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

Bellini’s duct RCC

Transitional cell Ca

Grade berdasarkan: Fuhrman nuclear

grade

:
Renal Cell Carcinoma
/Grawitz
Clear Cell Ca Renal
WILM’S 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 dx preop cukup sulit

Agresif 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
Nephroblastoma
klasik triphasik
epithelium
hanya satu elemen
mesenkim 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
transisionalmudah 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 jaring-

an 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
ø Diagnosis of penile precancer requires a
tissue biopsy.
ø 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 Kemoterapi

Radiasi
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
Prostat”Chips”
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 : Well-
circumscribed, white-
tan, 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

Frequency : 7-10 % of
Macroscopic 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