered simultaneously, the transitional epithelium is lining the renal pelvis and The renal pelvis is exposed to many potential carcinogenic factors in the urine. The excreted carcinogen may be activated by hydrolase in the urine, and it may cause carcinogenesis in the urinary system, resulting in a higher incidence of bladder cancer than in the upper urinary tract.
(two) pathogenesis
Most of the renal pelvic tumors are transitional cell papillary tumors. The tumors also have single and multiple tumors. The tumors are rich in blood supply, and they are prone to rupture and hemorrhage. The tumor cells fall off with urine and can be implanted in the ipsilateral ureter or bladder. The muscle wall of the renal pelvic wall is very thin, and the surrounding lymphoid tissue is rich. Therefore, there are often early lymphatic metastasis, and transitional cell carcinoma is common. The papillary transitional cell carcinoma is well differentiated, and it is indistinguishable from normal pelvic epithelium. Squamous cell carcinoma is rare, accounting for only 3%. 4%, adenocarcinoma is rare, located in the junction of the renal pelvis and ureter can be complicated by hydronephrosis, renal pelvis tumor is easy to pass the lymph, but also can be transferred by blood and direct dissemination.
Prevention
Renal pelvic tumor prevention
Prevention of renal pelvic tumors is classified as tertiary prevention in the same way as other malignant tumors.
1. Primary prevention is the cause of prevention. Its goal is to prevent the occurrence of cancer. Its tasks include studying various cancer causes and risk factors, taking specific preventive measures against chemical, physical, biological and other specific carcinogenic factors, cancer-promoting factors and in vitro and in vivo pathogenic conditions, and taking measures against healthy organisms. Strengthen environmental protection, suitable for diet, suitable for sports, to promote physical and mental health.
(1) Avoid smoking: Smoking has become a well-known carcinogenic factor, associated with 30% of cancers. Tobacco tar contains a variety of carcinogens and cancer-promoting substances. Smoking mainly causes lung, pharynx, larynx and esophagus. Cancer can increase the risk of developing tumors in many other areas.
(2) Adjusting the diet structure: A reasonable diet has a preventive effect on most cancers, especially in plant-type foods, there are various anti-cancer ingredients, and these ingredients are effective for the prevention of all cancers. It shows that colon cancer, breast cancer, esophageal cancer, stomach cancer and lung cancer are most likely to be prevented by changing eating habits.
(3) Prevention of tumors in different parts caused by occupational and environmental pollution, drugs, etc., such as lung cancer (asbestos), bladder (aniline dye), leukemia (benzene), etc. are related to the above factors, some infectious diseases and some Some cancers are also closely related: such as hepatitis B virus and liver cancer, human papillomavirus and cervical cancer. In some countries, parasitic infection of schistosomiasis significantly increases the risk of bladder cancer, exposure to some ionizing rays and a lot of ultraviolet light, especially from The sun's ultraviolet rays can also cause skin cancer. Commonly used carcinogenic drugs include estrogen and androgen, anti-estrogen drug tamoxifen (tamoxifen), and estrogen and endometrial cancer widely used in postmenopausal women. Breast cancer related.
2. Secondary prevention or preclinical prevention, the goal is to prevent the development of initial disease, including early detection of cancer, early diagnosis, early treatment, to prevent or slow the development of the disease, as early as possible to reverse to stage 0.
3. Tertiary prevention is clinical (stage) prevention or rehabilitation prevention. The goal is to prevent the deterioration of the disease and the occurrence of disability. The task is to adopt multidisciplinary diagnosis (MDD) and treatment (MDT), and to choose the right and the best treatment plan. Fight cancer as soon as possible, try to promote recovery and rehabilitation, prolong life, improve quality of life, and even reintegrate into society.
Complication
Renal pelvic tumor complications Complications anemia
The main complication of renal pelvic tumors is that it can spread directly or transfer blood to the lungs, liver, bones, etc., causing multiple organ tumors.
Symptom
Symptoms of renal pelvic tumor common symptoms cachexia lymphatic metastasis bone pain urgency secondary infection bone metastasis urinary frequency loss edema dysuria
The disease is more common in 40 to 70 years old, male: female is 2 to 3:1. The most common symptom is gross or microscopic hematuria (70% to 95% incidence), which is also the earliest symptom, even for smaller tumors. Hematuria can also occur early, intermittent, painless, macroscopic hematuria, such as tumors causing ureter or ureteropelvic junction obstruction can lead to sudden pain (8% to 40%), or due to more bleeding to form a cord Blood clots cause renal colic in the passage of the ureter. Late tumor enlargement or obstruction can cause hydronephrosis. At this time, there may be signs of kidney mass and metastasis. Some may have pain, secondary infection and urinary calculi, 5%. 10% of patients had bladder irritation, and there was no positive finding in physical examination. It was reported that 10% to 20% of patients had tumors or hydrolyzed hydrolyzed masses with most asymptomatic and physical signs, and 10% to 15% were accidentally discovered. In the advanced stage of renal pelvic tumor, multi-directional liver, lung, bone metastasis, early lymph node metastasis, late stage may have anorexia, weight loss, anemia and other cachexia, Jenett staging of renal pelvic tumor:
Tis O carcinoma in situ.
Ta O mucosal papillary carcinoma.
T1 A infiltrates the lamina propria.
T2 B1 infiltrates the superficial muscle layer.
T3a B2 infiltrates the deep muscle layer.
T3b C infiltrates extramuscular fat.
T4 D infiltrates nearby organs.
Examine
Examination of renal pelvic tumors
Laboratory inspection
1. Urine routine examination:
There are more red blood cells; erythrocyte sedimentation rate increases in advanced cases; flow cytometry of urine specimens can determine the presence or absence of malignant cells, and DNA staining can be used to understand the DNA content of abnormal cells (aneuploid cells).
2. Cytology:
Cytological detection of renal pelvis and ureteral tumors by cytology can be cytologically positive. The characteristics of the cells suggest the histological grade of the tumor. 80% of the well-differentiated low-grade tumors have false negative cytological examination, but poorly differentiated The tumor is 60% positive, but there is still a lack of direct relationship between cytological grade and aggressiveness.
Film degree exam
1. X-ray inspection:
(1) Excretory urography: visible irregular filling defects in the renal pelvis and renal pelvis, the density is not uniform; hydronephrosis, renal dysfunction when the kidney is not developed; such as renal pelvis funnel obstruction, manifested as renal hoarding Water, for highly suspected lesions, low-density contrast agents should be used, and multiple X-rays should be observed from different angles; retrograde urography should be used instead of renal non-developed cases.
(2) Retrograde urography: the most important means of diagnosing renal pelvis, especially when the urinary tractography is poorly developed. This method can also directly collect the affected side of the urine or wash it with saline, or pass the ureter brush. Take a biopsy, perform a tumor cytology test, and use a non-ionic contrast agent during retrograde urography, and prevent misdiagnosis by introducing air bubbles.
2. Ultrasound examination:
It is characterized by echogenic separation or hypoechoic in the central sinus, accompanied by a solid irregular echo or irregular contour in the renal pelvis with hydronephrosis, which is easy to miss for small tumors.
3. CT examination:
When the pyelography is not developed, the CT scan is of great significance. The soft tissue mass (CT value 20~40Hu) can be filled with the renal pelvis and the renal sinus is narrowed or disappeared, often accompanied by hydronephrosis. The CT value of the scanned mass was increased compared with the plain scan. The CT examination was superior to the B-mode ultrasound in tumor staging, and it was confirmed whether there was local infiltration, lymph node metastasis or vena cava tumor thrombus formation.
4. MRI, MRU (magnetic resonance urography):
The latter provides images of the renal parenchyma and the collection system, fully displaying the tumor, and is of great significance for the diagnosis of those with obstruction.
5. Cystoscopy:
It can be seen that the ureteral orifice of the affected side is spurted or the bladder tumor or ureteral tumor is often accompanied. Under the guidance of X-ray, a special ureteral catheter with a brush swab is used to directly brush the renal pelvis lesion for pathological examination. Can improve the diagnosis rate.
6. Renal ureteroscopy:
The renal pelvis is sent to the renal pelvis, and the lesion can be directly observed, and a biopsy can be taken to confirm the nature of the mass.
Diagnosis
Diagnosis and diagnosis of renal pelvic tumor
diagnosis
The main point of diagnosis is that the age of onset is more than 40 years old, more men than women, 2 to 4:1, mostly unilateral, clinical manifestations are:
1. Hematuria: It is often the first and most common symptom of renal pelvic cancer. The incidence rate is above 90%. It is characterized by frequent episodes of painless full-length gross hematuria, often accompanied by strips of blood clots, especially for people over 40 years old. Hematuria, a patient who is discharged with orthostatic red blood cells.
2. Low back pain: The incidence rate is about 50%, mostly persistent lumbar pain. If there is a blood clot blocking the ureter, it can cause renal colic.
3. Lump: less common, only about 2% is located in the waist or upper abdomen, the appearance of a mass indicates that the tumor obstruction drainage system leads to hydronephrosis, there may be tenderness of the rib angle, accompanied by weight loss, anemia, lower extremity edema, bone pain.
4. Bladder irritation symptoms: renal pelvic cancer has multiple organ onset characteristics, accompanied by bladder tumors can occur frequent urination, urgency, dysuria.
5. Cachexia: About 7% of cases have cachexia, indicating that the lesion is advanced and the prognosis is poor.
6. Intravenous pyelography:
For example, see the renal pelvis and renal pelvis filling defect, cystoscopy can be seen in the ureteral orifice hemorrhagic urine, B-ultrasound is a hypoechoic space-occupying lesion in the renal pelvis, can also be assisted by ureteroscopy and CT, MRI and urine exfoliated cell examination to assist diagnosis, Urine cytology found that cancer cells, the disease can be clearly diagnosed, patients with confirmed diagnosis must also carefully evaluate and stage the lesions, to exclude multiple and distant metastases, it has been reported that about half of patients with kidney tumors with bladder and (or) ureteral tumor, in addition to a detailed examination of the urinary tract, the patient needs to take a chest radiograph, bone scan and blood and urine biochemical examination, B-ultrasound or CT is helpful for the posterior peritoneal lymph node examination, which is helpful to the disease and its metastases. The choice of diagnosis and treatment methods, the stage of renal pelvic tumor is: O stage tumor is confined to the mucosa, stage A tumor invades the lamina propria, stage B tumor invades the muscle layer, stage C tumor spreads to the periorbital fat or renal parenchyma, and metastasis occurs in stage D. Transitional cell carcinoma may have blood or lymphatic metastasis, local lymph node involvement is generally earlier than other parts of the metastasis, therefore, the surgery needs to include local lymph node resection.
Differential diagnosis
1. Renal cell carcinoma: urinary angiography can also be filled with renal pelvis and renal pelvis, but the degree and frequency of hematuria is lighter. In some cases, there is no hematuria, and it is more likely to touch the abdominal mass. Urinary angiography shows that the renal pelvis is compressed. Displacement, deformation, renal angiography showed tumor blood vessels and contrast agent accumulation in the renal parenchyma, B-mode ultrasound, CT, MRI examination can clearly show the soft tissue mass in the renal parenchyma, the mass of the mass in the renal parenchyma, renal limitations, contour Outburst.
2. Renal cavernous hemangioma: severe hematuria can occur when rupture, urography may have renal pelvic filling defects, need to be identified, but most cases occur before the age of 40, skin mucosa may have hemangioma lesions, for sudden macroscopic eyes Hematuria, each time interval between hematuria, B-mode ultrasound, CT, MRI examination showed that the density of hemangioma was lower than soft tissue mass; selective renal angiography can be identified.
3. Primary renal purpura: manifested as severe hematuria, urography during renal dysplasia or renal pelvis filling defect, but its sudden onset, frequent hematuria, fierce, general hemostasis measures are difficult to achieve, imaging examination is often difficult to find Clear space-occupying lesions.
4. Renal sputum blood clot: urinary angiography is characterized by filling defects in the renal pelvis, which resembles neoplastic lesions. The main feature of renal pelvic clot is morphological instability. Repeated angiography or B-mode ultrasound within 2 weeks, CT examination, blood clots can be deformed and reduced , shift or disappear, repeated urine cytology tests are negative.
5. Undeveloped stones in the renal pelvis: urinary angiography shows filling defects of the renal pelvis, need to pay attention to the identification of renal pelvis cancer, pelvis negative stones may be accompanied by pain and microscopic hematuria, hematuria is not serious, gross hematuria is less common, retrograde angiography if injected The air can provide a high-density stone shadow, the ultrasound examination system presents a strong light spot, followed by sound and shadow, and the CT scan shows a high-density stone image.
6. Paracrine cyst: The disease may have lumbar discomfort, hematuria and hypertension, urinary angiography, renal pelvis, renal pelvis deformation, displacement, elongation and other similar renal pelvic tumor performance, but B-mode ultrasound examination shows the renal pelvis It is in the dark area of the liquid and can show the size of the cyst. The IVU examination shows that the round tumor in the renal or sinus sinus oppresses the renal pelvis and renal pelvis, showing a curved impression. CT examination shows that the right side of the renal pelvis is clear, uniform and low density. The elliptical mass has a CT value of 0-20 Hu, and the CT value changes little before and after enhancement.
7. Kidney papillary hypertrophy: Kidney nipple hypertrophy to the renal pelvis, pyelography or CT examination, visible signs of renal pelvic filling defects, should be differentiated from renal pelvis cancer, renal papillary hypertrophy is a variability change, generally no pelvic cancer common painless gross hematuria The medical history is long and the symptoms are not many. B-mode ultrasound and CT examination of the renal pelvis filling defect are connected with the renal parenchyma. The volume is small, the surface is smooth, and the dynamic observation, shape and size can be unchanged for a long time.
8. Kidney hydatid cyst: Kidney hydatid cyst urography is similar to intrarenal space-occupying lesions. Diagnosis should be combined with epidemiological exposure history and Casoni test to diagnose. Ultrasound is the first choice to confirm intrarenal space-occupying lesions. Cystic and most divided cystic lesions, CT examination can also be defined as cystic lesions, except for large cysts and thicker cystic wall with calcification and enhancement, the characteristic change is that low-density small sacs can be seen in the large sac, if Cyst rupture and renal pelvis and renal pelvis traffic, enhanced scanning visible contrast agent spilled into the sac.
