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UROGENITAl
LOWER
URINARY
TRACT
LOWER URINARY TRACT
=
TRANSITIONAL
EPITHELIUM
=
“URO”THELIUM
MUSCULARIS PROPRIA
TUMORS
• 95% Epithelial (urothelial), 5% mesenchymal,
i.e., mesodermally derived (mostly smooth
muscle)
• Benign or Malignant
• Primarily urothelial or transitional, but a few
squamous, from antecedent squamous
metaplasia, and a few adenocarcinomas,
from antecedent glandular metaplasia
TUMORS
• Benign
–Fibroepithelial Polyp
–Leiomyoma
• Malignant
–Transitional Cell Carcinoma, aka, TCC
–Also called UROTHELIAL Carcinoma
TCC TUMORS
• MULTIPLE, MULTIPLE, MULTIPLE, i.e., “soil”
theory
• Papillomas vs. Carcinomas
• Grading, I, II, III, or wellpoor
• 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
Papillomas vs. Carcinomas
• Very few pathologists will have enough guts to
diagnose a transitional papilloma. Why?
• PUNLMP, Papillary Urothelial Neoplasm of
Low Malignant Potential
– LOW grade PUC (TCC)
– HIGH grade PUC (TCC)
LOW Grade
HIGH Grade
BIOLOGIC BEHAVIOR
NORMAL MUCOSADYSPLASIA, SEVERE DYSPLASIA,
CARCINOMA IN SITU, INFILTRATION BASEMENT
MEMBRANELAMINA PROPRIAMUSCULARIS
MUCOSAMUSCULARIS PROPRIA (i.e.,
WALL)SEROSA or ADVENTITIALYMPH
NODESDISTANT METASTASES
TNM
TNM example:
• Ta----noninvasive, papillary
• Tis---Carcinoma in situ, flat
• T1----Lamina Propria
• T2----Muscularis propria
• T3a---Microscopic beyond the wall
• T3b---Grossly beyond the bladder wall
• T4----Invades adjacent structures
Male
Genital Tract
Diseases
Male Genital Tract
(short version)
–MIXED!!!!!,
60%
TERATOMA
MALIGNANT TERATOMA
TERATOCARCINOMA
clusters of squamous epithelium, hair, 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
SEX Cord Tumors
•Leydig,
tumor cells look
like Leydig cells
•Sertoli ,
tumor cells look
like sertoli cells
STAGING
I
• Stage : Tumor confined to the testis,
epididymis, or spermatic cord
II
• Stage : Distant spread confined to
retroperitoneal nodes below the diaphragm
TNM
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, 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, RECTUM, EXTERNAL SPHINCTER, LEVATOR MUSCLES, OR PELVIC
FLOOR
M0 NO DISTANT METASTASES
M1 DISTANT METASTASES PRESENT
M1a Metastases to distant lymph nodes
M1b Bone metastases
M1c Other distant sites
• Prostate is #1 most common malignancy in men
but NOT #1 killer.
• 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