Genitourinary Neoplasms
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Transcript of Genitourinary Neoplasms
Genitourinary Neoplasms
Neoplasms of GUT
Kidney Bladder Penis
Benign (Rare) Malignant TCC SCC
Should be
considered
Malignant
(if can clinically
recognized)
Adult Children
Renal Cell
Carcinoma
Nephroblastoma
(Wilm’s Tumour )
Benign Kidney Tumours
Fibroma
Adenoma
Villous Papillary Tumour
Angioma
Angiomyolipoma
Tubular Adenoma (Kidney)
Neoplastic Tubular Epithelium
Adenoma (Kidney)
Well Circumscribed Tumour
Nephroblast oma (Wilm’s Tumour)
Constitute 25-30% of Childhood Cancer
Peak age 2-4 y/o
Arise from Primitive Blastema Cells (that may persists in outer part of kidney)
Genetic – Deletion of Short Arm of Chromosome 11
Hereditary
• All Bilateral Wilms
• 1/3rd
of Unilateral Wilms
Clinical Features
Large Abdominal Mass – unilateral or cross the midline when very large
Hematuria – Indicate Tumour has Burst into Renal Pelvis
Pain in Abdomen
Pyrexia
Pulmonary Metastasis
Wilms’ Tumour
Large, Solitary, Well-circumscribed mass
Tumour
Soft, Homogenous, Tan → Gray, Foci of
Hemorrhage, Cystic Degeneration, Necrosis
Wilm’s Tumour
Nests, Sheets of Primitive Blastema
Abortive Tubules
Spindle Cell Stroma
Abortive Glomeruli
Striated muscles or other mesenchymal differentiation
Spread
Blood (Early) → Lungs (common), Liver, Bone
Investigations
AXR, U/S, CT Scan, Pyelography
Treatment
Immediate Nephrectomy, Postoperative Radiotherapy, Chemotherapy
Prognosis
90% Long Term Survival
Renal Cell Carcinoma (RCC)
Clear Cell Carcinoma, Hypernephroma, Grawitz Tumour
Arise from Tubular Epithelium
Occurs in Parenchyma of Kidney
Epidemiology
Most common type of Re nal Cancer
3% of Adult Malignancy
Male ↑
Rare – Age <35 y/o
2 Forms (Structural Alterations of Short Arm of Chromosome 3 – 3p)
Hereditary Non-Here ditary
von Hippel-Lindau (VHL) syndrome
(RCC Develop in 40% VHL Disease)
VHL gene is mutated in ↑ %
Hereditary Papillary Renal
Carcinoma (HPRC)
Familial Renal Oncocytoma (FRO)
Hereditary Renal Carcinoma (HRC)
Risk Factors
Cigarette smoking (25-30% case directly attributable to smoking)
Chronic Haemodialysis
Prolonged Estrogen Administration
(induce Kidney Tumours in Animals, Questionable in Humans)
Phenacetin (contain Analgesics)
Exposure to Asbestos, Cadmium, Gasoline
Patients who develop Cystic Disease
Clinical Features
Intermittent Hematuria
Clot Colic
Dragging Loin Pain
Palpable Renal Swelling
Rapidly developing Vericocele (Male)
Persistent Pyrexia, LOW, LOA
Polycythemia
Hypercalcemia
If Classical Traid
(Carcinoma has Metastasized)
• Hematuria
• Pain
• Palpable Renal Swelling
Renal Cell Carcinoma
Occupies 1 Pole
Well Circumscribed
Limited by Kidney Capsule
Kidney – Adenocar cinoma
(Clear Cell Type)
Cells in Solid Masses
Occur in Acinar Arrangement
Stroma Scanty
Rich in Blood Vessels
Renal Cell Carcinoma
Large Uniform Cells
Abundant Glycogen
Staging for Diagnosis
Cystoscopy Computed Tomography (CT)
KUB Magnetic Resonance Imaging (MRI)
Excretory Urogram (IVP)
(Distortion of Calyces)
Renal Angiography
Bone Scan
Renal Ultrasound
Spread
Local Distant
Medulla of Kidney Blood → Lungs, Bones, Brain, Liver
Renal Vein → IVC Lymphatics
(Renal Capsule Bursts → Node s at
Kidney Hilum → Paraaortic Nodes)
Perinephric Fat
Principles of Treatment
Surgery (Radical Nephrectomy) – Localized Tumour, Renal Vein/ IVC Involved
Radiation – Controversial
Chemotherapy – Ineffective
Immunotherapy
• Lymphocyte Activated Killer (LAK) cells combine d with IL-2
• Alpha Antiferon
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Bladder Carcinoma (Bladder Neoplasm)
Urothelial Origin (95%)
(eg. from Transitional Epithelium)
Common cancer in Malaysia
Benign counterpart – Rare
Villous Papilloma → Transitional Cell Carcinoma
(TCC)
Villous Papilloma is similar to Papillary TCC except
Thicker Epithelium
↑ Numerous Mitoses
Epithelial cells Larger, more Deeply Stained
Villi Stunted – Closely Packed
Surface Ulcerate, Necrotic
Foci of Invasion/ Extension to Lymphatics
Solid TCC – Raised plaque attaches to surface on broad base
TCC – Pathogenesis
Cigarette smokers (2-4X compared to non-smokers)
↑ Risk if exposed to
• Azo dyes
• Pigments used in Textiles, Printing, Plastic, Rubber, Cable Industries
β-naphtylamine, 4-aminobiphenyl, 4-nitrobiphenyl, 4,4-diaminobiphenyl
L-Tryptophan metabolite
Cyclophospha mide
Schistoma Hematobium Infe ction
TCC – Clinical Features
Features
• Intermittent Painless Hematuria
• Urinary Tract Infection if Uretheral Orifice is involved
Staging
• 0 – Carcinoma in situ
• A – Invades Lamina Propria
• B – Involves Muscle
• C – Invades Perivesicle Region
• D – Regional Metastasis
TCC – Macroscopy
Solid Type Papillary Type
Stage
T1 T2 T3 T4
Involve
Subepithelial
Connective Tissue
Infiltrate
Muscle
Infiltrate Full Muscle
Thickness, Mobile
Fixed to
Adjoining
Organs
TCC – Histology
Transitional Cell Carcinomas (90%)
Squamous Cell Carcinomas (5%)
Adenocarcinomas (2%)
Classifications (WHO)\
Grade Growth Pattern
Low (Grade 1, 2) Papillary (70%)
High (Grade 3) Sessile, Pluque (20%)
Nodular (10%)
Microscopy
Grade 1 Grade 2 Grade 3
Management
Investigation Treatment
Urine Exfoliative Cystology Coagulative Diathermy (for small
papillary lesion) Excretory Pyelography
Cystoscopy (should be done on all
cases of hematuria)
Local DXT
Cystectomy
Biopsy
Carcinoma of Penis
Epidemiology
Age 40-70 y/o
Male Malignancies (10-20%) in Africa, Asia, South America
Uncommon – Europe, US, Australasia
Circumcision Protective – Rare among Jews, Muslims
(↓ likelihood of HPV infection due to circumcision)
Causes
Smoking-related Tumour
HPV Detectable in Cancer Cells (50% patients) – Types 16 > 18
• ↓ common than in CIS (Bowen’s disease)
• HPV on its own cannot cause transformation
• Acts in concert with other carcinogenic influences (eg. Cigarette smoke)
Usually Arises on Glans or Inner Surface of Foreskin
Papillary or Flat – Papillary Lesions stimulate condylomata
Squamous Cell Carcinoma
Clinical
Slow Growing, Locally Invasive
Often there for Years before presentation
Classically Painless, unless Ulcerated/ Infected, Often Bleed
Early Nodal Spread (Inguinal/ Iliac), but Wide Dissemination uncommon
Prognosis (depend on Tumour Stage)
Small Lesion, No Nodal Involvement 66% - 5 year Survival Rate
Nodal Involvement 27% - 5 year Survival Rate
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