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TUMOR-TUMOR PADA SALURAN KEMIH DAN ALAT KELAMIN PRIA Dr.Delyuzar Sp.PA (K) Dr.T.Kemala Intan M.Pd.

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Presentasi berjudul: "TUMOR-TUMOR PADA SALURAN KEMIH DAN ALAT KELAMIN PRIA Dr.Delyuzar Sp.PA (K) Dr.T.Kemala Intan M.Pd."— Transcript presentasi:

1 TUMOR-TUMOR PADA SALURAN KEMIH DAN ALAT KELAMIN PRIA Dr.Delyuzar Sp.PA (K) Dr.T.Kemala Intan M.Pd

2 TUMOR GINJAL

3 Jenis-jenis Renal cell carcinoma Conventional RCC Chromophobe RCC Tubulopapillary RCC Bellini’s duct RCC Transitional cell Ca Grade berdasarkan: Fuhrman nuclear grade :

4 Renal Cell Carcinoma /Grawitz

5 Clear Cell Ca Renal

6 WILM’S TUMOUR Wilms tumor (WT) = Nephroblastoma Keganasan ke-5 pada anak-anak. Setelah usia 3 tahun >>> setelah usia 8 tahun <<< Pada satu atau kedua ginjal. Massa besar di abdomen anak 1-5 tahun curiga Wilms Tumor.

7 Massa ginjal padat dengan / tanpa hematuria. Kdg cystic, nekrosis fokal dan degenerasi. Orang dewasa dx preop cukup sulit Agresif metastase Responsif terhadap pemberian terapi. Angka kesembuhan hampir 90%.

8 PEMERIKSAAN GROSS Besar (berat gram) Bentuk ginjal terdistorsi. Penampangnya halus, mengkilat dan sering berbentuk lobulated berwarna putih keabuan (tampak seperti otak). Area perdarahan dan nekrosis (+) Dapat multifokal.

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11 Pemeriksaan Gross Perhatian : kapsul ginjal, pembuluh darah, ureter, KGB pelvis. Pewarnaan kapsul sebelum fiksasi dan insisi cegah over dx keterlibatan invasi kapsular.

12 HISTOPATOLOGI Nephroblastoma klasik triphasik hanya satu elemen dominan. (> 65%) blastema epithelium mesenkim

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14 Mucinous epithelium in Wilms’ tumor.

15 Microscopic appearance of Wilms’ tumor. A, Low-power microscopic view showing a combination of blastema, stroma, epithelial tubular formation, and immature glomeruli. B, High-power view showing blastema, stroma, and immature tubular formations.

16 TUMOR VESICA URINARIA

17 Jinak : Papilloma, jarang,berasal dari epithel transisional  mudah cepat menjadi karsinoma Ganas: Karsinoma,terbanyak, jarang berasal dari bukan epithel Gejala klinik:Hematuria tanpa rasa sakit Teori etiologi:Kimia,gangguan metabolisme,radang, parasit (s.Hematobium)

18 Cara Pertumbuhan: 1.Bentuk Papiler: a.tanpa tanda infiltrasi yang jelas,b.dengan tanda infiltrasi yang jelas 2.Bentuk datar dengan tanda-tanda infiltrasi 3.Bentuk ulcus dengan tanda-tanda infiltrasi 4.Tanpa bentuk menonjol/ulcus yang jelas, dgn tanda infiltrasi tidak jelas, tapi dinding menebal dan cepat metastasis

19 Jenis-Jenis Karsinoma V.U 1.Bentuk Transisional Karsinoma (90%) 2.Bentuk Epidermoid Karsinoma 3.Bentuk Adenokarsinoma 4.Bentuk Campuran 5.Bnetuk Undifferentiated

20 Bladder: Urothelial Carcinoma, Transitional Cell Carcinoma Note: papillary, invasive and friable.

21 Transisional Karsinoma V.U

22  Makroskopis Tumor berwarna pink muda, dan mempunyai gbrn papillary yang sebagian besar berbentuk pedunkulated. Nekrosis sgt jarang dijumpai  Mikroskopis Gbrn papil-papil yg tdd fibrovasculare core disentral dgn dilapisi epitel transisional yg identik dengan sel bladder yg normal. Mitosis sgt jarang bahkan kadang-kadang tidak ada GRADE I

23  Makroskopis Tumor tampak seperti pedunkulated maupun sessile, Nekrosis jarang dijumpai. Konsistensi lebih padat ataupun solid dan kenyal  Mikroskopis Masih tampak gbrn papillary tetapi lebih banyak dan sel-sel lebih berlapis dengan inti membesar, dan hiperkromatin. Mitosis sel lebih sering dijumpai GRADE II

24  Makroskopis Lebih banyak berbentuk sessile, seperti bunga kol. Nekrosis dan ulserasi lebih sering dijumpai  Mikroskopis Tampak gbrn papillary, tetapi sudah tersusun secara ireguler. Sel-sel ganas membentuk kelompokan-kelompokan kecil dan sel-sel yang mitotik lebih sering dijumpai GRADE III

25 Kedalaman Infiltrasi karsinoma (stadium) Stage: 0=Karsinoma terbatas pada epitel A=Karsinoma sampai dengan sub mukosa B=Karsinoma sampai dengan lapisan otot C=Karsinoma sampai dengan jaring- an lemak perivesikel D=Karsinoma sampai ke kelenjar limfe (keluar dari V.U)

26 Menegakkan Diagnosa: 1.Sitologi Urine 2.Cystoscopy 3.Radiologi

27 TUMOR PENIS

28 Epidemiology & Risk Factors Carcinoma of the penis accounts for less than 1% of cancers among males in the United States. Penile carcinoma may compose 10-20% of all malignant lesions. Penile carcinoma occurs most commonly in the sixth decade of life. The one etiologic factor most commonly associated with penile carcinoma is poor hygiene.

29 PATHOLOGY  Precancerous Dermatologic Lesion  Carcinoma in Situ  Invasive Carcinoma of the Penis

30 Precancerous Dermatologic Lesion ♪ Leukoplakia ♪ Balanitis xerotica obliterans ♪ Giant condylomata acuminata

31 LEUKOPLAKIA £ Leukoplakia is a precancerous disorder that's characterized by white, scaly patches on the glans and prepuce accompanied by skin thickening and occasionally fissures. £ Leukoplakia is a rare condition that most commonly occurs in diabetic patients.

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33 BALANITIS XEROTICA OBLITERANS ☺Balanitis xerotica obliterans is a white patch originating on the prepuce or glans and usually involving the meatus. ☺Microscopic examination reveals atrophic epidermis and abnormalities in collagen deposition.

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36 GIANT CONDYLOMATA ACUMINATA ¤ Giant condylomata acuminata are cauliflowerlike lesions arising from the prepuce or glans. ¤ The cause is believed to be viral HPV. ¤ These lesions may be difficult to distinguish from well-differentiated squamous cell carcinoma.

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42 HISTOPATOLOGY GIANT CONDYLOMATA ACUMINATA

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44 CARCINOMA IN SITU § Bowen Disease § Erythroplasia of Queyrat

45 BOWEN DISEASE € Bowen disease is a squamous cell carcinoma in situ typically involving the penile shaft. € Bowen's disease is a painless, premalignant lesion that commonly occurs on the penis or scrotum. € It appears as a brownish red, raised, scaly, indurated plaque with well-defined borders, which may ulcerate at its center.

46 BOWEN DISEASE

47 ERYTHROPLASIA OF QUEYRAT ¥ Characteristic lesions of EQ are solitary or multiple erythematous plaques. ¥ The texture can be smooth, velvety, scaly, or verrucous. ¥ Ulceration or distinct papillomatous papules within a plaque may indicate progression to invasive squamous cell carcinoma. ¥ Microscopic examination shows typical, hyperplastic cells in a disordered array with vacuolated cytoplasm and mitotic figures.

48 ERYTHROPLASIA OF QUEYRAT

49 SIGNS AND SYMPTOMS  Early signs of penile cancer include a small lesion, a pimple, or a sore on the penis.  The symptoms, such as pain, hemorrhage, dysuria, purulent discharge, and obstruction of the urinary meatus.

50 Diagnosis ø Diagnosis of penile precancer requires a tissue biopsy. ø CONFIRMING DIAGNOSIS Preoperative baseline studies include complete blood count, urinalysis, an electrocardiogram, and a chest X-ray.

51 TREATMENT Depending on the stage of progression. Treatment includes surgical resection of the primary tumor and, possibly, chemotherapy and radiation. Local tumors of the prepuce only require circumcision.

52 Karsinoma Penis Karsinoma sel skuamosa tampak sebagai lesi papular, abu-abu, berkrusta paling sering di glans penis atau prepusium

53 Kurang dari 1% kanker pada laki-laki Karsinoma menginfiltrasi jaringan ikat dibawahnya dan membentuk lesi keras yang mengalami ulserasi dengan batas iregular

54 SQUAMOUS CELL CARSINOMA PENIS ATROPHY

55 HYPERKERATOSIS

56 MIKROSKOPIS CA PENIS

57 Symptom dan Sign Lesi pada glans penis atau preputium Leukoplakia diikuti pembentukan papula putih yang meninggi Pembengkakan kelenjar lymph regional (inguinal) Diagnosa Biopsi

58 Faktor Resiko Usia > 40 tahun Sirkumsisi Higien Kontak seksual HPV

59 Treatment KemoterapiPenektomi Radiasi

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61 TUMOR PROSTAT

62 Divide into several regions:  Peripheral zone  Central zone  Transitional zone  Periurethral zone Prostate Gland…

63 Microscopic feature of prostate Stroma: Abundant and continuous with the gland capsule, it constitutes one third to one fourth of the gland volume and is composed of fibroelastic connective tissue intermixed with smooth muscle fibers. Glands are embedded in the stroma. Tubuloalveolar glands: Irregular, large lumen, widely spaced tubules with alveolar extensions, which vary greatly in shape and size. Epithelial lining in tissue sections is simple cuboidal to columnar in shape, depending upon physiological state. Prostatic concretions: Corpora amylacea, acidophilic condensed secretions of prostatic glands. They may be lamellated and increase in number with advancing age. Source of prostatic calculi.

64 Normal prostate

65 Benign Prostate Hyperplasia Hyperplasia = Benign = (Redundant & Misnomer) BPH is characterized by proliferation of both epithelial and stromal elements BPH rarely causes symptoms before age 40, but more than half of men in their sixties and as many as 90 percent in their seventies and eighties have some symptoms of BPH (prostate enlargement is as common a part of aging as gray hair)

66 MORPHOLOGY… Benign Prostate Hyperplasia

67 Macroscopic features of BPH BPH arises most commonly in the inner, periurethral glands of the prostate The affected prostate is enlarged (>300g in severe cases) The cut surface contains multiple, fairly well circumscribed nodules, which bulge from the cut surface The nodules may have a solid appearance, or they may contain cystic spaces (the latter corresponding to dilated glandular elements seen in histologic sections) The urethra is usually compressed by the hyperplastic nodules

68 Normal prostate and benign prostatic hyperplasia (BPH). - A normal prostate does not block the flow of urine from the bladder. - An enlarged prostate presses on the bladder and urethra and blocks the flow of urine.

69 Prostate hyperplasia Severe prostatic hyperplasia (arrows) with bladder neck obstruction and bladder calculi. Note the 4 bladder stones.

70 The prostate is on the bottom, and the bladder, with its front opened, is on top. You can see the enlarged central lobe of the prostate gland protruding into the bladder cavity. The prostate gland obstructed outflow from the bladder, forcing the bladder wall to become thicker and stronger

71 Microscopic features of BPH Proliferation of glands. Hyperplastic stromal muscle Glands larger than normal Papillary ingrowth.

72 Prostate hyperplasia

73 BPH Notice the large number of complex, infolded glands Notice that its epithelium is infolded. Even within the glands, the cells are too numerous

74 Prostat”Chips”

75 Adenocarcinoma Prostat

76 Adenocarcinoma w /Large Nuclei Cell

77 Immunoperoxidase Stain For Adeno Ca Prostat

78 At Low Magnification(Needle Biopsy)

79 TUMORS OF THE TESTIS

80 HISTOLOGY OF THE NORMAL TESTIS

81 HISTOGENESIS OF TESTICULAR TUMORS Hitogenesis of testicular tumors

82 SEMINOMA OF THE TESTIS Macroscopic Frequency : 40 % of the testis neoplasms Location : Testis Size : 1.7 x 1.7 x 1.9 cm Characteristic : Well- circumscribed, white- tan, firm mass Operative procedure : Orchiectomy

83 Microscopic Polygonal cell uniform Infiltrating lymphocyte in stroma Fibrosis stroma Circular nucleus with pure cytoplasma and clear membran cells

84 TERATOMA OF THE TESTIS Macroscopic Frequency : 7-10 % of the testis neoplasms Tumor location : Testis Tumor size : 2.5 cm diameter Tumor characteristics : Firm, whitish, ovoid mass with discrete yellow and grey areas Operative procedure : Orchiectomy

85 Microscopic Well-differentiated of nervous, muscle, chondrosit, fat, squamous cell and bronchus epithelium Irregular forms Diffuse small glands

86 EMBRYONIC CARCINOMA Frequency : % of testis neoplasms Macroscopic : smaller than seminoma, white-gray, nodules shape, hemorrhagic and necrosis Microscopic : low differentiated with tubular and papillary forms, pleomorphic cells with few stroma, uninfiltrating lymphocyte, invasive

87 CHORIOCARCINOMA Frequency : 1 % of testis neoplasms Characteristic : Pleomorphic cell with large nucleus Cytotrophoblast with cuboidal cell epithelium Syncitiotrophoblast with syncitium epithelium Bad prognosis

88 MIXED GERM CELL TUMOR OF THE TESTIS Macroscopic Frequency : 40 % of the testis tumors Tumor location : Testis Tumor size : 2.3 x 1.6 x 2.5cm Tumor characteristics : Red-tan nodular mass with grey-white cysts filled with light brown, viscous fluid Operative procedure : Orchiectomy

89 Microscopic Pleomorphic cell Papillary Irregular forms Low differentiated of nervous, muscle, and fat

90 TERATOCARCINOMA OF THE TESTIS Macroscopic Tumor location : Testis Tumor size : 4.9 x 2.6 x 1.9 cm Tumor characteristics : Well-circumscribed, septate mass with a white-tan cut surface Operative procedure : Orchiectomy

91 Microscopic

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