NEOPLASMA SISTEM

UROGENITAl
LOWER
URINARY
TRACT
 LOWER URINARY TRACT
=
TRANSITIONAL
EPITHELIUM
=
“URO”THELIUM

MINOR CALYCES URETERS

MAJOR CALYCES BLADDER
RENAL PELVIS URETHRA
EPITHELIUM

MUSCULARIS PROPRIA
 TUMORS
• 95% Epithelial (urothelial), 5% mesenchymal,
i.e., mesodermally derived (mostly smooth
muscle)
• Benign or Malignant
• Primarily urothelial or transitional, but a few
squamous, from antecedent squamous
metaplasia, and a few adenocarcinomas,
from antecedent glandular metaplasia
 TUMORS
• Benign
–Fibroepithelial Polyp
–Leiomyoma

• Malignant
–Transitional Cell Carcinoma, aka, TCC
–Also called UROTHELIAL Carcinoma
 TCC TUMORS
• MULTIPLE, MULTIPLE, MULTIPLE, i.e., “soil”
theory
• Papillomas vs. Carcinomas
• Grading, I, II, III, or wellpoor
• Staging, TNM, based on biologic behavior, really
based on normal anatomy
 TCC TUMORS
• Causes/Risk Factors
– Arylamines (aniline dyes)
–Cigarettes
–Shistosomiasis
– Longstanding analgesics, same as analgesic
nephropathy drugs, most common NSAIDS
– ChemoRX, esp. cyclophosphamides
– Radiation RX
 Papillomas vs. Carcinomas
• Very few pathologists will have enough guts to
diagnose a transitional papilloma. Why?
• PUNLMP, Papillary Urothelial Neoplasm of
Low Malignant Potential
– LOW grade PUC (TCC)
– HIGH grade PUC (TCC)
LOW Grade
HIGH Grade
 BIOLOGIC BEHAVIOR
NORMAL MUCOSADYSPLASIA, SEVERE DYSPLASIA,
CARCINOMA IN SITU, INFILTRATION BASEMENT
MEMBRANELAMINA PROPRIAMUSCULARIS
MUCOSAMUSCULARIS PROPRIA (i.e.,
WALL)SEROSA or ADVENTITIALYMPH
NODESDISTANT METASTASES

TNM
 TNM example:
• Ta----noninvasive, papillary
• Tis---Carcinoma in situ, flat
• T1----Lamina Propria

• T2----Muscularis propria
• T3a---Microscopic beyond the wall
• T3b---Grossly beyond the bladder wall
• T4----Invades adjacent structures
 Male
Genital Tract
Diseases
 Male Genital Tract
(short version)

• Penis: Congenital, Inflammation, Tumors

• Testis/Epididymis: Congenital,
Regressive, Inflammation, Vascular diseases,
Tumors
• Prostate: Inflammation, Benign
Enlargement, Malignancy
 Penis: Neoplasia
•Benign : Condyloma Acuminata (caused
by HPV), aka venereal or genital “warts”

•Malignant: Squamous cell carcinoma

Koilocytosis
BOWEN’s Disease = SQUAMOUS cell carcinoma-in-situ of
the skin of the penis
 Testicular TUMORS
• GERM CELL (malig.) • NON-GERM (benign)
– SEMINOMA • CELL, i.e., “sex cord”
– EMBRYONAL
– CHORIOCARCINOMA
– YOLK SAC – LEYDIG
– TERATOMA – SERTOLI

–MIXED!!!!!,
60%
 TERATOMA
MALIGNANT TERATOMA
TERATOCARCINOMA
clusters of squamous epithelium, hair, skin glands
neural tissue
retina
muscle bundles
islands of cartilage
structures reminiscent of thyroid gland
bronchial or bronchiolar epithelium
bits of intestinal wall or brain substance
 SEX Cord Tumors
•Leydig,
tumor cells look
like Leydig cells

•Sertoli ,
tumor cells look
like sertoli cells
 STAGING
I
• Stage : Tumor confined to the testis,
epididymis, or spermatic cord

II
• Stage : Distant spread confined to
retroperitoneal nodes below the diaphragm

• StageIII : Metastases outside the

retroperitoneal nodes or above the
diaphragm
 PROSTATE
• INFLAMMATIONS
• BENIGN ENLARGEMENT
• MALIGNANT TUMORS
CZ = CENTRAL
TZ = TRANSITIONAL
PZ = PERIPHAL
 BIOLOGIC BEHAVIOR
• NORMAL PROSTATE 
• HYPERPLASIA 
• P.I.N. (Prostatic Intraepithelial Neoplasia), is like
“dysplasia leading to adenocarcinoma-in situ 
• INFILTRATION of “stroma” 
• CAPSULE 
• LYMPH NODES 
• DISTANT, especially BONE 
P.I.N.
NUCLEOLI, NUCLEOLI, NUCLEOLI
PERINEURAL INVASION
 GRADING
• GLEASON SCORE = Predominant pattern

(1-5) + Secondary pattern (1-5)

• Best Score = 2, Worst Score = 10
STAGING

TNM
 T1 CLINICALLY INAPPARENT LESION (BY PALPATION/IMAGING STUDIES)
T1a Involvement of ≤5% of resected tissue
T1b Involvement of >5% of resected tissue
T1c Carcinoma present on needle biopsy (following elevated PSA)
T2 PALPABLE OR VISIBLE CANCER CONFINED TO PROSTATE
T2a Involvement of ≤5% of one lobe
T2b Involvement of >5% of one lobe, but unilateral
T2c Involvement of both lobes
T3 LOCAL EXTRAPROSTATIC EXTENSION
T3a Extracapsular extension
T3b Seminal vesical invasion
T4 INVASION OF CONTIGUOUS ORGANS AND/OR SUPPORTING STRUCTURES
INCLUDING BLADDER NECK, RECTUM, EXTERNAL SPHINCTER, LEVATOR MUSCLES, OR PELVIC
FLOOR

N0 NO REGIONAL NODAL METASTASES

N1 METASTASIS IN REGIONAL LYMPH NODES

M0 NO DISTANT METASTASES
M1 DISTANT METASTASES PRESENT
M1a Metastases to distant lymph nodes
M1b Bone metastases
M1c Other distant sites
• Prostate is #1 most common malignancy in men
but NOT #1 killer.
• 80% over 80
• Every elderly male presenting with widespread
bone metastases is carcinoma of the prostate until
proven otherwise
• PSA (Prostate Specific Antigen) has been
controversial as a screening test but is GREAT for
follow up of a known prostate cancer