PATOLOGI TUMOR SISTIM

UROGENITAL
Dr. T. Ibnu Alferraly, SpPA

DEPARTEMEN PATOLOGI ANATOMI

FK UISU
2009
The normal renal cortex contains glomeruli, other vessels, tubules and
interstitium. When evaluating a renal specimen by light microscopy on
an H&E stained section
In the glomerular diagram,
The different colors indicate the
various cell types that are of interest
in assessing the pathologic changes
that occur in a glomerulus
(green = epithelial cells, yellow =
endothelial cells, red = mesangial
cells).
Special stains that often are used in evaluating renal biopsy
specimensI from left to right: PAS, trichrome, H&E, Jones silver stains).
Diagram of a single glomerular capillary and illustrates the ultrastructural
features that are assessed when evaluating renal biopsy specimens.
Electron micrograph that shows a portion of 1 capillary loop with
adjacent mesangium
Much higher magnification electron micrograph.
The urinary space and the foot processes are at the top.
GENERAL CONSIDERATION
Most common tumor is cancer of bladder.
Secondary tumor is renal tumor.

, Renal tumor.

Most renal tumor is malignant tumor.

Clinical common renal tumor is renal

cancer coming from renal parenchyma
nephoroblastoma, papilloma coming from
pelvis and calyx.
TUMOR GINJAL
Jinak : Adenoma Ganas : Karsinoma
Fibroma Tumor Wilms
Myxoma ,dsb Fibrosarcoma,dsb

1.Karsinoma sel ginjal (Renal Cell Ca : tumor Grawitz, hypernephroma, clear

cell carcinoma)
berasal dari epitel tubulus

Makros : - Massa besar, berlobus-lobus

- Massa kuning
- Sebagian bercapsul
- Tampak daerah nekrosis dan perdarahan

Mikros : - Kelompokan sel-sel besar

- Sel dengan sitoplasma jernih
- Clear cell
2. Tumor Wilms : ( Nephroblastoma, Carcinoma )
Biasanya mengenai anak-anak.

Makros : Tumor putih kelabu seperti otak, lemak

Mikros : - Glomelurus abortive
- Stroma spindle
SIGNS AND SYMPTOMS

Hematuria Liver dysfunction

Fever Hypercalcemia

Weight loss Incidental finding of

Erythrocytosis lytic lesions on routine

chest x-ray
RENAL CANCER.

Three symptoms are hematuria, lump and

pain.

1)Hematuria: intermittent, painless gross and all

hematuria. It shows that tumor has invaded though
out renal pelvis and calyx.

2)Lump: when tumor is bigger, lump can be found in

abdomen artery.

3)Pain: dull pain or latent pain in common,but when

blood clot passes through ureter, tant produce renal
colic.
RCC ( Renal Cell Carcinoma )
 In 2003 31,900 new cases
RCC were expected in the
U.S., with 11,900 deaths
attributable to RCC

Classic triad: flank pain,

hematuria, palpable mass

Paraneoplastic syndromes:
erythrocytosis,
hypercalcemia
BACKGROUN
D Higher incidence in cigarette smokers

Associated with Von Hippel Lindau disease, which is caused

by mutations in chromosome 3

Frequently invades renal veins or IVC leading to

hematogenous dissemination

Prognosis (Young, et al 2003)

UCLA researchers described a staging system based on TNM stage,
histologic grade, and performance status

This system predicts the clinical outcome and survival for patients who
had surgical resection of their kidney tumor

Patients are assigned to low-, intermediate-, and high-risk groups based

on these 3 variables
 PROGNOSIS

5 year survival ranges (UCLA):

Nonmetastatic / low-risk = 83.8%

Nonmetastatic / high-risk = 44%

Metastatic / high-risk = 0%
 PROGNOSIS (RATHMELL 2004)
Patients with clear cell RCC had a poorer prognosis
than those with either papillary or sarcomatoid RCC
5-year survival rates:
68.9% clear cell
87.4% papillary
86.7% sarcomatoid

Currently researchers are trying to identify Rx for

each specific subtype of RCC, since the underlying
genetic changes are unique to each subtype
STAGING
Tx Primary tumor cannot be assessed.

TC No evidence of primary tumor.

T1 Tumor less than 7 cms in greatest dimension limited to

the kidney.

T2 Tumor more than 7 cms in greatest dimension

limited to the kidney.

T3 Tumor extends into major veins or invades adrenal

gland or perinephric tissue but not beyond Greotas fascia.
CRITERIA FOR NEPHRECTOMY
> 75% tumor debulking possible

No CNS, liver, or bone mets

Adequate pulmonary and cardiac function

Good performance status

Biopsy with clear cell type

RENAL PELVIS TUMOR

Pelvis, ureter, bladder and urethra are covered by migratory

epithelium.

Pthology: Papilloma of migratory cell. Early phase: metastasis of

lymph tissue.

Clinical manifestations and diagnosis:

1)Age. 40-70 years old, 55yeas old in average, male: female =2:1
2)Intermittent, painless, gross hematuria. Seldom with renal colic.
3)Cell in urine is examed and found cancer cell.
4)Cystoscopy.
5)IVP: filling defect and deformity in renal pelvis.
6)B-ultrosound and CT scan.
Wilms
Tumor
Wilms
Tumor
 BLADDER CANCER

Incidence

There are approximately 55,000 new cases of bladder, ureter and renal
pelvis cancers in the United States with approximately over 13,000
deaths each year.

Epidemiology

Gender
Men have more incidence of bladder cancer than women and
increased incidence in 7th decade of life.

Race
Cancers are more common in whites than blacks 2:1.
ETIOLOGY AND RISK FACTORS

Cigarette smoking
Analgesic abuse
Analgesic compounds, especially Phenacetin, has been
associated with increased risk of bladder cancer
Chronic urinary inflammation
Occupational exposures
Workers with organic chemicals, rubber, paint, and dye
industries have increased risks of urothelial cancers.

Balkan nephropathy
Increase of cancer with renal pelvis and ureters in patients in
Balkan nephropathy, unknown cause that results in progressive
inflammation of the renal parenchyma

Genetic factors
Families with higher risk of transitional cell carcinoma, no genetic
basis has been found as of yet
SIGNS AND SYMPTOMS
Hematuria
Urinary voiding symptoms
Symptoms of advanced disease usually involve swelling in lower
extremities secondary to a lymphatic obstruction
Pain and frank hematuria

Diagnostic Work-up
CT scan
Ultrasound
Intravenous pyelogram
Urine cytology from both ureters at time of cystoscopy
Bone scan
Chest x-ray
PATHOLOGY
Transitional cell carcinoma constitutes 90-95% of
bladder, ureter and renal pelvis cancers.

Squamous cell carcinoma up to 7%

Adenocarcinoma, rare, less than 3%

Adenocarcinoma in the bladder which arises from the dome
is felt to be urachal in origin.

Carcinoma in situ 30% of newly diagnosed bladder

cancer with multiple sites of bladder involvement
TNM STAGING

TX Definition Primary tumor cannot be

assessed

T10 No evidence of primary tumor

TA Noninvasive papillary tumor

Tis Carcinoma in situ flat tumor

T1 Tumor in wedge
Subepithelial connective tissue

T2 Tumor in wedge muscle

T2a tumor in wedge, superficial
muscle, inner half
T2a tumor in wedge, deep
muscle, outer half
PROGNOSTIC FACTOR

Lesions up to T1, especially TA, without carcinoma in situ have 95%

survival rate whereas those with high grade T1 lesion have a 10-
year survival rate of 50%.

Muscle invasive carcinoma 5-year survival rates are 20-50%. With

regional lymph node involvement 5-year survival rate is 0-20%.