Basuki B Purnomo

Department of Surgery
RSUD Dr Saiful Anwar
Malang
 Is it benign or malignant tumor?
Cytological examination
Tumor marker
Imaging

Histopatological examination
•Biopsy (Fine needle aspiration biopsy or FNAB) from prostate gland
•Intravesical, intraureteral, intrapelvic biopsy
•Open biopsy from penile carcinoma

Malignant tumor

Grading (cell tumor differentiation)

Incidence
 Prostatic carcinoma (the most
common)
 Bladder carcinoma
 Testicular, kidney, and penile
carcinoma
Stadium
 T (tumor): extension tumor in organ
or surrounding tissues
 N (nodule): spreading tumor through
lymphatic vessels
 M (metastasis): spreading tumor
through hematogenous route
 STAGING
Hematogenous metastasis
(M)

Lymphogenous spread •Bone scan

(N) •USG
•Thorax photo
•CT scan
•CT scan
•MRI
•Laparoscopic
•Surgical

•USG
Tumor mass extension •CT scan
(T) •MRI
 T0-4 N0-3 M0-1

Multiple tumor: T2(m) N2 M0

Incomplete staging: T2 Nx M0
Grading

 Differentiation of anaplastic cell

 According to Mostofi:
1. Well differentiated
2. Moderately differentiated
3. Poorly differentiated
4. Undifferentiated
Diagnosis
 Medical history
 Physical examination
 Laboratorium
(Tumor marker)
 Imaging
 Histopathology through:
 Biopsy
 Operation
 Signs & Symptoms
Tumor Mass

Bleeding Obstruction
(hematuria)

Lower urinary tract Upper urinary tract

Anemia, shock

Clot retention Urinary retention Hydronephrosis

Infection

Lost kidney
(Renal failure)
 TREATMENT
Early stadium: radical treatment
Advanced stadium: palliative treatment

Treatment options:
•Surgical
•Radiation
•Hormonal therapy
•Chemotherapy
•Gene therapy
•Immunotherapy
Malignant Kidney tumor
Parenchyma
 Renal adenocarcinoma (Grawitz’s tumor)
 Nephroblastoma (Wilm’s tumor)

Pelvicaliceal system
 Tumor of the pelvic kidney
Renal adenocarcinoma
Synonym:
 Grawitz’s tumor

 Internist tumor

 Renal cell carcinoma

Clinical sign and symptoms
 Trias kidney tumor:
 Flank pain
 Hematuria
 Flank mass
 Febris
 Hypertension
 Anemia
 Paraneoplastic syndrome
Robson stadium
II
I

IV
III
Lung
metastasis of
RCC
Therapy
Depend on tumor stadium:
 Nephrectomy
 Radical
 Partial
 Palliative
 Hormonal ?
 External radiation ?
 Chemotherapy ?
 Immunotherapy?
Nephroblastoma (Wilm’s tumor)

 Wilm’s tumor or embryonal cell carcinoma

(malignancy from metanephric blastema)
 Pediatric tumor
 Histopathologic picture:
 Favorable
 Unfavorable
Diagnosis
 Clinical picture
 Upper abdominal mass
 Hematuria
 Hypertension
 Imaging
 IVU
 USG
 CT Scan
 DD neuroblastoma  VMA urine
 Stadium  NWTSG
KUB: Ground glass appearance
Right Kidney Left Kidney

USG : Mass on both kidneys

CT Scan : Bilateral Wilms Tumor
Differential diagnosis
Upper abdominal tumor
 Neuroblastoma (adrenal gland tumor)

 Positive result of urine vanyl mandelic acid

 Retroperitoneal teratoma
 Hydronephrosis?
Therapy
 Nephrectomy
+/- Chemotherapy preoperatively
 Chemotherapy (actinomycine D +
vincristine)
 External radiation (radiosensitive tumor)
Transitional cell
carcinoma
 Urinary tract epithelium
consist of transitional cell:
 Pelviocalyceal system
 Ureter
 Bladder
 Proximal urethra

 The most common: bladder

 Multifocal
Diagnosis
 Clinical picture
 Imaging
IVP / RPG: filling defect
USG : mass
CT Scan : mass (T,N, and M)
 Cystoscopy or ureterorenoscopy  biopsy
Therapy
 Depend on stadium
Pyelum / ureter
nephroureterectomy with removal of the bladder
cuff
 Radiation?
 Chemotherapy?
Bladder Carcinoma
 Histopathology:
 Transitional cell carcinoma
 Adenocarcinoma
 Epidermoid carcinoma
 Risk factor
Diagnosis
 Clinical picture:
 Hematuria: total-intermittent-painless
 Suprapubic mass
 Laboratorium: BTA, urine cytology.
 Imaging
 USG
 IVP
 CT scan
 MRI
 Cystoscopy and biopsy
Bimanual
palpation of
bladder tumor
Filling defect
Therapy
 TURT bladder and staging (T)
 Intravesical therapy
 Radical cystectomy
 External radiation
 Chemotherapy (CysCA)
Partial
Cystectomy
Prostatic carcinoma
 The most common urologic malignancy
 Incidence increase because of
 Increase survival life
 Diagnosis tool
 information
 Histopathology: adenocarcinoma
Natural History of Disease
 T: extension tumor through
surrounding organ: bladder, rectum,
seminal vesicle
 N: lymphatic spread
 M: hematogenous spread
 Bone metastasis
 Liver
 Lung
 Brain
Natural history of disease
Hematogenous
spread
Diagnosis
 Anamnesis
 Asymptomatic
 Symptoms not related with urinary system (metastasis)
 Voiding symptoms
 Physical examination
 Pathologic fracture
 Neurological symptom (inferior paraplegia)
 Digital rectal examination (DRE) or Rectal toucher:
prostatic nodule
 Laboratorium: tumor marker (PSA)
 Prostate biopsy
Imaging

 Transrectal ultrasonography (TRUS)

 IVP
 CT Scan
 MRI
 Bone survey: osteoblastic lesion
 Bone scanning
TRUS guided
biopsy
and TURP
Stadium
Gleason grading system
 T
Local

M
Osteoblastic lesion
Therapy
Depend on age and stadium
 Observation
 Radical prostatectomy
 External radiation
 Hormonal therapy
 Surgical (bilateral sub capsular orchidectomy)
 Medicamentosis
 Genetic therapy
Hormonal therapy
 Huygins
androgen prostatic carcinoma

 Prostatic carcinoma
 androgen dependence
 androgen independence
Testicular Carcinoma
 Germinal cell carcinoma:
 Seminoma
 Non seminoma
 Trimodal age: pediatric- young adult- old age
 Most common lymhogenic spread, except: chorio
carcinoma (hematogenous)
 First lymphogenic station: Para aortic lymph node
 Predisposition factor: chryptorchidism
Diagnosis
 Clinical picture
 solid, painless testicular mass
 upper abdominal mass (lymphogenic aortic metastasis)
 Tumor marker: α feto protein, β HCG
 Imaging
 USG
 CT Scan
 MRI
 Histopathology after Tran inguinal orchiectomy
Therapy
Testicular tumor

orchiectomy

Histopathology

Seminoma Non-seminoma
External Radiation
Cytostatic drug
RPLND
Penile carcinoma
 Skin malignancy
 Histopathology: epidermoid carcinoma
 Poor penile hygiene
 Barrier: Buck fascia
 Lesion, ulcer, bleeding
 Lymphogenic spread to inguinal lymh node
Therapy

 Primary lesion
 Circumcision: preputial carcinoma
 Penectomy: total / partial
 Laser Nd:YAG, topical chemotherapy, external
radiation
 Inguinal lymph node: dissection
 Systemic:
Chemotherapy  bleomisine