Renal Pathology, Copy

7/28/2019 Renal Pathology, Copy

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RENAL PATHOLOGY

DEPARTEMEN PATOLOGI ANATOMIFK UMI


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KELAINAN-KELAINAN YANG DAPAT

DIJUMPAI PADA GINJAL:

KELAINAN KONGENITAL

CYSTIC DISEASE PADA GINJAL

GLOMERULAR DISEASE TUBULES AND INTERSTITIUM DISEASE

BLOOD VESSEL DISEASE

URINARY TRACT OBSTRUCTION

RENAL CALCULI STONE

TUMOR PADA GINJAL


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ANOMALI KONGENITAL PADA GINJAL :

1. Agenesis Kidney

2. Hypoplasia : kegagalan ginjal untuk

berkembang mencapai ukuran yang normal

3. Ectopic Kidney: adanya ectopic foci akibatgangguan perkembangan bagian

metaneprhros pada masa embryo

4. Horseshoe kidney : bersatunya polus

superior dan inferior sehingga berbentukseperti ladam kuda


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CYSTIC DISEASE OF THE KIDNEY

Cystic renal Dysplasia

Polycystic Kidney Disease :- Autosomal dominan (adult)

- Autosomal resesif (childhood)

Medullary cystic

Acquired cystic (dialysis associated) Localized (simple) renal cyst

Renal cyst in hereditary malformationsyndromes

Glomerulocystic disease Extraparenchymal renal cyst


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POLYCYSTIC KIDNEY DISEASE

(AUTOSOMAL DOMINANT - ADULT)

Kelainan herediter dengan karakteristikadanya kista-kista yang biasanya padakedua ginjal merusak parenkimginjal menyebabkan gagal ginjal


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POLYCYSTICKIDNEY


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GLOMERULAR DISEASE

Sering merupakan problem utama pada nefrologiTerbanyak : Glomerulonefritis kronis

penyebab utama gagal ginjal kronik

Biasanya diawali dengan penyakit sistemik, spt :

SLE, hipertensi, polyarteritis nodosa, DM

Manifestasi Klinis :

- Acute nefrotik syndrom

- Papillary progressive glomerlonefritis- Cronic renal failure

- Asymptomatik ( proteinuria atau hematuria)


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Contd

Perubahan morfologi :

hipersellularity

- biasanya disertai dengan proliferasi selluler

dari sel mesangial atau endothelial

- infiltrasi leukosit- Crescent formation

penebalan basement membrane

hialinisasi dan sklerosis


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Hyaline arteriolosclerosisThe lesions are characterized by glassy thickening of arterial and arteriolar walls. Inthis section an involved arteriole (arrow) is adjacent to a sclerotic glomerulus(asterisk). Hyaline arteriolosclerosisis seen in elderly patients, with or withouthypertension or diabetes, and in patients with long-standing diabetes but the lesions

are most common and most severe in hypertensive patients.


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PENY. PADA TUBULUS DAN INTERSTITIUM

Terdiri dari 2 kelompok :1. Iskemik atau tubular injury

Acute tubular necrosis

Acute renal failure

2. Tubulointerstitial nefritis

Penyebab

utama gagalginjal akut


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Note : necrosis and sloughing of epithelial cells of the proximal convolutedtubules.

The glomeruli and distal convoluted tubules are preserved

Acute tubular necrosis


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Tubulointerstitial nefritis


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TUMOR PADA

GINJAL

BENIGN

MALIGNANT


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TUMOR GINJAL BENIGN

1. Renal Papillary Adenoma

2. Renal Fibroma(Hamartoma)3. Angiomyolipoma

4. Oncocytoma


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Renal Cell Carcinoma

( Adenocarcinoma Ginjal )- Clear Cell Ca (70% - 80%)

- Papillary Ca (10% - 15%)

- Chromophobe Renal Ca

- Collecting Duct Ca

(Bellini Duct)

Urothelial Ca pada pelvisrenalis

Tumor

GinjalMalignant


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RENAL CELL CARCINOMA

Merupakan suatu keganasan yang berasal dariepitel tubulus renal

90% dari seluruh kasus keganasan yang terjadi

pada ginjal

Etiologi belum jelas, diduga ada hubungan

dengan asap rokok, paparan zat arsenic pada

industri

Gejala : trias simptom hematuri, nyeri danteraba massa pada daerah pinggang


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Multilocular cystic renal cell carcinoma


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Chromophobe renal cell carcinoma (RCC).Typical homogeneously tan coloured tumour of thelower pole of the kidney.


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Chromophobe renal cell carcinoma

Chromophobe renal cell carcinoma comprises about 5% of epithelial renalneoplasms. Microscopically, it is composed of variably-sized cells with abundantpale reticular or flocculent cytoplasm.


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Renal cell carcinoma was formerly known as hypernephroma and is also calledadenocarcinoma of the kidney.The most common type, clear cell carcinoma, is illustrated here. The number of cells

with clear cytoplasm vs eosinophilic granular cytoplasm varies from tumor to tumorand in different sections in an individual tumor

Renal cellcarcinoma


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Clear Cell Renal Cell Carcinoma

Grading Renal Cell Carcinoma: Fuhrman Grade 1

Fuhrman nuclear gradingsystem correlated well

with survival in patientswith renal cell carcinoma.Grade 1 tumors haveround, uniform nucleiwith inconspicuous orabsent nucleoli.


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Renal Cell Carcinoma : Fuhrman Grade 2

Nuclear contours are moreirregular than Grade 1;nuclei are about 15 micronsin diameter. Nucleoli maybe visible at highmagnification.


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Renal Cell Carcinoma : Fuhrman Grade 3

Nuclear contours are

even more irregular.Nuclear diameters canapproach 20 microns.Nucleoli are readilyseen.


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Cystic Renal Cell Carcinoma

Some cases of renal cellcarcinoma are composed largelyof multilocular cysts separated bythin septa containing tumor cells.The cystic nature of this tumor isillustrated in this low-power scan.


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Papillary Renal Cell Carcinoma

Papillary renal cell carcinoma comprises 15% to 18% of renal cell carcinoma.Note the prominent papillary structures many of which enclose clusters offoamy macrophages.


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WILLMS TUMOR

Tumor primer ginjal malignant yang dijumpai pada

anakTerjadi akibat kelainan gen

Makroskopis : massa yang besar , bulat dan solid,

warna coklat keabuan, bisa disertai

hemorrhage, cyst dan nekrosis

Mikroskopis :

dijumpai gambaran komponen triphasic :

blastema, stromal dan epitelKlinis : massa pd abdomen, nyeri, hematuria,

hipertensi

Prognosis baik : nefrektomi dan kemoterapi


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Wilms Tumor


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The triphasic nature of Wilms Tumor is obvious here. The epithelialelements surround nodules of blastema and are attempting for formrosettes. The nodules of blastem are separated by myxoid stroma.


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Wilms' Tumor : Epithelium

The epithelial component in this Wilms tumor consists of primitivecuboidal cells forming tubular structures and rosettes.


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Wilms' Tumor : BlastemaBlastema in WT consists of sheets of densely packed small blue cells withhyperchromatic nuclei, little cytoplasm and conspicuous mitotic activity

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Renal Pathology, Copy