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Approximately 40 to 60% of these lesions are ultimately found to be malignant, most commonly in the forms of cystic renal cell carcinoma and its multiloculated variant. [8] [9] [10] The remaining lesions are benign and include hemorrhagic cysts, chronic infected cysts, and multiloculated cystic nephromas.
The RENAL Nephrometry Scoring System is used to measure the complexity of kidney tumors for determining whether a renal mass is appropriate for partial or radical nephrectomy, and is estimated by CT scan as follows: [7] The nephrometery score takes into account the size of the tumor (Radius), how much of the tumor is inside or outside of the ...
For small exophytic lesions that do not extensively involve the major vessels or urinary collecting system, a partial nephrectomy (also referred to as "nephron sparing surgery") can be performed. This may involve temporarily stopping blood flow to the kidney while the mass is removed as well as renal cooling with an ice slush.
Gross appearance of a renal oncocytoma (left of image) and a slice of a normal kidney (right of image). Note the rounded contour, the mahogany colour and the central scar. In gross appearance, the tumors are tan or mahogany brown, well circumscribed and contain a central scar. They may achieve a large size (up to 12 cm in diameter).
Cystic kidney disease includes various conditions related to the formation of cysts in one or both kidneys. The most common subset is polycystic kidney disease (PKD), which is a genetic anomaly with two subsets, autosomal recessive polycystic kidney disease (ARPKD) and autosomal dominant polycystic kidney disease (ADPKD).
Angiomyolipoma seen as a hyperechoic mass in the upper pole of an adult kidney on renal ultrasonography. Renal ultrasonography of a person with tuberous sclerosis and multiple angiomyolipomas in the kidney: Measurement of kidney length on the US image is illustrated by '+' and a dashed line. CT scan of a renal angiomyolipoma.
The histologic pattern of injury can also provide insight into the prognosis of the glomerular disorder. Mesangial proliferation indicates a mild, though active, lesion. [8] Overall, a kidney biopsy should address the following: [8] Primary diagnosis, with clinical modifiers; Pattern of injury
Caseous necrosis in the kidney. In caseous necrosis no histological architecture is preserved (unlike with coagulative necrosis). [5] [6] On microscopic examination with H&E staining, the area is acellular, characterised by amorphous, roughly granular eosinophilic debris of now dead cells, [6] also containing interspearsed haematoxyphilic remnants of cell nucleus contents. [5]
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