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Nephrectomy and partial nephrectomy
Published in Mark Davenport, James D. Geiger, Nigel J. Hall, Steven S. Rothenberg, Operative Pediatric Surgery, 2020
Imran Mushtaq, Alberto Mantovani, Judy Hung Wing Suet
The ureter from the affected moiety is separated from the unaffected moiety ureter and divided just distal to the UPJ (Figure 68.7). The proximal stump of this ureter is lifted cranially, rotating it laterally to expose the posteromedial surface. There may be additional vessels supplying the affected moiety, which only become evident with this maneuver. These should be ligated and divided. Maintaining the dissection plane close to the wall of the transected ureter allows access into the renal sinus between the two collecting systems.
Renal cancer
Published in Anju Sahdev, Sarah J. Vinnicombe, Husband & Reznek's Imaging in Oncology, 2020
Conrad von Stempel, Lee Alexander Grant, Miles Walkden, Navin Ramachandran
Over 90% of tumours greater than 10 cm demonstrate extracapsular, perirenal fat involvement and are therefore T3 disease (100). In contrast, the renal sinus is not separated from the renal cortex by capsule, and assessment of invasion of the renal sinus on imaging is relatively insensitive (82). Underestimating renal sinus invasion is the most frequent cause for surgical upstaging to T3 disease (101). Abutment of the renal sinus by a cortically based tumour (even without overt invasion) should be considered as highly suspicious for renal sinus invasion and therefore T3 disease (102).
The Urinary System and Its Disorders
Published in Walter F. Stanaszek, Mary J. Stanaszek, Robert J. Holt, Steven Strauss, Understanding Medical Terms, 2020
Walter F. Stanaszek, Mary J. Stanaszek, Robert J. Holt, Steven Strauss
The glandular portion of the kidney that surrounds the structures of the renal sinus is divided into the medulla and the cortex [Figure 11.1(B)], The medullary portion consists of a series of conical structures called renal pyramids with their blunted points facing in toward the renal sinus. The blunted end of each renal pyramid is perforated by the openings of ducts and projects into a minor calyx. The cortex lies between the bases of these pyramids and the capsule or surface of the kidney and projects between the pyramids in the renal columns.
Hot topics in renal cancer pathology: implications for clinical management
Published in Expert Review of Anticancer Therapy, 2022
Alessia Cimadamore, Anna Caliò, Laura Marandino, Stefano Marletta, Carmine Franzese, Luigi Schips, Daniele Amparore, Riccardo Bertolo, Stijn Muselaers, Selcuk Erdem, Alexandre Ingels, Nicola Pavan, Angela Pecoraro, Önder Kara, Eduard Roussel, Umberto Carbonara, Riccardo Campi, Michele Marchioni
Renal sinus invasion can be present as direct soft tissue invasion or involvement of vascular spaces within the adipose tissue of the renal hilum (Figure 4). Contrarily to the renal capsule, the renal sinus has no discrete capsular barrier and houses prominent vessels. The likelihood of invasion of the renal sinus increases sharply with increasing tumor size [39–41]. Variability in specimen handling may affect tumor staging, with laboratories that normally sample 2 to 3 blocks of the tumor-sinus interface even if there is low suspicion of tumor invasion and other than sample just one block of the hilum or even none if the mass is grossly not in contact with the sinus adipose tissue. Often sinus fat invasion occurs as well circumscribed tumor nodules, or as lymphovascular invasion, sometimes not easily discernible one another. In any case, the ISUP consensus statement indicates that any lymphovascular invasion in the renal sinus can be considered as renal sinus invasion.
Confirmation of Xp22.11 Duplication as a Germline Susceptibility Alteration in a Wilms Tumor Arising in Horseshoe Kidney
Published in Fetal and Pediatric Pathology, 2022
Hui-fang Zhou, Ina E. Amarillo, Stacy Snyder, Jorge L. Granadillo, Christopher J. O’Conor, Patrick Dillon, David Wilson, Frederick S. Huang, Louis P. Dehner, Mai He
On pathological evaluation, the left kidney had an 8.0 × 7.0 × 6.5 cm, well-circumscribed upper pole mass with a typical post-treatment Wilms tumor appearance. The mass had a heterogenous white/tan/yellow cut surface, containing a 4.0 × 2.0 × 1.0 cm necrotic nodule adjacent to the intact capsule (Fig. 2A). A white, firm capsule of 3 mm thickness enclosed the entire tumor mass (Fig. 2B). Microscopically, the tumor mass of the left kidney showed post-treatment Wilms tumor with triphasic components, heterologous cartilage, and extensive treatment effect but without anaplasia (Fig. 2B). Clusters of viable tumor were present within a renal sinus soft tissue. Above findings supported a favorable histology Wilms tumor with extensive therapy effects, post-therapy local stage of III. The right upper posterior pole lesion contained microscopic foci of well-encapsulated Wilms tumor with treatment effect. The viable component consists of small clusters showing blastemal morphology, consistent with a post-therapy intermediate risk category. The right anterior medial lesion contained perilobar nephrogenic rest. Both lesions on the right side were confined within the renal parenchyma and wereexcised with free surgical margins (post-therapy local stage I). The pulmonary artery and inferior vena cava thrombus contained residual Wilms tumor. The morphology of renal hilum, iliac bifurcation and portal lymph nodes consisted only of reactive changes with nometastatic tumor.
Is multidetector CT-scan able to detect T3a renal tumor before surgery?
Published in Scandinavian Journal of Urology, 2019
Anne Sophie Renard, Cosmina Nedelcu, Anita Paisant, Patrick Saulnier, Jérôme Le Bigot, Abdel Rahmene Azzouzi, Pierre Bigot, Christophe Aubé
Tumors were classified according to the TNM 2009 classification [9]. Stage T3a was defined by three features: perinephric fat infiltration, sinus fat infiltration or renal vein invasion. In this study, we used the term peritumoral instead of perinephric fat, to exclude the notion of perinephric soft-tissue which is not a reliable indicator of perinephric fat invasion as there are many causes resulting in thickening of perinephric septa such as inflammation, edema, vascular engorgement or fibrosis [10,11]. Peritumoral fat infiltration was defined as the presence of small hyperdense strands on the periphery of the kidney surrounding a cortical lesion, more accentuated than perinephric soft-tissue stranding. Infiltration of the sinus fat was defined as the presence of small hyperdense strands surrounding a sinusal lesion near the pelvicaliceal system (Figure 1(1)). A bulging tumor with direct contact in the renal sinus without any hyperdense strands was not considered as sinus fat infiltration (Figure 1(2)). Venous invasion was defined as venous enlargement with tumor thrombus enhancement or intraluminal filling defect in a segmental or main renal vein. We stratified the cT3a results according to their size < or ≥7 cm.