MALE GENITAL AND

KIDNEY TUMORS
Anatomy of the male pelvic region
Congenital

Bladder exstrophy Diverticulum

 Cystitis

Secondary to infection of the lower urinary tract

Factors: age, sex, bladder calculi, bladder outlet
obstruction, DM, immunodeficiency,
instrumentation/ catheterization,
radiation/ chemo therapy
Coliform bacteria, pseudomonas etc…
Schistosomiasis---- squamous cell carcinoma
Schistozomiasis Squamous cell ca
 Malakoplakia of the bladder

Multiple nodular thickenings of the mucosa and sub-mucosa,

in the region of the trigone
May be mistaken for a carcinoma
Associated with Immune deficiency states, renal transplant
recipient
Micros: histiocytes with granular acidophilic cytoplasm
accumulate beneath the surface epitheluim.
Michaelis-Gutmann bodies: intracytoplasmic inclusions
Positive :PAS, Iron, Calcium staining
Bacterial identification : gram negative colliform bacilli
Malakoplakia of the bladder
Amiloidosis of the bladder
 IV. BLADDER NEOPLASMA
Ganas > 90% berasal dari urotelium dalam
sekwen hiperplasi (>7 lapis)  displasia
 karsinoma in situ  karsinoma invasif
Sering hematuria tanpa nyeri
Jenis:
- Jinak: papiloma
- Ganas: A. Ca sel transisional, B. Ca sel
skuamosa, C. adenokarsinoma
 Papilloma
Discrete exophytic growth with central
fibrovascular core lined by urothelium of
normal thickness and cytology
Delicate papillae
Normal organisation of cells
Normal nuclear size and shape
Fine chromatin, no nucleoli
No mitoses
Umbrella cells present
papilloma of the urinary bladder
papilloma of the urinary bladder
Papilloma

Exophytic type Inverted type

 Dysplasia: Low-grade
intra-urothelial neoplasia

Appreciable cytologic and architectural changes to be

called neoplastic, but falling short of the threshold
for CIS
 Carcinoma in situ
High-grade intra-urothelial neoplasia
Flat lesion that is the precursor of
invasive carcinoma in some cases
Presence of cells with large, irregular,
hyperchromatic nuclei
Often mitotic activity, often in mid and
upper urothelium
 Carcinoma in situ
High-grade intra-urothelial neoplasia
Papillary carcinoma of the bladder
IV. A. Karsinoma Sel Transisional

Lebih banyak pada pria, usia pertengahan

Etiologi: lingkungan misanya merokok, industri (anilin),
metabolit triptofan, parasit, iritasi mekanik (batu,
divertikuli)
Sampai dengan 70%: papilar, non-invasif, low-grade
Grading hitologik penting untuk menentukan prognosis:
- Grade I: stroma fibrovaskular dikelilingi kelompok sel
transisional uniform, papilar, lapisan sel 7-10 lapis sel
- Grade II: konfigurasi sel makin tak teratur, lapisan 15-
20, atau lebih, mitosis, inti hiperkromatik
- Grade III: sel lebih padat, atipia dan mitosis banyak,
nekrosis dan ulserasi.
MALIGNANT TUMOR OF THE BLADDER
Pathology

• Transitional cell carcinoma 90%

• Squamous cell carcinoma 5%

• Adenocarcinoma <2%

• Rhabdomyosarcoma <1%
Transitional cell carcinoma of the bladder
Etiology

• Chemical compounds
naphtalamine
benzidine
smoking
phenacetine

• Parasites
schistosomiasis

• Chronic irritation
infection
irradiation
Transitional cell carcinoma of the bladder
Symptoms

Gross, macroscopic, painless haematuria

Frequency, urge, dysuria

Weight loss, palpable mass

Flank pain, lymphedema
Transitional cell carcinoma of the bladder
Diagnostic

Urinalysis
Sediment Cytology
Low-grade transitional cell ca
Fused, branching and delicate papillae
Predominantly ordered organisation, but
minimal crowding and loss of polarity, any
thickness, cohesive
Enlarged, variable nuclei
Round-oval nuclear shape with variations
Chromatin varies within and between cells
Usually inconspicuous nucleoli
Occasional mitoses at any level
Usually umbrella cells present
transitional cell carcinoma, low grade
Transitional cell ca, low grade
Transitional cell Ca, high grade
Fused, branching, delicate papillae
Loss of polarity, any thickness, often
dyscohesive
Nuclei enlarged with variation in size
Pleomorphism
Hyperchromasia and variations in and
between cells
Nucleoli prominent
Usually mitoses at any level
Umbrella cells may be absent
Transitional cell ca , high-grade
Proliferation marker (KI 67)
Invasive neoplasm
Nested type of transitional cell carcinoma
 Transitional cell carcinoma of the bladder

Superficial

Muscle invasive
 MALE
REPRODUCTIVE
SYSTEM
Male Reproductive Organs

Penis
Testis
Prostate
 Neoplasm
1. Carcinoma in situ: Bowen disease
- usually presents as a single erythematous plaque, most
often on the shaft of penis or on the scrotum
- predominantly affects uncircumcised men
- has peak incidence after the fifth decade
- evolve into invasive carcinoma in less than 10%
2. Carcinoma
- Most frequently SCC
- is rare in circumcised men
- si predisposed by poor personal hygiene and veneral
disease
- often associated with HPV type 16, 18, 31, 33 infection
 Bowen’s disease

Carcinoma in situ of the penis, with intact basement

membrane
Higher magnification demonstrating cellular atypia, with
occasional mitosis and lack of normal maturation
PENIS: SQUAMOUS CELL CARCINOMA
Squamous cell carcinoma

The glans penis is

deformed by a firm,
ulcerated, infiltratif
mass
Squamous Cell Ca, non-keratinizing
 TESTES
Developmental anomalies
Inflammations
Neoplasms
Scrotal masses
Seminoma of the Testis

A fairly well
circumscribed, pale,
fleshy, homogeneous
mass

Large cells with distinct

cell borders, pale
nuclei, prominent
nucleoli, sparse
lymphocytic infiltration
Embryonal carcinoma

In contrast to the
seminoma, this tumor
is bulky, hemorrhagic
mass

Primitive
hyperchromatic cells
that form sheets and
occasional glands
 Choriocarcinoma

The tumor contains cytotrophoblastic and

syncytiotrophoblastic elements which elaborates hCG
 TESTICULAR TERATOMA

The tumor contains mature cells from endodermal

(glandular), mesodermal (cartilaginous), and ectodermal
(squamous) epithelial elements.
Intratubular germ cell neoplasia (ITGCN)

Normal Neoplastic
Seminoma testis
Seminoma testis
Nonseminomatous germ cell tumor
 NSGCT

Embryonal carcinoma component

 NSGCT

Cartilaginous component
 NSGCT

Yolk sac component

 NSGCT

Choriocarcinoma component
Mature Teratoma
Yolk sac tumor
Leydig cell tumor

Reinke crystal
Sertoli cell tumor
Features of testicular tumors
 PROSTATE

Prostatic hyperplasia
Neoplasms
Growth of the prostate & nodular
hyperplasia
Adult prostate

The normal prostate

contains several
distinct regions:
CZ: central zone
PZ: peripheral zone
TZ: transitional zone
Periurethral zone
Prostatic hyperplasia

Hyperplastic median
lobe protruding into
the bladder
Nodular hyperplasia of the prostate

Well defined nodules

bulge from the cut
surface
The proximity of the
nodules to the urethra
accounts for the
urinary obstruction
associated with lesion
Nodular hyperplasia of the Prostate
Nodular hyperplasia of the Prostate
Nodular hyperplasia
Low power photograph:
Well-demarcated nodule
at the top of the field,
populated by
hyperplastic glands

Higher power:
Characteristic inner
columnar and outer
cuboidal cell layer
Prostatic hyperplasia versus carcinoma

Subcapsular focus of
carcinoma

Median groove obliterated

by carcinoma arising in
subcapsular zone
Adenocarcinoma of the prostate

The parenchyma contains a poorly defined, pale,

infiltrative tumor
 Well differentiated carcinoma of the prostate

Neoplastic glands infiltrating Crowded “back-to-back”

the fibrous stroma glands lined by single
layer of cuboidal cells
Comparison between normal prostate,
nodular hyperplasia, and Ca
PSA: normal prostate
(IH) x 50
Prostatic adenocarcinoma
High grade prostatic intraepithelial neoplasia
Gleason grade 1
Gleason grade 3
Gleason grade 5
Staging
Metastatic
prostatic
carcinoma
KIDNEY
 IX. Neoplasms
Cortical adenoma
Renal cell carcinoma (RCC)
– The most frequent renal cancer in adult
– It may have endocrine-like effect  procuce
polycytemia, hypercalcemia, hypertension (renin)
Cushing’s syndrome, etc.
Wilms’ tumor
- More common tumor in childhood
Tansitional cell carcinoma
- 5-10% of adult cancer
 Pathology of

The Adrenal Glands

Here are normal adrenal glands. Each adult adrenal gland
weighs from 4 to 6 grams.
Sectioning across the adrenals reveals a golden
yellow outer cortex and an inner red to grey
medulla.
 normal adrenal glands, atrophy, hyperplasia

The pair of adrenals in the center are normal. Those at the top come from a
patient with adrenal atrophy (with either Addison's disease or long-term
corticosteroid therapy). The adrenals at the bottom represent bilateral
cortical hyperplasia. This could be due to a pituitary adenoma secreting
ACTH (Cushing's disease), or Cushing's syndrome from ectopic ACTH
production, or idiopathic adrenal hyperplasia.
Normal adrenal gland
normal adrenal glands

Lapisan dari kanan ke kiri :

periadrenal fat
capsule
zona glomerulosa
zona fasiculata
zona reticularis
medula
NORMAL CORTEX ADRENAL
 ADRENOCORTICAL HYPERPLASIA
The adrenal cortex are yellow, thickened and multinodular
ADRENAL CORTICAL ADENOMA
ADRENOCORTICAL ADENOMA
Solitary, circumscribed
 Adrenal Cortical Adenoma

Gross appearance. Both tumors are well circumscribed, of

homogenous appearance, without hemorrhage or necrosis.
The tumor in A has the typical golden yellow color
associated with aldosterone secretion.
 Adrenal Cortical Carcinoma

Gross appearance. Both tumors are large and exhibit areas of

hemorrhage and necrosis. The tumor shown in A has destroys
the upper pole of the kidney.
 The Adrenal Cortical Adenoma

The tumor showing numerous lipid-laden clear cells similar to

those of the normal fasciculata layer
Cells in adrenocortical adenoma
Aldosterone-secreting Adrenal
Cortical Adenoma

G F R

Various morphologic pattern

normal adrenal glands

Lapisan dari kanan ke kiri :

periadrenal fat
capsule
zona glomerulosa
zona fasiculata
zona reticularis
medula
Compact adenoma
 Adrenal Cortical Carcinoma

There is nuclear hyperchromasia, diffuse pattern of growth,

and mitotic activity
Renal cell carcinoma (RCC)
Renal cell carcinoma

Typical cross-section
of yellowish,
spherical neoplasm
in one pole of the
kidney
Note the tumor in the
dilated, thrombosed
renal vain
Renal cell carcinoma
Renal cell carcinoma
chomophope renal cell ca
chomophope renal cell ca
papillary renal cell carcinoma
Wilms’ tumor (kidney)
NEPHROBLASTOMA
NEPHROBLASTOMA
Wilms’ tumor (kidney)
Nephroblastoma
(HE) x 50