Light-cellular adenocarcinoma of a kidney (gipernefrom) – a malignant epitelialny tumor of a kidney, a kind of kidney and cellular cancer. Gipernefroma is shown by local and paraplastic (general) symptoms: a makrogematuriya, pain in a kidney, the palpated opukholepodobny formation, deterioration in the general state, weakness, weight loss etc. For recognition of a gipernefroma and a difdiagnostika the excretory urography, a retrograde piyelografiya, a kidney angiography, ultrasonography of kidneys, KT and MPT, a tonkoigolny biopsy of a kidney is used. Treatment of a light-cellular adenocarcinoma is carried out with respect for the oncological principles and includes a nefrektomiya with a limfadenektomiya, beam and medicinal chemotherapy.
Gipernefroma (light-cellular adenocarcinoma, Gravits's tumor, gipernefroidny cancer) makes 2-5% of malignant new growths in general, and in urology - to 85% of all cases of cancer of kidney. Gipernefroma treats tumors of an epitelialny origin and can develop practically from any structure of a nefron: capsules of a ball, Genle's loop, disteel and proximal tubules. At men of a gipernefrom comes to light by 2,5-3 times more often than among women. In 2/3 cases of a gipernefrom occurs at patients at the age of 40–70 years.
Gipernefroma represents softish knot of motley coloring with the pseudo-capsule at which microscopic studying the light polygonal and polymorphic cages containing lipids, numerous mitoses are found. Tumor cells unite in the alveoluses and segments merging in tubulyarny and sosochkovy structures. Strom it is expressed poorly, hemorrhages and necroses of a tumor are typical. In 45% of cases the invasive growth of a gipernefroma, germination of a lokhanka by it, distribution in the form of tumoral blood clots on veins is found. Gipernefroma metastasis limfogenny (in lymph nodes) and hematogenic (in lungs, a counterlateral kidney, a liver, bones).
TNM stages of development of a gipernefroma are similar to that at kidney and cellular cancer.Please Help us - click on the advertisement
The reasons of development of a gipernefroma remain unknown, however allocate certain factors which influence considerably increases probability of developing of cancer of kidney. It is known that the gipernefroma twice more often comes to light at males and smokers. Smoking is considered the main factor of risk of developing of tumors of urological localization – cancer of a bladder and kidneys. Meanwhile, the refusal of smoking leads to decrease in this risk by 15% within 25 years. Adverse influence on a kidney epithelium makes impact of various chemicals: gasoline, asbestos, cadmium, organic solvents, herbicides, fenatsetinsoderzhashchy medicines, etc.
It is noticed that the frequency of identification of a gipernefroma correlates with such diseases as obesity, arterial hypertension, diabetes, and also pathology of kidneys (chronic pyelonephritis, nefrolitiazy, tuberculosis, an allotopia, polikistozy, nephrosclerosis, etc.). The patients with a renal failure forced to be on a long hemodialysis are more predisposed to development of a gipernefroma. The increased risk of emergence of a gipernefroma at patients with genetic pathology (Gippelya-Lindau's disease), the burdened family anamnesis (a hereditary papillary and cellular carcinoma, gipernefroidny cancer) is noted.Please Help us - click on the advertisement
From the moment of emergence of a gipernefroma in a kidney before development of the first clinical symptoms there can pass several years. The clinic of a gipernefroma is characterized by a classical kidney triad (the gematuriya, pain palpatorno determined by a tumor) and extra kidney manifestations.
The first that is usually noted by 2/3 patients from gipernefromy, is an emergence in urine of impurity of blood (gematuriya). As a rule, the gematuriya develops suddenly and is not followed by pain; can be passing, have insignificant, total or profuzny character. Often repeating or intensive gematuriya leads to a sharp anemization of the patient. In certain cases at a gipernefroma the mikrogematuriya which can be revealed only at an urine research takes place.
Formation of blood clots can cause occlusion of a mochetochnik and a bad attack of renal colic. Emergence of pains after a gematuriya, but not before it, as is very characteristic of a gipernefroma at a pochechnokamenny disease. More often pain happens constant and has the stupid aching character.
It is possible to palpate the changed kidney through a forward belly wall or a waist only in half of cases. Sdavleniye of veins (kidney, lower hollow, yaichkovy) at men can bring to development to a varikotsela. Causeless fever from oznoba, a mialgiya, an artralgiya, weakness, a loss of appetite, weight loss, nausea and vomiting belongs to paraplastic (general) manifestations of a gipernefroma.Please Help us - click on the advertisement
Diagnostics of a gipernefroma
Identification and differential diagnostics of a gipernefroma demands carrying out the detailed urological inspection including excretory urography, a retrograde piyelografiya, a kidney angiography, ultrasonography of kidneys, KT of kidneys and MRT, a tonkoigolny biopsy of a kidney and the morphological analysis of a tumor. Already during survey of the patient characteristic asymmetry of a stomach, strengthening of the venous drawing on a lobby of a belly wall in the form of "the head of a jellyfish", expansion of veins of a seed kanatik, hypostases on the lower extremities can be revealed.
In clinical blood test increase SOE, anemia, a politsetemiya turns removal; in the general analysis of urine – an eritrotsituriya. For a bleeding source exception in a bladder (stones, a diverticulum, tumors) performance of a tsistoskopiya can be required. At the first stage ultrasonography and UZDG of vessels of kidneys allow to obtain information on an arrangement and the amount of volume education, probability of an invasion of vessels.
The intravenous urography at a gipernefroma finds deformation or defect of filling cup systems, a pushing off of a mochetochnik to a spine column. At the expressed decrease in function of kidneys and impossibility of receiving excretory resort to performance of a retrograde piyelografiya. For a research of interest of kidney vessels carry out by a tumoral invasion a kidney angiography and a flebografiya. By means of KT or MPT the size, degree of prevalence of a gipernefroma is detailed, the increased lymph nodes come to light.
For the purpose of presurgical morphological verification of the diagnosis and a stadirovaniye of an onkoprotsess the biopsy of a kidney or a biopsy of a lymph node with definition of a gistotip of tumoral education is carried out. To exclude probability of metastasises of a gipernefroma in the remote bodies the osteostsintigrafiya, a X-ray analysis of a thorax, ultrasonography of a liver is carried out.Please Help us - click on the advertisement
Treatment of a gipernefroma
At detection of a gipernefroma surgical treatment, x-ray radiation or system chemotherapy can be undertaken. At satisfactory function of the second kidney and operability of a gipernefroma the radical nefrektomiya including removal of a kidney with an adrenal gland, surrounding cellulose and lymph nodes is made. At the I stage of tumoral process (a gipernefroma with a diameter less than 7 cm, not going beyond the capsule), bad functioning or lack of other kidney the partial nefrektomiya can be carried out.
In case of impossibility of radical intervention at a gipernefroma the arterial embolization directed to blocking of the blood vessels of a kidney feeding a tumor can be undertaken. X-ray or chemotherapy at a gipernefroma can be applied separately or in combination with a surgical stage. Such methods as cryotherapy, a radio-frequency ablation, HIFU therapy by the high-energy focused ultrasound have experimental value.Please Help us - click on the advertisement
Forecast and prevention of a gipernefroma
In general the remote results at a gipernefroma same, as at kidney and cellular cancer.
For prevention of a gipernefroma it is necessary to exclude harmful cancerogenic effects (smoking, chemical and medicinal agents), in due time to eliminate the available pathology of kidneys. Regular performing ultrasonography of kidneys to almost healthy people can become guarantee of early identification of a gipernefroma. At emergence of blood in urine, waist pains detailed inspection at the urologist (nephrologist) is necessary.