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What is Renal medullary carcinoma and explain in detail?
Renal medullary carcinoma is a rare type of cancer that affects the kidney.  It tends to be aggressive, difficult to treat, and is often metastatic at the time of diagnosis.  Most individuals with this type of cancer have sickle cell trait or rarely sickle cell disease, suggesting that the sickle cell trait may be a risk factor for this type of cancer.

Signs and symptoms
In a case series of 34 patients, Davis and colleagues reported the following signs and symptoms:
macroscopically visible (gross) hematuria (60%)
abdominal or back/flank pain (50%)
significant weight loss (25%)Other researchers have reported a palpable renal mass or enlarged lymph nodes.

Causes
The etiology of renal medullary carcinoma is still not completely understood.  However, the majority of individuals diagnosed with this type of cancer have had sickle cell trait, in which the person carries one normal copy of the hemoglobin A gene (HbA) and one copy of the hemoglobin A gene harboring the genetic mutation found in sickle cell disease (HbS).  These individuals do not have sickle cell disease but can manifest symptoms such as kidney damage over the course of their lives.  The other genetic or environmental factors that contribute to the risk of renal medullary carcinoma are unknown.

Mechanism
The finding that virtually all people affected by renal medullary carcinoma carry at least one copy of the HbS mutation suggests that sickle cell trait somehow predisposes to this type of cancer. The precise mechanism is unknown, but red blood cells with a sickle cell configuration have been identified in pathology specimens.

Diagnosis
The diagnosis of renal medullary carcinoma is typically made after individuals with sickle cell trait present with the typical signs and symptoms outlined above, in combination with radiographic imaging (usually abdominal/pelvic CT scan) studies and ultimately surgical biopsy and pathological examination of the tumor.  Findings on radiographic examination are non-specific and can reveal a mass deep within the kidney. Histopathology studies show a distinctive pattern that can be distinguished from other renal tumors.

Classification
Renal medullary carcinoma has been termed "the seventh sickle cell nephropathy" because it is found almost exclusively in individuals with sickle cell trait or occasionally in those with sickle cell disease.

Prevention
Renal medullary carcinoma is extremely rare and it is not currently possible to predict those individuals with sickle cell trait who will eventually develop this cancer