Tumors of Urinary System PDF

Tumor of urinary system By Prof. Dr. Ahmed Rabie M.B., B.Ch. M.D..  TUMORS OF THE BLADDER I) EPITHELIAL BLADDER TUMORS A) UROTHELIAL (TRANSITIONAL) TUMORS: Flat lesion: Urothelial (transitional) cell carcinoma in situ Nonpapillary urothelial (transitional)...

Tumor of urinary system By Prof. Dr. Ahmed Rabie M.B., B.Ch. M.D..  TUMORS OF THE BLADDER I) EPITHELIAL BLADDER TUMORS A) UROTHELIAL (TRANSITIONAL) TUMORS: Flat lesion: Urothelial (transitional) cell carcinoma in situ Nonpapillary urothelial (transitional) cell carcinoma Papillary lesions: 1. Inverted papilloma (benign) 2. Transitional cell papilloma (benign) 3. Papillary carcinoma, low grade 4. Papillary carcinoma, high grade  TUMORS OF THE BLADDER B) SQUAMOUS TUMORS: Arise on top of squamous metaplasia or from female bladder trigone Squamous papilloma (Condyloma) Squamous carcinoma in situ Squamous cell carcinoma Verrucous squamous carcinoma C) GLANDULAR TUMORS: Arise from urachus or on top of glandular metaplasia (cystitis glandularis) Villous adenoma (resembling that of colon) Adenocarcinoma  TUMORS OF THE BLADDER II) NONEPITHELIAL BLADDER TUMORS BENIGN: leiomyoma, paraganglioma MALIGNANT: a)Sarcomas as leiomyosarcoma, rhabdomyosarcoma, angiosarcoma & others. b)Lymphoma. III) SECONDARY TUMORS a) Direct spread from cancer prostate, rectum or uterine cervix b) Transluminal implantation from transitional carcinoma of pelvis or ureter.  CARCINOMA OF THE URINARY BLADDER - The most common tumor of Egyptian males due to bilharzial cystitis However it may arise also in non-bilharzial bladder. - It is less common in females. - In Egypt bladder cancer is of two types: BILHARZIAL CARCINOMA NONBILHARZIAL CARCINOMA CARCINOMA OF THE URINARY BLADDER BILHARZIAL CARCINOMA NONBILHARZIAL CARCINOMA Age Relatively younger: 30-50 years. Usually above age of 50 years PREDISPOSING FACTORS 1-Bilharzial urothelial precancerous 1-Transitional papilloma. lesions as: cystitis glandularis. squamous 2-Chemical carcinogens as aniline dye metaplasia. leukoplakia and dysplasia. 3-Stones leading to squamous metaplasia. 2-tryptophan metabolites released from 4- Smoking. the worms into the blond & excreted in urine are carcinogenic CARCINOMA OF THE URINARY BLADDER BILHARZIAL CARCINOMA NONBILHARZIAL CARCINOMA Gross 1-NON PAPILLARY TYPES (more 1-PAPILLARY PATTERN (common). common): 2-NON PAPILLARY TYPES : a)Fungating polypoid pattern. a)Fungating polypoid pattern. b) Ulcerative pattern (describe). b) Ulcerative pattern (describe). c) Infiltrative pattern. c) Infiltrative pattern. 2-PAPILLARY PATTERN (less common). CARCINOMA OF THE URINARY BLADDER BILHARZIAL CARCINOMA NONBILHARZIAL CARCINOMA Microscopic 1-Squamous cell carcinoma (common) : 1-Transitional carcinoma (commonest) classical of rarely verrucous types a) Papillary TCC (better prognosis) 2-Transitional cell carcinoma (TCC) b) Nonpapillary TCC a) Nonpapillary TCC Papillary TCC 2-Adenocarcinoma (rare). 3-Adenocarcinoma (rare). 3-Squamous cell carcinoma (Rare)  CARCINOMA OF THE URINARY BLADDER BILHARZIAL NONBILHARZIAL CARCINOMA CARCINOMA EFFECTS AND COMPLICATIONS 1-Spread: Direct: To prostate, seminal vesicles, ureters, rectum, vagina Lymphatic to iliac and para-aortic lymph nodes Blood: Late to lungs, liver, bone.. 2-Urinary Obstruction (hydroureter, hydronephrosis, retention of urine, renal failure). 3- Infection (cystitis, pyelonephritis, pyoureter, pyonephrosis). 4-Haematuria. 5-Fistula Formation; with rectum or vagina due to direct spread.  T.N.M. STAGING OF BLADDER CARCINOMA: T (Tumor)Tis: Noninvasive flat tumor (carcinoma insitu). Ta: Noninvasive papillary carcinoma. T1: Invasion to lamina propria. T2: Invasion of musculosa. T3: Invasion of perivesical fat T4: Contiguous spread to adjacent organs. N (lymph nodes) NO: negative LN N1: Single LN< 2 cm N2: Single LN 2-5 cm or multiple LNs‹ 5 cm N3:Any LN > 5 cm. M (Distant metastases) MO: No evidence. M1: Evidence of distant metastases  TUMORS OF KIDNEY& RENAL PELVIS PRIMARY TUMORS: 1- Tumors of Pelvis: A)Benign Tumors: a) Transitional papilloma & inverted papilloma.. b) Hemangioma (capillary or cavernous). c) Leiomyoma., neurofibroma B)Malignant Tumors: a) Transitional cell carcinoma b) Squamous cell carcinoma  2-Tumors of Kidney A) Benign Renal Tumors: a) Cortical Adenoma: It is a benign tumor Well circumscribed, round, yellowish nodule in the cortex., usually 2 cm or less in diameter. It may change into carcinoma b) Oncocytoma: It is a benign tumor derived from proximal tubular cells and may reach a large size. Grossly have central scar. Microscopically, it consists of tumor cells having eosinophilic cytoplasm (oncocytes). c) Angiomyolipoma: Hamartoma which may reach large size, composed of mature adipose tissue, smooth muscle cells and abnormal blood vessels. Usually occurs in association with tuberous sclerosis (epilepsy, mental retardation & sebaceous adenoma of skin). d) Others: as hemangioma,, lymphangioma, lipoma.  2-Tumors of Kidney B) Malignant Renal Tumors: a)Wilm's tumor (Nephroblastoma, Embryoma). b)Renal cell carcinoma (hypernephroma). c)Sarcomas & lymphoma. SECONDARY (METASTATIC) TUMORS: These are uncommon tumors which may reach the kidney by 1-Blood spread from distant malignant tumors and from myeloma and leukemia 2-Direct or lymphatic spread from adrenal glands, pancreas & colon.  RENAL CELL CARCINOMA (HYPERNEPHROMA) Renal cell carcinoma (RCC) accounts for about 3% of adult malignancy The peak incidence is in the sixth decade of life Gross appearance: Most tumors arise in pole of the kidney, upper or lower. The tumor finally invades the renal parenchyma and renal pelvis Tumor ranges in length >2 →30 cm, Cut section is typically irregular bulging and yellowish (due to high lipid & glycogen content of tumor cells). hemorrhage & necrosis are common.  RENAL CELL CARCINOMA (HYPERNEPHROMA) Microscopic appearance: 1- Clear cell type: This is the most common type. Tumor cells show vacuolated clear cytoplasm (due high content of lipids & glycogen) 2- Papillary type: Tumor cells forming papillary projections. 3-chromophobe cell type: Cells show abundant acidophilic granular cytoplasm. 4- Sarcomatoid type: least common variant, formed of undifferentiated spindle epithelial cells; thus resembling sarcoma. 5-Renal medullary carcinoma: An extremely rare tumor, centered in the renal medulla, arising in young black patients with sickle cell disease  RENAL CELL CARCINOMA (HYPERNEPHROMA) Spread: 1-Direct to renal pelvis, renal vein. perinephric tissue and surrounding structures. 2-Lymphatic: Para-aortic nodes. 3-Blood: to lungs (commonly causing cannon ball metastases), bones & others. Clinical features: 1-Painiess hematuria 2-Loin pain 3-Palpable loin mass 5-It may remain clinically occult and manifest by metastatic disease, NEPHROBLASTOMA (WILM'S TUMOR) : - The commonest embryonic tumor in infancy and childhood. - in children under 15 years of age. - In 6% of cases the tumor is bilateral. - One third of tumors are hereditary. Gross picture: Most tumors are large. Cut surface, is demarcated, non capsulated, whitish & fleshy Hemorrhage& necrosis are common. NEPHROBLASTOMA (WILM'S TUMOR) : Microscopic picture: Classically the tumor is triphasic consists of: 1-Small undifferentiated blastemal cells. 2-Epithelial cells arranged in primitive tubules or glomeruloid structures 3- Mesenchymal elements which may be spindle cells fibrous stroma Spread: 1-Direct to perinephric tissue and surrounding structures. 2-Lymphatic: Para-aortic nodes. 3-Blood: Lungs, bone, others.  STAGING OF RENAL TUMORS Staging of RCC (TNM Staging): T1- Tumor limited to kidney ≤ 7 cm T2 Tumor limited to kidney >7 cm TЗa Perinephnic or adrenal gland invasion T3b Invasion of renal vein or vena cava T3c Extension to vena cava above diaphragm T4 Tumor invades beyond Gerota fascia NO: Negative nodes N1 single node N2 2 or more MO: no distant metastases M1: distant metastases Thank you