Renal cell carcinoma

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Renal cell carcinoma

Renal system


Renal cell carcinoma


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USMLE® Step 1 questions

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High Yield Notes

9 pages


Renal cell carcinoma

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USMLE® Step 1 style questions USMLE

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A 52-year-old man comes to the clinic because of vague right-sided back pain over the past two months. He denies any recent trauma, heavy lifting, or new activity. The patient has also noticed a 4.2 kg weight loss during this time, despite not making any changes to diet or activity. The patient has a 20 pack-year smoking history. The patient’s temperature is 37.8°C (100°F), pulse is 75/min, and blood pressure is 128/85 mm Hg. Physical examination shows no abnormalities. The results of his urinalysis are shown below:  
Laboratory value   Result 
 Erythrocytes  60/hpf 
 Leukocytes  4/hpf 
 Bacteria  None 
Which of the following is a possible complication of this patient's condition?  

External References

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Chromosome disorders

renal cell carcinoma p. 623


renal cell carcinoma association p. 623

Paraneoplastic syndromes p. 221

renal cell carcinoma and p. 623

Proximal convoluted tubules (PCT)

renal cell carcinoma and p. 623

Renal cell carcinomas p. 623

associations p. 731

bevacizumab for p. 449

carcinogens for p. 223

chromosome association p. 62

horseshoe kidney and p. 603

hypercalcemia and p. 221

IFN- αfor p. 201

immunohistochemical stain for p. 220

metastases of p. 202

recombinant cytokines p. NaN

therapeutic antibodies p. 120

von Hippel-Lindau disease p. 543, 719


renal cell carcinoma p. 623

Von Hippel-Lindau disease p. 543

renal cell carcinoma and p. 623

Weight loss

renal cell carcinoma p. 623

External Links


Renal cell carcinomas (or RCC’s) are the most common type of malignant kidney cancer in adults, generally affecting older men.

Unfortunately, RCC is often considered a “silent” cancer because symptoms don’t typically get noticed until the tumor has grown pretty large.

Renal cell carcinomas form from epithelial cells in the proximal convoluted tubule of the kidney; this is the section of the nephron that is usually located in the renal cortex—the outer rim of the kidney.

The most common type of renal cell carcinoma is composed of polygonal epithelial cells, which have funny angular shapes with at least four sides and are filled with clear cytoplasm full of carbohydrates and lipids. It’s those lipids that give the tumors their yellow color.

At a genetic level, renal cell carcinomas have been linked to mutations on the short arm of chromosome 3, or 3p. An easy way to remember this is that RCC has three letters and it’s linked to chromosome 3.

One of the main genes involved in renal cell carcinomas is the VHL gene, which codes for the von Hippel-Lindau tumor suppressor protein, or pVHL which is normally expressed in all tissues.

Mutations in pVHL can allow IGF-1, the type 1 insulin-like growth factor, pathway to go into overdrive. This does two things.

First, there is dysregulated cell growth, and second it upregulates specific transcription factors called hypoxia-inducible factors, which in turn help generate more vascular endothelial growth factor or VEGF, as well as VEGF receptor, leading to growth of new blood vessels, or angiogenesis. Dysregulated cellular growth and angiogenesis are a recipe for tumor formation.

Renal cell carcinomas can arise sporadically or they can be a part of an inherited syndrome. Sporadic tumors are usually solitary tumors in the upper pole of the kidney, and most often happen among older men that smoke cigarettes.

Inherited syndromes, like von Hippel-Lindau disease, can also give rise to renal cell carcinomas, and in this situation the tumors typically affect younger men and women and often involve both kidneys.


Renal cell carcinoma (RCC) is a type of kidney cancer that originates in epithelial cells in the proximal convoluted tubule of the kidney. RCCs are the most common type of malignant kidney cancer in adults, generally affecting older men. RCCs can arise sporadically or as part of a genetic condition like von Hippel-Lindau's disease. Symptoms may include blood in the urine, abdominal pain, and a mass in the kidney area. Treatment options include surgery, radiation therapy, and immunotherapy.


  1. "Robbins Basic Pathology" Elsevier (2017)
  2. "Harrison's Principles of Internal Medicine, Twentieth Edition (Vol.1 & Vol.2)" McGraw-Hill Education / Medical (2018)
  3. "Pathophysiology of Disease: An Introduction to Clinical Medicine 8E" McGraw-Hill Education / Medical (2018)
  4. "CURRENT Medical Diagnosis and Treatment 2020" McGraw-Hill Education / Medical (2019)
  5. "Renal cell carcinoma" Current Opinion in Oncology (2008)
  6. "Renal-Cell Carcinoma" New England Journal of Medicine (2005)
  7. "Renal cell carcinoma" The Lancet (2009)

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