TUMOR-TUMOR PADA SALURAN KEMIH DAN ALAT KELAMIN PRIA

Dr.Delyuzar Sp.PA (K) Dr.T.Kemala Intan M.Pd

TUMOR GINJAL

Jenis-jenis Renal cell carcinoma

Conventional RCC Chromophobe RCC Tubulopapillary RCC Bellinis duct RCC Transitional cell Ca Grade berdasarkan: Fuhrman nuclear grade :

Renal Cell Carcinoma /Grawitz

Clear Cell Ca Renal

WILMS TUMOUR
Wilms tumor (WT) = Nephroblastoma Keganasan ke-5 pada anak-anak. Setelah usia 3 tahun >>> setelah usia 8 tahun <<< Pada satu atau kedua ginjal. Massa besar di abdomen anak 1-5 tahun curiga Wilms Tumor.

Massa ginjal padat dengan / tanpa hematuria. Kdg cystic, nekrosis fokal dan degenerasi. Orang dewasa Agresif dx preop cukup sulit metastase

Responsif terhadap pemberian terapi. Angka kesembuhan hampir 90%.

PEMERIKSAAN GROSS
Besar (berat 100 - 1000 gram) Bentuk ginjal terdistorsi. Penampangnya halus, mengkilat dan sering berbentuk lobulated berwarna putih keabuan (tampak seperti otak). Area perdarahan dan nekrosis (+) Dapat multifokal.

Pemeriksaan Gross
Perhatian : kapsul ginjal, pembuluh darah, ureter, KGB pelvis. Pewarnaan kapsul sebelum fiksasi dan insisi cegah over dx keterlibatan invasi kapsular.

HISTOPATOLOGI

blastema epithelium mesenkim

Nephroblastoma klasik triphasik hanya satu elemen dominan. (> 65%)

Mucinous epithelium in Wilms tumor.

Microscopic appearance of Wilms tumor. A, Low-power microscopic view showing a combination of blastema, stroma, epithelial tubular formation, and immature glomeruli. B, High-power view showing blastema, stroma, and immature tubular formations.

TUMOR VESICA URINARIA

TUMOR VESICA URINARIA

Jinak : Papilloma, jarang,berasal dari epithel transisional mudah cepat menjadi karsinoma Ganas: Karsinoma,terbanyak, jarang berasal dari bukan epithel Gejala klinik:Hematuria tanpa rasa sakit Teori etiologi:Kimia,gangguan metabolisme,radang, parasit (s.Hematobium)

Cara Pertumbuhan:
1.Bentuk Papiler: a.tanpa tanda infiltrasi yang jelas,b.dengan tanda infiltrasi yang jelas 2.Bentuk datar dengan tanda-tanda infiltrasi 3.Bentuk ulcus dengan tanda-tanda infiltrasi 4.Tanpa bentuk menonjol/ulcus yang jelas, dgn tanda infiltrasi tidak jelas, tapi dinding menebal dan cepat metastasis

Jenis-Jenis Karsinoma V.U

1.Bentuk Transisional Karsinoma (90%) 2.Bentuk Epidermoid Karsinoma 3.Bentuk Adenokarsinoma 4.Bentuk Campuran 5.Bnetuk Undifferentiated

Bladder: Urothelial Carcinoma, Transitional Cell Carcinoma Note: papillary, invasive and friable. http://erl.pathology.iupui.edu/C604/GENE750.HTM

Transisional Karsinoma V.U

GRADE I Makroskopis Tumor berwarna pink muda, dan mempunyai gbrn papillary yang sebagian besar berbentuk pedunkulated. Nekrosis sgt jarang dijumpai Mikroskopis Gbrn papil-papil yg tdd fibrovasculare core disentral dgn dilapisi epitel transisional yg identik dengan sel bladder yg normal. Mitosis sgt jarang bahkan kadang-kadang tidak ada

GRADE II Makroskopis Tumor tampak seperti pedunkulated maupun sessile, Nekrosis jarang dijumpai. Konsistensi lebih padat ataupun solid dan kenyal Mikroskopis Masih tampak gbrn papillary tetapi lebih banyak dan sel-sel lebih berlapis dengan inti membesar, dan hiperkromatin.

GRADE III Makroskopis Lebih banyak berbentuk sessile, seperti bunga kol. Nekrosis dan ulserasi lebih sering dijumpai Mikroskopis Tampak gbrn papillary, tetapi sudah tersusun secara ireguler. Sel-sel ganas membentuk kelompokan-kelompokan kecil dan sel-sel yang mitotik lebih sering dijumpai

Kedalaman Infiltrasi karsinoma (stadium)

Stage: 0=Karsinoma terbatas pada epitel A=Karsinoma sampai dengan sub mukosa B=Karsinoma sampai dengan lapisan otot C=Karsinoma sampai dengan jaringan lemak perivesikel D=Karsinoma sampai ke kelenjar limfe (keluar dari V.U)

Menegakkan Diagnosa:
1.Sitologi Urine 2.Cystoscopy 3.Radiologi

TUMOR PENIS

Epidemiology & Risk Factors

Carcinoma of the penis accounts for less than 1% of cancers among males in the United States. Penile carcinoma may compose 10-20% of all malignant lesions. Penile carcinoma occurs most commonly in the sixth decade of life. The one etiologic factor most commonly associated with penile carcinoma is poor hygiene.

PATHOLOGY
Precancerous Dermatologic Lesion Carcinoma in Situ Invasive Carcinoma of the Penis

Precancerous Dermatologic Lesion

Leukoplakia Balanitis xerotica obliterans Giant condylomata acuminata

LEUKOPLAKIA
Leukoplakia is a precancerous disorder that's characterized by white, scaly patches on the glans and prepuce accompanied by skin thickening and occasionally fissures. Leukoplakia is a rare condition that most commonly occurs in diabetic patients.

BALANITIS XEROTICA OBLITERANS

Balanitis xerotica obliterans is a white patch originating on the prepuce or glans and usually involving the meatus. Microscopic examination reveals atrophic epidermis and abnormalities in collagen deposition.

GIANT CONDYLOMATA ACUMINATA

Giant condylomata acuminata are cauliflowerlike lesions arising from the prepuce or glans. The cause is believed to be viral HPV. These lesions may be difficult to distinguish from well-differentiated squamous cell carcinoma.

HISTOPATOLOGY GIANT CONDYLOMATA ACUMINATA

CARCINOMA IN SITU
Bowen Disease Erythroplasia of Queyrat

BOWEN DISEASE
Bowen disease is a squamous cell carcinoma in situ typically involving the penile shaft. Bowen's disease is a painless, premalignant lesion that commonly occurs on the penis or scrotum. It appears as a brownish red, raised, scaly, indurated plaque with well-defined borders, which may ulcerate at its center.

BOWEN DISEASE

ERYTHROPLASIA OF QUEYRAT
Characteristic lesions of EQ are solitary or multiple erythematous plaques. The texture can be smooth, velvety, scaly, or verrucous. Ulceration or distinct papillomatous papules within a plaque may indicate progression to invasive squamous cell carcinoma. Microscopic examination shows typical, hyperplastic cells in a disordered array with vacuolated cytoplasm and mitotic figures.

ERYTHROPLASIA OF QUEYRAT

SIGNS AND SYMPTOMS

Early signs of penile cancer include a small lesion, a pimple, or a sore on the penis. The symptoms, such as pain, hemorrhage, dysuria, purulent discharge, and obstruction of the urinary meatus.

Diagnosis
Diagnosis of penile precancer requires a tissue biopsy. CONFIRMING DIAGNOSIS Preoperative baseline studies include complete blood count, urinalysis, an electrocardiogram, and a chest X-ray.

TREATMENT

Depending on the stage of progression. Treatment includes surgical resection of the primary tumor and, possibly, chemotherapy and radiation. Local tumors of the prepuce only require circumcision.

Karsinoma Penis
Karsinoma sel skuamosa tampak sebagai lesi papular, abu-abu, berkrusta paling sering di glans penis atau prepusium

Kurang dari 1% kanker pada laki-laki Karsinoma menginfiltrasi jaringan ikat dibawahnya dan membentuk lesi keras yang mengalami ulserasi dengan batas iregular

SQUAMOUS CELL CARSINOMA PENIS

ATROPHY

HYPERKERATOSIS

MIKROSKOPIS CA PENIS

Symptom dan Sign

Lesi pada glans penis atau preputium Leukoplakia diikuti pembentukan papula putih yang meninggi Pembengkakan kelenjar lymph regional (inguinal)

Diagnosa
Biopsi

Faktor Resiko
Usia > 40 tahun Sirkumsisi Higien Kontak seksual HPV

Treatment

Penektomi Radiasi

Kemoterapi

TUMOR PROSTAT

Prostate Gland
Divide into several regions:
Peripheral zone Central zone Transitional zone Periurethral zone

Microscopic feature of prostate

Stroma: Abundant and continuous with the gland capsule, it constitutes one third to one fourth of the gland volume and is composed of fibroelastic connective tissue intermixed with smooth muscle fibers. Glands are embedded in the stroma. Tubuloalveolar glands: Irregular, large lumen, widely spaced tubules with alveolar extensions, which vary greatly in shape and size. Epithelial lining in tissue sections is simple cuboidal to columnar in shape, depending upon physiological state. Prostatic concretions: Corpora amylacea, acidophilic condensed secretions of prostatic glands. They may be lamellated and increase in number with advancing age. Source of prostatic calculi.

Normal prostate

Benign Prostate Hyperplasia

Hyperplasia = Benign = (Redundant & Misnomer) BPH is characterized by proliferation of both epithelial and stromal elements BPH rarely causes symptoms before age 40, but more than half of men in their sixties and as many as 90 percent in their seventies and eighties have some symptoms of BPH (prostate enlargement is as common a part of aging as gray hair)

Benign Prostate Hyperplasia MORPHOLOGY

Macroscopic features of BPH

BPH arises most commonly in the inner, periurethral glands of the prostate The affected prostate is enlarged (>300g in severe cases) The cut surface contains multiple, fairly well circumscribed nodules, which bulge from the cut surface The nodules may have a solid appearance, or they may contain cystic spaces (the latter corresponding to dilated glandular elements seen in histologic sections) The urethra is usually compressed by the hyperplastic nodules

Normal prostate and benign prostatic hyperplasia (BPH). - A normal prostate does not block the flow of urine from the bladder. - An enlarged prostate presses on the bladder and urethra and blocks the flow of urine.

Prostate hyperplasia

Severe prostatic hyperplasia (arrows) with bladder neck obstruction and bladder calculi. Note the 4 bladder stones.

www.pathguy.com

The prostate is on the bottom, and the bladder, with its front opened, is on top. You can see the enlarged central lobe of the prostate gland protruding into the bladder cavity. The prostate gland obstructed outflow from the bladder, forcing the bladder wall to become thicker and stronger

Microscopic features of BPH

Proliferation of glands. Hyperplastic stromal muscle Glands larger than normal Papillary ingrowth.

Prostate hyperplasia

www.pathguy.com

BPH

Notice the large number of complex, infolded glands

Notice that its epithelium is infolded. Even within the glands, the cells are too numerous

ProstatChips

Adenocarcinoma Prostat

Adenocarcinoma w/Large Nuclei Cell

Immunoperoxidase Stain For Adeno Ca Prostat

At Low Magnification(Needle Biopsy)

TUMORS OF THE TESTIS

HISTOLOGY OF THE NORMAL TESTIS

HISTOGENESIS OF TESTICULAR TUMORS

Hitogenesis of testicular tumors

SEMINOMA OF THE TESTIS

Macroscopic Frequency : 40 % of the testis neoplasms Location : Testis Size : 1.7 x 1.7 x 1.9 cm Characteristic : Wellcircumscribed, whitetan, firm mass Operative procedure : Orchiectomy

Microscopic

Polygonal cell uniform Infiltrating lymphocyte in stroma Fibrosis stroma Circular nucleus with pure cytoplasma and clear membran cells

TERATOMA OF THE TESTIS

Macroscopic Frequency : 7-10 % of the testis neoplasms Tumor location : Testis Tumor size : 2.5 cm diameter Tumor characteristics : Firm, whitish, ovoid mass with discrete yellow and grey areas Operative procedure : Orchiectomy

Microscopic

Well-differentiated of nervous, muscle, chondrosit, fat, squamous cell and bronchus epithelium Irregular forms Diffuse small glands

EMBRYONIC CARCINOMA
Frequency : 10-20 % of testis neoplasms Macroscopic : smaller than seminoma, white-gray, nodules shape, hemorrhagic and necrosis Microscopic : low differentiated with tubular and papillary forms, pleomorphic cells with few stroma, uninfiltrating lymphocyte, invasive

CHORIOCARCINOMA
Frequency : 1 % of testis neoplasms Characteristic :
Pleomorphic cell with large nucleus Cytotrophoblast with cuboidal cell epithelium Syncitiotrophoblast with syncitium epithelium

Bad prognosis

MIXED GERM CELL TUMOR OF THE TESTIS

Macroscopic Frequency : 40 % of the testis tumors Tumor location : Testis Tumor size : 2.3 x 1.6 x 2.5cm Tumor characteristics : Red-tan nodular mass with grey-white cysts filled with light brown, viscous fluid Operative procedure : Orchiectomy

Microscopic

Pleomorphic cell Papillary Irregular forms Low differentiated of nervous, muscle, and fat

TERATOCARCINOMA OF THE TESTIS

Macroscopic Tumor location : Testis Tumor size : 4.9 x 2.6 x 1.9 cm Tumor characteristics : Well-circumscribed, septate mass with a white-tan cut surface Operative procedure : Orchiectomy

Microscopic