Hypernephroma is also called clear cell adenocarcinoma, hypernephroid carcinoma, or Gravitz tumor. The frequency of occurrence of such a tumor is 1 case out of 20 malignant neoplasms. In urological practice, hypernephroma occurs in 85% of cases. Hypernephroma is of epithelial origin, therefore it can develop from any structure of the nephron. Hypernephroma is more common in men, predominantly between the ages of 40 and 70. Read the main clinical manifestations and methods of treatment of hypernephroma in our article.
What does hypernephroma consist of? Appearance of hypernephroma
Hypernephroma has the appearance of a soft knot of variegated color, which is surrounded by a pseudocapsule. Microscopy reveals light polymorphic polygonal cells that contain lipids and mitoses. Tumor cells are combined into alveoli and lobules, which merge into papillary and tubular structures. The severity of the stroma is insignificant, hemorrhages and tumor necrosis are possible. In half of the cases, there is an invasive growth of hypernephroma and spread in the form of tumor thrombi through the veins. Hypernephroma metastasizes by lymphogenous or hematogenous route.
What are the main causes of hypernephroma?
The main causes of hypernephroma, like many other neoplasms, remain unknown. However, some factors significantly increase the risk of hypernephroma. What factors increase the risk of developing hypernephroma, read further on estet-portal.com. Since the tumor appears more often in men, especially often in smokers, smoking is a major risk factor for the occurrence of neoplasms of urological localization. Smoking cessation is associated with a 15% reduction in the risk of developing the disease over 25 years.
Affects the kidneys and exposure to chemicals such as cadmium, asbestos, gasoline, herbicides, organic solvents and drugs. Patients with a genetic pathology have an increased risk of developing hypernephroma. This is Hippel's disease – Lindau, hereditary papillary – cell carcinoma, as well as hypernephroid cancer.
What are the clinical symptoms of hypernephroma?
Hypernephroma may be present without clinical manifestations for several years. Over time, the clinical picture appears, which consists in the classic renal triad – hematuria, pain, and palpable swelling. Extrarenal manifestations are also present.
The first symptom that worries patients is the appearance of blood impurities in the urine. As a rule, hematuria is not accompanied by pain. Frequently recurring hematuria leads to anemia in the patient. In some cases, hypernephroma is manifested by microhematuria. The formation of blood clots can provoke ureteral occlusion, which leads to an acute attack of renal colic.
Hypernephroma is characterized by the appearance of pain after hematuria, and not before it, as in nephrolithiasis. The pain has a aching dull character.
Palpation of the damaged kidney through the anterior abdominal wall is successful only in half of the cases. In men, the kidney can put pressure on the veins and provoke the development of varicocele.
General symptoms of hypernephroma include:
- unmotivated fever with chills;
- arthralgia;
- myalgia;
- decreased appetite;
- nausea and vomiting.
How to detect hypernephroma? Basic methods for diagnosing hypernephroma
Identification of hypernephroma and its differential diagnosis requires many studies. These are urography, renal angiography, ultrasound of the kidneys, fine-needle biopsy of the kidneys with morphological analysis of the tumor, retrograde pyelography.
A clinical examination of the patient may reveal changes in objective status typical of hypernephroma. These are the asymmetry of the abdomen, the expansion of the veins of the spermatic cord, the strengthening of the venous pattern on the anterior abdominal wall in the form of a "head of a jellyfish", edema of the lower extremities.
Cystoscopy may be required to rule out sources of bladder bleeding, such as a tumor, stones, or bladder diverticulum.
Intravenous urography allows to detect deformation or filling defect of cup – pelvis system. The size and extent of the hypernephroma is determined by CT or MRI.
Main aspects of the treatment of hypernephroma
Treatment of hypernephroma is performed taking into account the functional state of the affected kidney, and also depends on the state of the second kidney. Therapy can be carried out surgically, systemic polychemotherapy and X-ray irradiation. Radical nephrectomy with removal of the kidney and surrounding tissue, lymph nodes is performed with the preserved function of the second kidney and the operability of hypernephroma. In case of poor functioning or absence of the second kidney, a partial nephrectomy is performed. X-rays and chemotherapy are used alone or together with the surgical treatment of hypernephroma.
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