MALE GENITAL AND

KIDNEY TUMORS
Anatomy of the male pelvic region
Congenital

Bladder exstrophy Diverticulum

 Cystitis

Secondary to infection of the lower urinary tract

Factors: age, sex, bladder calculi, bladder outlet
obstruction, DM, immunodeficiency,
instrumentation/ catheterization,
radiation/ chemo therapy
Coliform bacteria, pseudomonas etc
Schistosomiasis---- squamous cell carcinoma
Schistozomiasis Squamous cell ca
 Malakoplakia of the bladder

Multiple nodular thickenings of the mucosa and sub-mucosa,

in the region of the trigone
May be mistaken for a carcinoma
Associated with Immune deficiency states, renal transplant
recipient
Micros: histiocytes with granular acidophilic cytoplasm
accumulate beneath the surface epitheluim.
Michaelis-Gutmann bodies: intracytoplasmic inclusions
Positive :PAS, Iron, Calcium staining
Bacterial identification : gram negative colliform bacilli
Malakoplakia of the bladder
Amiloidosis of the bladder
 IV. BLADDER NEOPLASMA
Ganas > 90% berasal dari urotelium dalam
sekwen hiperplasi (>7 lapis) displasia
karsinoma in situ karsinoma invasif
Sering hematuria tanpa nyeri
Jenis:
- Jinak: papiloma
- Ganas: A. Ca sel transisional, B. Ca sel
skuamosa, C. adenokarsinoma
 Papilloma
Discrete exophytic growth with central
fibrovascular core lined by urothelium of
normal thickness and cytology
Delicate papillae
Normal organisation of cells
Normal nuclear size and shape
Fine chromatin, no nucleoli
No mitoses
Umbrella cells present
papilloma of the urinary bladder
papilloma of the urinary bladder
Papilloma

Exophytic type Inverted type

 Dysplasia: Low-grade
intra-urothelial neoplasia

Appreciable cytologic and architectural changes to be

called neoplastic, but falling short of the threshold
for CIS
 Carcinoma in situ
High-grade intra-urothelial neoplasia
Flat lesion that is the precursor of
invasive carcinoma in some cases
Presence of cells with large, irregular,
hyperchromatic nuclei
Often mitotic activity, often in mid and
upper urothelium
 Carcinoma in situ
High-grade intra-urothelial neoplasia
Papillary carcinoma of the bladder
IV. A. Karsinoma Sel Transisional

Lebih banyak pada pria, usia pertengahan

Etiologi: lingkungan misanya merokok, industri
(anilin), metabolit triptofan, parasit, iritasi mekanik
(batu, divertikuli)
Sampai dengan 70%: papilar, non-invasif, low-grade
Grading hitologik penting untuk menentukan
prognosis:
- Grade I: stroma fibrovaskular dikelilingi kelompok sel
transisional uniform, papilar, lapisan sel 7-10 lapis sel
- Grade II: konfigurasi sel makin tak teratur, lapisan
15-20, atau lebih, mitosis, inti hiperkromatik
- Grade III: sel lebih padat, atipia dan mitosis banyak,
nekrosis dan ulserasi.
MALIGNANT TUMOR OF THE BLADDER
Pathology

Transitional cell carcinoma 90%

Squamous cell carcinoma 5%

Adenocarcinoma <2%

Rhabdomyosarcoma <1%
Transitional cell carcinoma of the bladder
Etiology

Chemical compounds
naphtalamine
benzidine
smoking
phenacetine

Parasites
schistosomiasis

Chronic irritation
infection
irradiation
Transitional cell carcinoma of the bladder
Symptoms

Gross, macroscopic, painless haematuria

Frequency, urge, dysuria

Weight loss, palpable mass

Flank pain, lymphedema
Transitional cell carcinoma of the bladder
Diagnostic

Urinalysis
Sediment Cytology
Low-grade transitional cell ca
Fused, branching and delicate papillae
Predominantly ordered organisation, but
minimal crowding and loss of polarity, any
thickness, cohesive
Enlarged, variable nuclei
Round-oval nuclear shape with variations
Chromatin varies within and between cells
Usually inconspicuous nucleoli
Occasional mitoses at any level
Usually umbrella cells present
transitional cell carcinoma, low grade
Transitional cell ca, low grade
Transitional cell Ca, high grade
Fused, branching, delicate papillae
Loss of polarity, any thickness, often
dyscohesive
Nuclei enlarged with variation in size
Pleomorphism
Hyperchromasia and variations in and
between cells
Nucleoli prominent
Usually mitoses at any level
Umbrella cells may be absent
Transitional cell ca , high-grade
Proliferation marker (KI 67)
Invasive neoplasm
Nested type of transitional cell carcinoma
 Transitional cell carcinoma of the bladder

Superficial

Muscle invasive
 MALE
MALE
REPRODUCTIVE
REPRODUCTIVE
SYSTEM
SYSTEM
Male Reproductive Organs

Penis
Testis
Prostate
 Neoplasm
Neoplasm
1. Carcinoma in situ: Bowen disease
- usually presents as a single erythematous plaque, most
often on the shaft of penis or on the scrotum
- predominantly affects uncircumcised men
- has peak incidence after the fifth decade
- evolve into invasive carcinoma in less than 10%
2. Carcinoma
- Most frequently SCC
- is rare in circumcised men
- si predisposed by poor personal hygiene and veneral
disease
- often associated with HPV type 16, 18, 31, 33 infection
 Bowens disease

Carcinoma in situ of the penis, with intact basement

membrane
Higher magnification demonstrating cellular atypia, with
occasional mitosis and lack of normal maturation
PENIS: SQUAMOUS CELL CARCINOMA
Squamous cell carcinoma

The glans penis is

deformed by a firm,
ulcerated, infiltratif
mass
Squamous Cell Ca, non-keratinizing
 TESTES
TESTES
Developmental anomalies
Inflammations
Neoplasms
Scrotal masses
Epididymal cyst
Diagram of a spermatocele.
Idiopathic
obstruction of the
epididymal ducts
is one
hypothesis that
explains the
formation of
spermatoceles
Intraoperative view of spermatocele with
adjacent testicle and spermatic cord
 Spermatocele
after complete excision.
Spermatocele
Seminoma of the Testis

A fairly well
circumscribed, pale,
fleshy, homogeneous
mass

Large cells with distinct

cell borders, pale nuclei,
prominent nucleoli,
sparse lymphocytic
infiltration
Embryonal carcinoma

In contrast to the
seminoma, this tumor
is bulky, hemorrhagic
mass

Primitive
hyperchromatic cells
that form sheets and
occasional glands
 Choriocarcinoma

The tumor contains cytotrophoblastic and

syncytiotrophoblastic elements which elaborates hCG
 TESTICULAR TERATOMA

The tumor contains mature cells from endodermal

(glandular), mesodermal (cartilaginous), and ectodermal
(squamous) epithelial elements.
Intratubular germ cell neoplasia (ITGCN)

Normal Neoplastic
Seminoma testis
Seminoma testis
Nonseminomatous germ cell tumor
 NSGCT

Embryonal carcinoma component

 NSGCT

Cartilaginous component
 NSGCT

Yolk sac component

 NSGCT

Choriocarcinoma component
Mature Teratoma
Yolk sac tumor
Leydig cell tumor

Reinke crystal
Sertoli cell tumor
Features of testicular tumors