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    MEDICINSKI FAKULTET UNIVERZITETA U BEOGRADU

    INSTITUT ZA PATOLOGIJU

    TEMA DIPLOMSKOG RADA:

    TUMORI BUBREGA KOD ODRASLIH

    Mentor: Doc. dr Sn! Rdo!e"#$ %&odr#$ St'dent: M#(#c V'&no"#$ )*+,-

    Beo/rd0 !'n 1-)2.

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    SADR3AJ

    I UVOD4444444444444444444444444444.. .5

    1.1 Anto6#! 7'7re/4444444444444444444444.5

    1.2 U(o/ 7'7re/4444444444444444444444445

    II TUMORI BUBREGA4444444444444444444444..8

      1.) K(9##&c#! S"et9&e Zdr"9t"ene Or/n#;c#!e44444444444

      1.1 Odre

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    I UVOD

    1.1 Anatomija bubrega

    B'7re;# 9' rn# or/n# 96eten# ' retroer#tone(no6 ro9tor' n ;dn!e6 ;#d' 7do6en0 9 o7e 9trne 6eno/ 9t'7 =' "#9#n# )1./r'dno/ # ).# 1.9(7#n9&o/ r(!en>. De9n# 7'7re/0  ot#9n't !etro60 o9t"(!en !e 6(o n#@e ' odno9' n (e"#. Te@#n 7'7re/ odr9(o/ o"e& !e o&o )*-/. Un'trn! 9trn 9dr@# 7'7re@n# #('9 &o!# "od# ' 7'7re@n' d'(!'0  &ro; &o!# ro(;e &r"n# # (#6n# 9'do"#0 ner"# # 'reter.

    Sred !e o&r#"en r#!et(n#6 er#tone'6o60  9 9"# 9trn / o&r'@'!' 7'7re@n 9c#!0 69n &9'( # #7ro;n &9'(.

    S9to!# 9e #; &orte&9 # 6ed'(e. O9no"n 6oro(o& # 'n&c#on(n !ed#n#c 7'7re/ !e neron. S" 7'7re/ 9e 99to!# od re&o 6#((#on neron. Neron 9e 99to!# od 7'7re@no/ te(c =&or'9&'(> # 7'7re@no/ t'7'(. Kor'9&'( 9e 99to!# od /(o6er'( =#n# / 9(et /'9to ;7#!en# &#(r &o!# o"e;'!' erentn' 9 eerentno6 rter#o(o6> # Bo'6no"e &9'(e =99to!# 9e #;  r#!et(no/ # "#9cer(no/ (#9t>. B'7re@n# t'7'( #ne ro&9#6(n# t'7'(0 en(eo" et(! # d#9t(n# t'7'(. U(o/ t'7'( !e 9t"rn!e &onne 6o&r$e roce9#6 9orc#!e # 9e&rec#!e.

    To&o6 9tren!0 7ro! 'n&c#on(n# neron 9e o9teeno 96n!'!e0 t&o d ' +-./od#n# 6no/# (!'d# #6!' 96o 5- od oetno/ 7ro!.

    1. U!oga bubrega

    O9no"n 'n&c#! !e or6#rn!e &onne 6o&r$e0 (# ored to/ 7'7re;# #6!' "#e9tr'&' '(o/' ' odr@"n!' o6eo9t;e0 9to odr;'6e":

    H re/'(c#!' r"note@e "ode # e(e&tro(#t0

    H re/'(c#!' c#do  7;ne r"note@e0

    H re/'(c#!' rter#!9&o/ r#t#9&0

    H #;('#"n!e rod'&t 6et7o(#;6 # tetn# e6#&(#!0

    H 9e&rec#!' or6on #td4

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    ). M(#/#!e" #r6#d 8. B'7re@n &r(#c )). Gorn!# o( )8. P#(e

    1. Inter(o7'(rne rter#!e . Ureter )1. Inter(o7'(rn "en ). Bert#n#!e" &o(o6n

    2. B'7re@n rter#! +. M( 7'7re@n #c )2. Neron

    5. B'7re@n "en ?. F#7ro;n &9'( )5. B'7re@n d'(! *. #('9 )-. Don!# o( )*. Ve(#& 7'7re@n #c

    II TUMORI BUBREGA

    Ko # 9"e "r9te t'6or0 # t'6ore 7'7re/ 6o@e6o 'oteno ode(#t# n o9no"' n!#o"o/  7#o(o&o/ onn! n 7en#/ne # 6(#/ne. M(#/n# t'6or# 9' d(e&o e$#0  ' o&"#r' o"e /r'e n(;e 9e d"e od/r'e:

    ). Pr#6rn# t'6or# =t'6or# ore&( 7'7re@no/ ren#6> 1. Se&'ndrn# t'6or# = 6et9t;e>.

     N!'e9t(#!# t'6or# 7'7re/ odr9(# o9o7 9' &rc#no6# 7'7re@n# $e(#! =RCC  ren( ce(( crc#no6> # de(e 9e n 9(ede$e n!e$e #9to(o&e odt#o"e: 9"et(o$e(#!9 6'(t#(o&'(rn# c#9t#n#0 #(rn#0 ro6oo7n#0 6ed'(rn# # ne&(9##&o"n#. S"# RCC ot#' od t'7'(rn# e#t(n# $e(#! 7'7re/0 t!. neron.

    Krc#no6 7'7re/ #n# 9"e/ 1 9"# &rc#no6 o"e&0 9 odr#(#&e )?-0--- no"# 9('!e" &o!# 9e d#!/no9t#&'!' 9"&e /od#ne. e$e 9e !"(! ' ;e6(!6 ' r;"o!'.

    Ve$#n' 6(#/n# neo(;6# 7'7re/ #ne 9ord#n# 9('!e"#0 do& !e o&o 5 &rc#no6  7'7re@n# $e(#! n9(edno # o"e;no !e 9 ered#trn#6 &ncer9 9#ndro6#6. Do 9d 9' o#9n et#r# /("n t# n9(edn# &rc#no6 7'7re/: "on #e(  L#nd'0 ered#trn#  #(rn# &rc#no6 7'7re/ =PRC>0 B#rt  o// D'7e =BD> # &rc#no6 7'7re@n# $e(#!

    'dr'@en 9 ered#trno6 (e#!o6#o6to;o6 =LRCC>.

    .1 K!a"i#i$a%ija S&et"$e '(ra&"t&ene Organi)a%ije* +i"to!o,$a $!a"i#i$a%ija tumora bubrega

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    Tabela 2. TNM klasifikacija

    T3M $!a"i#i$a%ija

    T   r#6rn# t'6or 

    T  r#9'9t"o r#6rno/ t'6or n#!e 't"r

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    Krc#no6 7'7re@n# $e(#! =RCC> red9t"(! /r'' 6(#/n#tet &o!# ot#' od e#te( 7'7re@n# &n(#$.

     Epidemiološki podaci 

    RCC #n# re&o ?- 9"# t'6or 7'7re/ odr9(# &o!# 9e !"(!!' od!edn&o &od o7 o(. Nd"ne9to6 6e9t' !e &od 6'&rc0  9d6ne9to6 &od @en =)>. Inc#denc !"(!n! !e 9r;6ern #nd'9tr#!9&o! r;"#!eno9t# ;e6(!e0  !e ' Jn' n e9to6 6e9t' ;!edno 9 nonH od/n (#6o6o60 do& !e ' 6n!e r;"#!en#6 ;e6(!6 n e9ne9to6 6e9t' ;!edno 9 &rc#no6o6 n;or#n/9. Po!" &rc#no6 !e 6n! ' Ar#c# # A;#!#0 ; r;(#&' od J'@ne A6er#&e0 tn#!e Ur'/"!0 /de !e )??*. /od#ne d#!/no9t#&o"n n!"e$# 7ro! no"# 9('!e" ' ce(o6 9"et'. Ze6(! 9 "#9o&o6 9too6 !"(!n! !e # e& Re'7(#&0 /de 9e n /od#n!e6 n#"o' ot&r#!e )-H1- no"# 9('!e" n )--0--- 9tno"n#&0 9r;6erno &od o7 o( =1>.

       Etiološki faktori 

    ). P'en!e  do&;n# # n!e$# &tor r#;#& ; n9tn& RCCH. Met  n(#; 18 9t'd#!  !e o&;( d 'en!e do"od# do ;n!no/ o"e$n! r#;#& od n9tn& o"e 7o(e9t#. T&od!e0 o&;no !e d re9tn& 'en! do"od# do 96n!en! r#;#& &od o7 o(. Pored 't#c! n n9tn& &rc#no60 red9t"(! # ne;"#9n &tor ; r;"o! ';nredo"(o/ &rc#no6 7'7re/ =2>.

    1. Go!;no9t  or9t BMI =7od 699 #nde> !e o"e;n 9 n9tn&o6 &rc#no6 =5>. 2. #erten;#!  o"#en &r"n# r#t#9& !e &tor r#;#& ; n9tn& RCCH0 6d t'6or#

     7'7re/ 6o/' d o9ee o!"' #erten;#!e. U r#(o/ o"o6e /o"ore 6no/e &oortne # 9t'd#!e 9('! # &ontro(e. Kontro( #erten;#!e !e ' &ore(c#!# 9 96n!en!e6 r#;#& =*0 8>

    5. A(&oo(  6d 't#c! (&oo( n o!"' &rc#no6 !o '"e& n#!e do"o(!no !9n0

    odre

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     Prognostički faktori kod karcinoma bubrežnih ćelija

    Pro/no9t# &tor# 9' "eo6 &or#9n# ; odre

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    9' (o7'(rne /r

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     r#9'tn ' 9&oro * o"# t'6or # on /o"or# ' r#(o/ (o#!o! ro/no;#. Ve$# 7ro! 9"et(o$e(#!9 RCCH 9dr@# $e(#!e #6'n9&o/ od/o"or0 t!. (#6oc#tn# #(# ne'tro#(n# #n#(trt.

    S(#& 5. Krc#no6 ore&( 7'7re@n# $e(#!0 9"et(o$e(#!9 t#0 n'&(ern# /rd'9 ) =o F'r6'>

    12

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    S(#& *. Krc#no6 ore&( 7'7re@n# $e(#!0 9"et(o$e(#!9 t#0 n'&(ern# /rd'9 5 =o F'r6'>

      Imunohistohemijski profil 

    Ve$#n o"# t'6or o;#t#"no re/'!e 9 ren( ce(( cr#c#no6 6r&ero6 =RCCHo6>  CD)-0e#te(n#6 6e67rn9 6r&ero6 =EMA> # &r7on n#dr;o6 I =)-0 ))>. O7#no 9' o;#t#"n# # n n#9&o6o(e&'(9&e c#to&ert#ne AE),AE20 CAM *.1 # &oe&9r#6#r!' "#6ent#n.

    7.1b 0i"ti2ni mu!ti!o$u!arni $ar%inom bubre-ni+ e!ija

    C#9t#n# 6'(t#(o&'(rn# &rc#no6 7'7re@n# $e(#! 9dr@# "e(# 7ro! c#9t# # 9et# &o!e 9e 99to!e od

    6(# /r'