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NEOPLASMA SISTEM

UROGENITAl

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LOWER URINARY TRACT .

LOWER URINARY TRACT = TRANSITIONAL EPITHELIUM = “URO”THELIUM MINOR CALYCES URETERS MAJOR CALYCES BLADDER RENAL PELVIS URETHRA .

EPITHELIUM MUSCULARIS PROPRIA .

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

TUMORS • Benign –Fibroepithelial Polyp –Leiomyoma • Malignant –Transitional Cell Carcinoma. TCC –Also called UROTHELIAL Carcinoma . aka.

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

Why? • PUNLMP. Papillomas vs. Carcinomas • Very few pathologists will have enough guts to diagnose a transitional papilloma. Papillary Urothelial Neoplasm of Low Malignant Potential – LOW grade PUC (TCC) – HIGH grade PUC (TCC) .

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LOW Grade .

HIGH Grade .

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BIOLOGIC BEHAVIOR NORMAL MUCOSADYSPLASIA.. CARCINOMA IN SITU. WALL)SEROSA or ADVENTITIALYMPH NODESDISTANT METASTASES TNM . INFILTRATION BASEMENT MEMBRANELAMINA PROPRIAMUSCULARIS MUCOSAMUSCULARIS PROPRIA (i.e. SEVERE DYSPLASIA.

flat • T1----Lamina Propria • T2----Muscularis propria • T3a---Microscopic beyond the wall • T3b---Grossly beyond the bladder wall • T4----Invades adjacent structures . papillary • Tis---Carcinoma in situ. TNM example: • Ta----noninvasive.

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Male Genital Tract Diseases .

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Malignancy . Tumors • Prostate: Inflammation. Regressive. Inflammation. Inflammation. Tumors • Testis/Epididymis: Congenital. Benign Enlargement. Vascular diseases. Male Genital Tract (short version) • Penis: Congenital.

aka venereal or genital “warts” •Malignant: Squamous cell carcinoma . Penis: Neoplasia •Benign : Condyloma Acuminata (caused by HPV).

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Koilocytosis .

BOWEN’s Disease = SQUAMOUS cell carcinoma-in-situ of the skin of the penis .

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60% ..e. i. Testicular TUMORS • GERM CELL (malig.) • NON-GERM (benign) – SEMINOMA • CELL. “sex cord” – EMBRYONAL – CHORIOCARCINOMA – YOLK SAC – LEYDIG – TERATOMA – SERTOLI –MIXED!!!!!.

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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 . hair. TERATOMA MALIGNANT TERATOMA TERATOCARCINOMA clusters of squamous epithelium.

SEX Cord Tumors •Leydig. tumor cells look like Leydig cells •Sertoli . tumor cells look like sertoli cells .

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 . STAGING I • Stage : Tumor confined to the testis.

PROSTATE • INFLAMMATIONS • BENIGN ENLARGEMENT • MALIGNANT TUMORS .

CZ = CENTRAL TZ = TRANSITIONAL PZ = PERIPHAL .

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BIOLOGIC BEHAVIOR • NORMAL PROSTATE  • HYPERPLASIA  • P. is like “dysplasia leading to adenocarcinoma-in situ  • INFILTRATION of “stroma”  • CAPSULE  • LYMPH NODES  • DISTANT.I. especially BONE  . (Prostatic Intraepithelial Neoplasia).N.

.N.I.P.

NUCLEOLI. NUCLEOLI . NUCLEOLI.

PERINEURAL INVASION .

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GRADING • GLEASON SCORE = Predominant pattern (1-5) + Secondary pattern (1-5) • Best Score = 2. Worst Score = 10 .

STAGING TNM .

LEVATOR MUSCLES. EXTERNAL SPHINCTER. 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 . RECTUM. 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. 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.

• 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 .• Prostate is #1 most common malignancy in men but NOT #1 killer.