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Pathology - Scrotal disorders
Epidermoid cysts are a common source of scrotal cutaneous lumps, characterized by yellow keratinous debris and squamous epithelium with epidermoid-type keratinization.
Scrotal calcinosis is a rare condition that causes numerous calcified nodules on the scrotal skin. The dystrophic calcification is likely caused by ancient epidermoid cysts.
Angiokeratomas are benign vascular lesions that appear as several tiny blue/red lesions on the scrotal skin. Histologically, they are made up of dilated vascular channels in the papillary dermis, accompanied by hyperplasia and hyperkeratosis of the epidermis.
Fournier’s gangrene • Diabetes and immunosuppression are the main risk factors for this clinical variant of necrotizing fasciitis which affects the penis, scrotum, perineum, and abdominal wall of men. • It is a polymicrobial infection caused by a mix of aerobic and anaerobic bacteria. • Histology reveals a severe necrotizing inflammatory process involving the skin and deep subcutaneous tissue. • Mortality rates range from 15-20%.
Scrotal squamous cell cancer. • A uncommon cancer that has historically been linked to occupational exposure to toxins among chimney workers.
Epidermoid cysts are a common source of scrotal cutaneous lumps, characterized by yellow keratinous debris and squamous epithelium with epidermoid-type keratinization.
Scrotal calcinosis is a rare condition that causes numerous calcified nodules on the scrotal skin. The dystrophic calcification is likely caused by ancient epidermoid cysts.
Angiokeratomas are benign vascular lesions that appear as several tiny blue/red lesions on the scrotal skin. Histologically, they are made up of dilated vascular channels in the papillary dermis, accompanied by hyperplasia and hyperkeratosis of the epidermis.
Fournier’s gangrene • Diabetes and immunosuppression are the main risk factors for this clinical variant of necrotizing fasciitis which affects the penis, scrotum, perineum, and abdominal wall of men. • It is a polymicrobial infection caused by a mix of aerobic and anaerobic bacteria. • Histology reveals a severe necrotizing inflammatory process involving the skin and deep subcutaneous tissue. • Mortality rates range from 15-20%.
Scrotal squamous cell cancer. • A uncommon cancer that has historically been linked to occupational exposure to toxins among chimney workers.
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Pathology -Benign vulval tumours
Bartholin duct cysts
• Arise due to obstruction of a Bartholin’s gland duct.
• Present as painless lumps of the vulva in young women.
• Histologically, they are lined by transitional-type epithelium with areas
of squamous metaplasia.
Papillary hidradenoma
• Benign sweat gland tumour which usually presents in middle-aged
women as a small painless vulval lump.
• Histologically, they are well-circumscribed papillary tumours of the
dermis. The epithelium covering the papillae is double-layered, with
inner tall columnar cells and outer small myoepithelial cells.
Condylomas
• Solitary or multiple lesions related to certain types of human papilloma
virus (HPV) infection.
• Histologically, they show papillary squamous proliferations with
koilocytes (keratinocytes showing HPV cytopathic effect).
• Widespread vulval condylomas may be seen in the immunosuppressed
.
Granular cell tumour
• Uncommon neural tumour that may occur in the vulva.
• Histologically composed of nests of large polygonal cells with abundant
granular cytoplasm.
• The vast majority behave in a benign fashion.
Angiomyofi broblastoma
• Benign mesenchymal neoplasm that occurs almost exclusively in the
vulvovaginal region of young women.
• Presents as a small subcutaneous lump, often mistaken for a cyst.
• Histologically, they are well-circumscribed lesions composed of dilated
capillary-sized vessels set in an oedematous stroma containing many
plump epithelioid stromal cells.
Cellular angiofi broma
• Benign mesenchymal neoplasm presenting as a small painless
subcutaneous mass in the vulvovaginal region of reproductive age
women.
• Histologically, they are well-circumscribed cellular lesions composed of
bland spindle cells and many small thick-walled blood vessels.
Deep angiomyxoma
• Locally infi ltrative, but non-metastasizing, mesenchymal neoplasm that
presents as a large deep-seated mass in the pelvis and perineum of
reproductive age women.
• Histologically, they are infi ltrative, paucicellular tumours composed of
small numbers of bland spindle cells set in a myxoid stroma containing
thick-walled blood vessels
Bartholin duct cysts
• Arise due to obstruction of a Bartholin’s gland duct.
• Present as painless lumps of the vulva in young women.
• Histologically, they are lined by transitional-type epithelium with areas
of squamous metaplasia.
Papillary hidradenoma
• Benign sweat gland tumour which usually presents in middle-aged
women as a small painless vulval lump.
• Histologically, they are well-circumscribed papillary tumours of the
dermis. The epithelium covering the papillae is double-layered, with
inner tall columnar cells and outer small myoepithelial cells.
Condylomas
• Solitary or multiple lesions related to certain types of human papilloma
virus (HPV) infection.
• Histologically, they show papillary squamous proliferations with
koilocytes (keratinocytes showing HPV cytopathic effect).
• Widespread vulval condylomas may be seen in the immunosuppressed
.
Granular cell tumour
• Uncommon neural tumour that may occur in the vulva.
• Histologically composed of nests of large polygonal cells with abundant
granular cytoplasm.
• The vast majority behave in a benign fashion.
Angiomyofi broblastoma
• Benign mesenchymal neoplasm that occurs almost exclusively in the
vulvovaginal region of young women.
• Presents as a small subcutaneous lump, often mistaken for a cyst.
• Histologically, they are well-circumscribed lesions composed of dilated
capillary-sized vessels set in an oedematous stroma containing many
plump epithelioid stromal cells.
Cellular angiofi broma
• Benign mesenchymal neoplasm presenting as a small painless
subcutaneous mass in the vulvovaginal region of reproductive age
women.
• Histologically, they are well-circumscribed cellular lesions composed of
bland spindle cells and many small thick-walled blood vessels.
Deep angiomyxoma
• Locally infi ltrative, but non-metastasizing, mesenchymal neoplasm that
presents as a large deep-seated mass in the pelvis and perineum of
reproductive age women.
• Histologically, they are infi ltrative, paucicellular tumours composed of
small numbers of bland spindle cells set in a myxoid stroma containing
thick-walled blood vessels
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Pathology -Vulvar carcinoma
Definition • A malignant epithelial neoplasm originating in the vulva.
Epidemiology: Rare, having a yearly incidence of 0.8 per 100,000 individuals. • Predominantly occurs in elderly women, though it may sometimes manifest in younger women.
Aetiology • Often unidentified in numerous instances. • Certain occurrences are associated with chronic vulval dermatoses, including lichen sclerosus and lichen planus. • The majority of instances occurring in younger women are correlated with high-risk HPV infection of the vulva.
Carcinogenesis • The majority of instances originate from a precursor lesion
identified as vulval intraepithelial neoplasia (VIN). VIN is a dysplastic lesion of the vulvar squamous epithelium, categorized into two types: classical and differentiated. The classical type is observed in young women and is associated with HPV infection. The differentiated type is observed in older women and is associated with chronic vulvar inflammation. Both VIN and vulval carcinomas exhibit genetic anomalies, including mutations in TP53 and PTEN.
Presentation • The majority present with a vulvar tumor that may undergo ulceration and hemorrhage.
Macroscopy • A vulvar tumor mass that may present as nodular, verrucous, or ulcerated. Histopathology • The majority of cases are squamous cell carcinomas, characterized by infiltrating malignant epithelial cells exhibiting squamous differentiation. • The squamous epithelium next to the tumor may demonstrate vulvar intraepithelial neoplasia (VIN).
Prognosis • The primary prognostic factors are tumor size, invasion depth, and the degree of lymph node metastasis. Tumors with a depth of invasion of 1 mm exhibit a little risk of lymph node metastasis and a favorable prognosis for cure following local excision. The 5-year survival rate for people with unilateral lymph node disease is 65%, but it decreases to 25% for those with bilateral disease.
Definition • A malignant epithelial neoplasm originating in the vulva.
Epidemiology: Rare, having a yearly incidence of 0.8 per 100,000 individuals. • Predominantly occurs in elderly women, though it may sometimes manifest in younger women.
Aetiology • Often unidentified in numerous instances. • Certain occurrences are associated with chronic vulval dermatoses, including lichen sclerosus and lichen planus. • The majority of instances occurring in younger women are correlated with high-risk HPV infection of the vulva.
Carcinogenesis • The majority of instances originate from a precursor lesion
identified as vulval intraepithelial neoplasia (VIN). VIN is a dysplastic lesion of the vulvar squamous epithelium, categorized into two types: classical and differentiated. The classical type is observed in young women and is associated with HPV infection. The differentiated type is observed in older women and is associated with chronic vulvar inflammation. Both VIN and vulval carcinomas exhibit genetic anomalies, including mutations in TP53 and PTEN.
Presentation • The majority present with a vulvar tumor that may undergo ulceration and hemorrhage.
Macroscopy • A vulvar tumor mass that may present as nodular, verrucous, or ulcerated. Histopathology • The majority of cases are squamous cell carcinomas, characterized by infiltrating malignant epithelial cells exhibiting squamous differentiation. • The squamous epithelium next to the tumor may demonstrate vulvar intraepithelial neoplasia (VIN).
Prognosis • The primary prognostic factors are tumor size, invasion depth, and the degree of lymph node metastasis. Tumors with a depth of invasion of 1 mm exhibit a little risk of lymph node metastasis and a favorable prognosis for cure following local excision. The 5-year survival rate for people with unilateral lymph node disease is 65%, but it decreases to 25% for those with bilateral disease.
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Pathology - Vaginal neoplasms
Vaginal carcinoma • Rare relative to cervical and vulvar carcinomas. • Predominantly squamous cell carcinomas originating from a precursor dysplastic lesion termed vaginal intraepithelial neoplasia (VAIN).
• Risk factors encompass HPV infection, tobacco use, and immunosuppression. • Prognosis is typically unfavorable, with a 5-year survival rate of approximately 60%. Fibroepithelial stromal polyp • Benign lesion of the distal female genital system, primarily affecting the vagina, but may also occur in the vulva. • Hormonal-responsive lesions manifesting in women of reproductive age as tiny polypoid masses.
• Histologically, they consist of a central fibrovascular core enveloped by hyperplastic squamous epithelium. Stellate and multinucleate stromal cells are generally observed within the core next to the epithelial surface.
Genital rhabdomyoma • A benign tumor exhibiting skeletal muscle differentiation, predominantly found in the vagina. • Typically manifests in middle-aged women with symptoms associated with a mass lesion. • Histologically characterized by a disorganized proliferation of spindle cells featuring abundant, brightly eosinophilic cytoplasm with cross-striations.
Embryonal rhabdomyosarcoma is a malignant tumor exhibiting skeletal muscle differentiation, which may develop in the vagina of children. The majority of cases occur in children under 5 years of age, presenting with vaginal hemorrhage. A tumor may be observed protruding through the vaginal entrance. • Macroscopically, the tumor consists of edematous polypoid nodules protruding from the vaginal wall. • Histologically, the tumor comprises tiny round and spindle-shaped cells aggregated beneath the squamous epithelium of the vaginal wall. Certain tumor cells have prominently eosinophilic cytoplasm, with potential visibility of cytoplasmic cross-striations. The prognosis post-treatment is typically outstanding, with 10-year survival rates above 90%.
Vaginal carcinoma • Rare relative to cervical and vulvar carcinomas. • Predominantly squamous cell carcinomas originating from a precursor dysplastic lesion termed vaginal intraepithelial neoplasia (VAIN).
• Risk factors encompass HPV infection, tobacco use, and immunosuppression. • Prognosis is typically unfavorable, with a 5-year survival rate of approximately 60%. Fibroepithelial stromal polyp • Benign lesion of the distal female genital system, primarily affecting the vagina, but may also occur in the vulva. • Hormonal-responsive lesions manifesting in women of reproductive age as tiny polypoid masses.
• Histologically, they consist of a central fibrovascular core enveloped by hyperplastic squamous epithelium. Stellate and multinucleate stromal cells are generally observed within the core next to the epithelial surface.
Genital rhabdomyoma • A benign tumor exhibiting skeletal muscle differentiation, predominantly found in the vagina. • Typically manifests in middle-aged women with symptoms associated with a mass lesion. • Histologically characterized by a disorganized proliferation of spindle cells featuring abundant, brightly eosinophilic cytoplasm with cross-striations.
Embryonal rhabdomyosarcoma is a malignant tumor exhibiting skeletal muscle differentiation, which may develop in the vagina of children. The majority of cases occur in children under 5 years of age, presenting with vaginal hemorrhage. A tumor may be observed protruding through the vaginal entrance. • Macroscopically, the tumor consists of edematous polypoid nodules protruding from the vaginal wall. • Histologically, the tumor comprises tiny round and spindle-shaped cells aggregated beneath the squamous epithelium of the vaginal wall. Certain tumor cells have prominently eosinophilic cytoplasm, with potential visibility of cytoplasmic cross-striations. The prognosis post-treatment is typically outstanding, with 10-year survival rates above 90%.
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Pathology -Vaginal infections
Bacterial vaginosis is the most prevalent cause of abnormal vaginal discharge, resulting from the proliferation of anaerobic bacteria, including Gardnerella vaginalis and Bacteroides species. • The metabolic byproducts of these bacteria comprise volatile amines that provide a characteristic fishy odor to the discharge. • There is an absence of true inflammation in the vaginal wall, so the term vaginosis is utilized instead of vaginitis.
Vulvovaginal candidiasis, commonly referred to as 'thrush.'• A prevalent infection in young women caused by Candida albicans. The usual manifestation is vulvovaginal pruritus and burning, dyspareunia, and dysuria. A copious white discharge is prevalent. • Wet mount microscopy of the specimen reveals fungal pseudohyphae. The organism can additionally be cultivated in the microbiology laboratory. • Persistent Candida infections may indicate underlying diabetes mellitus or immunosuppression.
Trichomoniasis • A sexually transmitted infection caused by the flagellate protozoan, Trichomonas vaginalis. • The male partner is often asymptomatic, and around fifty percent of infected women are likewise asymptomatic. Women exhibiting symptoms typically report vaginal pruritus and a thin, frothy, malodorous discharge. Dyspareunia and dysuria may also manifest. • Wet mount microscopy of the discharge reveals motile trichomonads
Bacterial vaginosis is the most prevalent cause of abnormal vaginal discharge, resulting from the proliferation of anaerobic bacteria, including Gardnerella vaginalis and Bacteroides species. • The metabolic byproducts of these bacteria comprise volatile amines that provide a characteristic fishy odor to the discharge. • There is an absence of true inflammation in the vaginal wall, so the term vaginosis is utilized instead of vaginitis.
Vulvovaginal candidiasis, commonly referred to as 'thrush.'• A prevalent infection in young women caused by Candida albicans. The usual manifestation is vulvovaginal pruritus and burning, dyspareunia, and dysuria. A copious white discharge is prevalent. • Wet mount microscopy of the specimen reveals fungal pseudohyphae. The organism can additionally be cultivated in the microbiology laboratory. • Persistent Candida infections may indicate underlying diabetes mellitus or immunosuppression.
Trichomoniasis • A sexually transmitted infection caused by the flagellate protozoan, Trichomonas vaginalis. • The male partner is often asymptomatic, and around fifty percent of infected women are likewise asymptomatic. Women exhibiting symptoms typically report vaginal pruritus and a thin, frothy, malodorous discharge. Dyspareunia and dysuria may also manifest. • Wet mount microscopy of the discharge reveals motile trichomonads
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Pathology - Vaginal neoplasms
Vaginal carcinoma • Rare relative to cervical and vulvar carcinomas. • Predominantly squamous cell carcinomas originating from a precursor dysplastic lesion termed vaginal intraepithelial neoplasia (VAIN).
• Risk factors encompass HPV infection, tobacco use, and immunosuppression. • Prognosis is typically unfavorable, with a 5-year survival rate of approximately 60%. Fibroepithelial stromal polyp • Benign lesion of the distal female genital system, primarily affecting the vagina, but may also occur in the vulva. • Hormonal-responsive lesions manifesting in women of reproductive age as tiny polypoid masses.
• Histologically, they consist of a central fibrovascular core enveloped by hyperplastic squamous epithelium. Stellate and multinucleate stromal cells are generally observed within the core next to the epithelial surface.
Genital rhabdomyoma • A benign tumor exhibiting skeletal muscle differentiation, predominantly found in the vagina. • Typically manifests in middle-aged women with symptoms associated with a mass lesion. • Histologically characterized by a disorganized proliferation of spindle cells featuring abundant, brightly eosinophilic cytoplasm with cross-striations.
Embryonal rhabdomyosarcoma is a malignant tumor exhibiting skeletal muscle differentiation, which may develop in the vagina of children. The majority of cases occur in children under 5 years of age, presenting with vaginal hemorrhage. A tumor may be observed protruding through the vaginal entrance. • Macroscopically, the tumor consists of edematous polypoid nodules protruding from the vaginal wall. • Histologically, the tumor comprises tiny round and spindle-shaped cells aggregated beneath the squamous epithelium of the vaginal wall. Certain tumor cells have prominently eosinophilic cytoplasm, with potential visibility of cytoplasmic cross-striations. The prognosis post-treatment is typically outstanding, with 10-year survival rates above 90%.
Vaginal carcinoma • Rare relative to cervical and vulvar carcinomas. • Predominantly squamous cell carcinomas originating from a precursor dysplastic lesion termed vaginal intraepithelial neoplasia (VAIN).
• Risk factors encompass HPV infection, tobacco use, and immunosuppression. • Prognosis is typically unfavorable, with a 5-year survival rate of approximately 60%. Fibroepithelial stromal polyp • Benign lesion of the distal female genital system, primarily affecting the vagina, but may also occur in the vulva. • Hormonal-responsive lesions manifesting in women of reproductive age as tiny polypoid masses.
• Histologically, they consist of a central fibrovascular core enveloped by hyperplastic squamous epithelium. Stellate and multinucleate stromal cells are generally observed within the core next to the epithelial surface.
Genital rhabdomyoma • A benign tumor exhibiting skeletal muscle differentiation, predominantly found in the vagina. • Typically manifests in middle-aged women with symptoms associated with a mass lesion. • Histologically characterized by a disorganized proliferation of spindle cells featuring abundant, brightly eosinophilic cytoplasm with cross-striations.
Embryonal rhabdomyosarcoma is a malignant tumor exhibiting skeletal muscle differentiation, which may develop in the vagina of children. The majority of cases occur in children under 5 years of age, presenting with vaginal hemorrhage. A tumor may be observed protruding through the vaginal entrance. • Macroscopically, the tumor consists of edematous polypoid nodules protruding from the vaginal wall. • Histologically, the tumor comprises tiny round and spindle-shaped cells aggregated beneath the squamous epithelium of the vaginal wall. Certain tumor cells have prominently eosinophilic cytoplasm, with potential visibility of cytoplasmic cross-striations. The prognosis post-treatment is typically outstanding, with 10-year survival rates above 90%.
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Pathology - Urothelial carcinomas
Definition • A category of neoplasms originating in the urothelial tract. Equivalent term • Transitional cell carcinomas.
Epidemiology • Prevalent with more than 250,000 new cases globally. • Can manifest throughout the urothelial system, with the predominant occurrence in the bladder, followed by the renal pelvis and ureters (50:3:1, respectively).
Bladder tumors are likely more prevalent because to carcinogens traversing the urine tract residing in the bladder for extended periods.
Aetiology • Tobacco consumption through cigarettes. • Professional exposure to aromatic amines. Genetics • Non-invasive low-grade papillary urothelial carcinomas exhibit little genetic modifications, with the predominant change being deletions of chromosome 9. Non-invasive high-grade papillary urothelial carcinomas, urothelial carcinoma in situ, and infiltrating urothelial carcinomas exhibit genetic instability characterized by several chromosomal aberrations, including mutations in TP53 and RB genes.
Presentation: • The majority present with hematuria.
Macroscopy Non-invasive papillary tumors often develop as frond-like projections from the urothelial mucosa. Infiltrating urothelial carcinomas generally present as solid masses that invade adjacent tissues. Urothelial carcinoma in situ is a flat lesion that may be macroscopically undetectable or present as an erythematous mucosal region.
Urinary cytopathology • Insufficient sensitivity in detecting low-grade urothelial carcinomas. • Proficient in identifying high-grade lesions characterized by significantly abnormal urothelial cells exhibiting big pleomorphic nuclei with black, coarsely granular chromatin. Histopathology Non-invasive low-grade papillary urothelial carcinoma consists of slender papillae bordered by urothelium with minor disorganization and low-grade nuclear atypia. Non-invasive high-grade papillary urothelial carcinoma consists of branching, fused papillae bordered by urothelium exhibiting significant disorganization and pronounced nuclear atypia.
Urothelial carcinoma in situ is a planar lesion characterized by distinctly high-grade nuclear atypia in the urothelium. Infiltrating urothelial carcinoma is a urothelial tumor that has breached the basement membrane. This group is not officially categorized into low and high grade, however the majority have high-grade nuclear atypia.
Prognosis: All have a propensity for multifocality and recurrence. Non-invasive low-grade papillary urothelial carcinomas present a minimal risk of progression to invasion and mortality (<5%). non-invasive high-grade papillary urothelial carcinomas and carcinoma in situ possess a significantly elevated risk of progression. the prognosis infiltrating primarily depends on stage disease. lymphovascular invasion is an unfavorable prognostic indicator.< />pan>
TNM 7 pathological staging of bladder carcinomas
Primary tumour (T)
pTa: non-invasive tumour.
pT1: tumour invades the lamina propria.
pT2: tumour invades the muscularis propria.
pT3: tumour invades perivesical tissue.
pT4: tumour invades adjacent organs (prostate, uterus, vagina, pelvic wall).
Regional lymph nodes (N)
pN1: single positive node in the primary drainage region.
pN2: multiple positive nodes in the primary drainage region.
pN3: common iliac node involvement.
TNM 7 pathological staging of renal pelvis and ureter
carcinomas
Primary tumour (T)
pTa: non-invasive tumour.
Definition • A category of neoplasms originating in the urothelial tract. Equivalent term • Transitional cell carcinomas.
Epidemiology • Prevalent with more than 250,000 new cases globally. • Can manifest throughout the urothelial system, with the predominant occurrence in the bladder, followed by the renal pelvis and ureters (50:3:1, respectively).
Bladder tumors are likely more prevalent because to carcinogens traversing the urine tract residing in the bladder for extended periods.
Aetiology • Tobacco consumption through cigarettes. • Professional exposure to aromatic amines. Genetics • Non-invasive low-grade papillary urothelial carcinomas exhibit little genetic modifications, with the predominant change being deletions of chromosome 9. Non-invasive high-grade papillary urothelial carcinomas, urothelial carcinoma in situ, and infiltrating urothelial carcinomas exhibit genetic instability characterized by several chromosomal aberrations, including mutations in TP53 and RB genes.
Presentation: • The majority present with hematuria.
Macroscopy Non-invasive papillary tumors often develop as frond-like projections from the urothelial mucosa. Infiltrating urothelial carcinomas generally present as solid masses that invade adjacent tissues. Urothelial carcinoma in situ is a flat lesion that may be macroscopically undetectable or present as an erythematous mucosal region.
Urinary cytopathology • Insufficient sensitivity in detecting low-grade urothelial carcinomas. • Proficient in identifying high-grade lesions characterized by significantly abnormal urothelial cells exhibiting big pleomorphic nuclei with black, coarsely granular chromatin. Histopathology Non-invasive low-grade papillary urothelial carcinoma consists of slender papillae bordered by urothelium with minor disorganization and low-grade nuclear atypia. Non-invasive high-grade papillary urothelial carcinoma consists of branching, fused papillae bordered by urothelium exhibiting significant disorganization and pronounced nuclear atypia.
Urothelial carcinoma in situ is a planar lesion characterized by distinctly high-grade nuclear atypia in the urothelium. Infiltrating urothelial carcinoma is a urothelial tumor that has breached the basement membrane. This group is not officially categorized into low and high grade, however the majority have high-grade nuclear atypia.
Prognosis: All have a propensity for multifocality and recurrence. Non-invasive low-grade papillary urothelial carcinomas present a minimal risk of progression to invasion and mortality (<5%). non-invasive high-grade papillary urothelial carcinomas and carcinoma in situ possess a significantly elevated risk of progression. the prognosis infiltrating primarily depends on stage disease. lymphovascular invasion is an unfavorable prognostic indicator.< />pan>
TNM 7 pathological staging of bladder carcinomas
Primary tumour (T)
pTa: non-invasive tumour.
pT1: tumour invades the lamina propria.
pT2: tumour invades the muscularis propria.
pT3: tumour invades perivesical tissue.
pT4: tumour invades adjacent organs (prostate, uterus, vagina, pelvic wall).
Regional lymph nodes (N)
pN1: single positive node in the primary drainage region.
pN2: multiple positive nodes in the primary drainage region.
pN3: common iliac node involvement.
TNM 7 pathological staging of renal pelvis and ureter
carcinomas
Primary tumour (T)
pTa: non-invasive tumour.
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Pathology - Benign prostatic hyperplasia
Definition: Enlargement of the prostate gland resulting from a rise in cellular proliferation. Epidemiology • Extremely prevalent. • Symptomatic illness impacts approximately 3% of men aged 45–49, increasing to roughly 25% by age 80. Histological evidence is observed in 90% of men by the age of 80.
Aetiology • Ambiguous.
Pathogenesis • Androgens play a pivotal role in the pathogenesis of benign prostatic hyperplasia (BPH), particularly through elevated local concentrations of dihydrotestosterone in the prostate. • Contemporary evidence indicates that heightened estrogen levels in the bloodstream, which increase with age, activate androgen receptors in prostate tissue and promote hyperplasia. Presentation: Frequency, urgency, nocturia, hesitancy, diminished flow, and terminal dribbling, generally referred to as lower urinary tract symptoms (LUTS). • Certain individuals exhibit urinary tract infection, acute urine retention, or renal failure.
Macroscopy The prostate exhibits nodular enlargement, typically affecting the transition zone. • The association between prostate size and symptom severity is weak.
Histopathology • There is a proliferation of both epithelial and stromal components of the prostate, resulting in the formation of nodules. • The ratio of epithelial to stromal components varies significantly among instances, with some being primarily epithelial and others mostly stromal.
Complications • Urinary retention. • Recurrent urinary tract infections. • Uroliths. • Obstructive nephropathy
Definition: Enlargement of the prostate gland resulting from a rise in cellular proliferation. Epidemiology • Extremely prevalent. • Symptomatic illness impacts approximately 3% of men aged 45–49, increasing to roughly 25% by age 80. Histological evidence is observed in 90% of men by the age of 80.
Aetiology • Ambiguous.
Pathogenesis • Androgens play a pivotal role in the pathogenesis of benign prostatic hyperplasia (BPH), particularly through elevated local concentrations of dihydrotestosterone in the prostate. • Contemporary evidence indicates that heightened estrogen levels in the bloodstream, which increase with age, activate androgen receptors in prostate tissue and promote hyperplasia. Presentation: Frequency, urgency, nocturia, hesitancy, diminished flow, and terminal dribbling, generally referred to as lower urinary tract symptoms (LUTS). • Certain individuals exhibit urinary tract infection, acute urine retention, or renal failure.
Macroscopy The prostate exhibits nodular enlargement, typically affecting the transition zone. • The association between prostate size and symptom severity is weak.
Histopathology • There is a proliferation of both epithelial and stromal components of the prostate, resulting in the formation of nodules. • The ratio of epithelial to stromal components varies significantly among instances, with some being primarily epithelial and others mostly stromal.
Complications • Urinary retention. • Recurrent urinary tract infections. • Uroliths. • Obstructive nephropathy
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Pathology - Pediatric kidney neoplasms
Nephroblastoma (Wilms' tumor) is a malignant kidney neoplasm occurring in children. • The second most prevalent pediatric cancer, occurring at an incidence of approximately 1 in 8,000. • The majority of children aged 2 to 5 years exhibit an abdominal mass. Macroscopically, they are distinctly defined tumors with a grey or tan hue. Histologically, the majority of nephroblastomas comprise a combination of undifferentiated small round blue cells (blastema) and regions of highly differentiated epithelial and stromal elements, referred to as 'triphasic' tumors. Most nephroblastomas are classified as low stage with favorable histology, resulting in an excellent prognosis following treatment. Approximately 5% of cases have unfavorable histology, marked by nuclear anaplasia or the presence of multipolar mitotic figures; these instances are linked to a negative prognosis.
Clear cell sarcoma -A rare pediatric renal sarcoma with a significant tendency to metastasis to bone. • The majority of youngsters present between the ages of 1 and 2 years. Macroscopically, they are generally substantial tumors located in the renal medulla. • Histologically, the typical pattern consists of nests or cords of cells interspersed with fibrovascular septa.
Rhabdoid tumor: A rare, extremely aggressive kidney neoplasm occurring in young children. • Typically manifests at one year of age with either hematuria or symptoms indicative of disseminated illness. The tumors are big and infiltrative, with patches of necrosis. The malignant cells exhibit vesicular chromatin, large cherry-red nucleoli, and hyaline pink intracytoplasmic inclusions histologically. Significant vascular invasion is typically apparent. • The prognosis is exceedingly unfavorable, with fatality rates exceeding 80% within two years following diagnosis.
Congenital mesoblastic nephroma • A low-grade fibrolastic renal sarcoma occurring in pediatric patients. • It may be identified via prenatal ultrasound or manifest within the first year of life as an abdominal tumor. • The tumor is predominantly located in the renal sinus and exhibits either a firm whorled morphology or a softer cystic cut surface. Histologically, two forms are identified: a 'classic' type consisting of fascicles of benign spindle cells and a 'cellular' type including sheets of densely packed rounded cells. • The prognosis is often outstanding when the tumor is entirely removed with nephrectomy.
Nephroblastoma (Wilms' tumor) is a malignant kidney neoplasm occurring in children. • The second most prevalent pediatric cancer, occurring at an incidence of approximately 1 in 8,000. • The majority of children aged 2 to 5 years exhibit an abdominal mass. Macroscopically, they are distinctly defined tumors with a grey or tan hue. Histologically, the majority of nephroblastomas comprise a combination of undifferentiated small round blue cells (blastema) and regions of highly differentiated epithelial and stromal elements, referred to as 'triphasic' tumors. Most nephroblastomas are classified as low stage with favorable histology, resulting in an excellent prognosis following treatment. Approximately 5% of cases have unfavorable histology, marked by nuclear anaplasia or the presence of multipolar mitotic figures; these instances are linked to a negative prognosis.
Clear cell sarcoma -A rare pediatric renal sarcoma with a significant tendency to metastasis to bone. • The majority of youngsters present between the ages of 1 and 2 years. Macroscopically, they are generally substantial tumors located in the renal medulla. • Histologically, the typical pattern consists of nests or cords of cells interspersed with fibrovascular septa.
Rhabdoid tumor: A rare, extremely aggressive kidney neoplasm occurring in young children. • Typically manifests at one year of age with either hematuria or symptoms indicative of disseminated illness. The tumors are big and infiltrative, with patches of necrosis. The malignant cells exhibit vesicular chromatin, large cherry-red nucleoli, and hyaline pink intracytoplasmic inclusions histologically. Significant vascular invasion is typically apparent. • The prognosis is exceedingly unfavorable, with fatality rates exceeding 80% within two years following diagnosis.
Congenital mesoblastic nephroma • A low-grade fibrolastic renal sarcoma occurring in pediatric patients. • It may be identified via prenatal ultrasound or manifest within the first year of life as an abdominal tumor. • The tumor is predominantly located in the renal sinus and exhibits either a firm whorled morphology or a softer cystic cut surface. Histologically, two forms are identified: a 'classic' type consisting of fascicles of benign spindle cells and a 'cellular' type including sheets of densely packed rounded cells. • The prognosis is often outstanding when the tumor is entirely removed with nephrectomy.
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Pathology - Renal cell carcinoma
Definition: A malignant epithelial tumor originating in the kidney.
Epidemiology • Represents approximately 2% of all cancers globally. • Prevalent in developed nations, with an average incidence of approximately 10 per 100,000 in males and 3 per 100,000 in females.
Aetiology • Identified risk factors encompass smoking, hypertension, obesity, environmental toxins, and prolonged dialysis. Certain genetic disorders, such as von Hippel-Lindau and tuberous sclerosis, are linked to renal cell carcinoma (RCC). Genetics Clear cell renal cell carcinomas exhibit deletions on chromosome 3p. Papillary RCCs exhibit trisomy of chromosomes 7 and 17, together with the deletion of chromosomal Y in males. Chromophobe RCCs exhibit significant chromosomal deletions.
Presentation • Approximately fifty percent of all cases manifest as painless hematuria. • The majority of the remaining cases are detected incidentally by imaging. A minor percentage exhibits metastatic illness.
Macroscopy The tumors are typically located in the renal cortex. • The clear cell types exhibit heterogeneity, characterized by golden yellow regions. • Papillary tumors may exhibit friability. • Chromophobe tumors are often solid and brown-hued. Histopathology transparent cell RCC (70%) consists of cells exhibiting transparent or eosinophilic cytoplasm arranged within a fine vascular framework. • Papillary RCC (15%) exhibits a papillary or tubulopapillary development pattern and measures greater than 5 mm in size. Chromophobe RCC (5%) consists of layers of big cells characterized by well-defined cell boundaries. The tumor's vasculature is characterized by thick walls. The remaining components consist of a combination of uncommon subtypes, including collecting duct carcinoma and mucinous tubular and spindle cell carcinoma.
Prognosis • The overall five-year survival rate is around 60%. • Stage and grade are the primary prognostic determinants. • The prevalent grading system utilized is the four-tiered Fuhrman system, which assesses nuclear size, shape, chromatin structure, and nucleolar prominence. Grade 1 exhibits the most favorable outlook, while grade 4 demonstrates the least favorable.
TNM 7 pathological staging of renal cell carcinomas
Primary tumour (T)
pT1a: tumour d 4cm, limited to the kidney.
pT1b: tumour > 4cm, but d 7cm, limited to the kidney.
pT2a: tumour > 7cm, but d 10cm, limited to the kidney.
pT2b: tumour > 10cm, limited to the kidney.
pT3a: tumour extends into perinephric fat or renal veins.
pT3b: tumour extends into the vena cava below the diaphragm.
pT3c: tumour extends into the vena cava above the diaphragm.
pT4: tumour directly invades the adrenal gland or beyond the Gerota fascia.
Regional lymph nodes (N)
pN0: no regional lymph node metastasis.
pN1: metastasis in regional lymph node
Definition: A malignant epithelial tumor originating in the kidney.
Epidemiology • Represents approximately 2% of all cancers globally. • Prevalent in developed nations, with an average incidence of approximately 10 per 100,000 in males and 3 per 100,000 in females.
Aetiology • Identified risk factors encompass smoking, hypertension, obesity, environmental toxins, and prolonged dialysis. Certain genetic disorders, such as von Hippel-Lindau and tuberous sclerosis, are linked to renal cell carcinoma (RCC). Genetics Clear cell renal cell carcinomas exhibit deletions on chromosome 3p. Papillary RCCs exhibit trisomy of chromosomes 7 and 17, together with the deletion of chromosomal Y in males. Chromophobe RCCs exhibit significant chromosomal deletions.
Presentation • Approximately fifty percent of all cases manifest as painless hematuria. • The majority of the remaining cases are detected incidentally by imaging. A minor percentage exhibits metastatic illness.
Macroscopy The tumors are typically located in the renal cortex. • The clear cell types exhibit heterogeneity, characterized by golden yellow regions. • Papillary tumors may exhibit friability. • Chromophobe tumors are often solid and brown-hued. Histopathology transparent cell RCC (70%) consists of cells exhibiting transparent or eosinophilic cytoplasm arranged within a fine vascular framework. • Papillary RCC (15%) exhibits a papillary or tubulopapillary development pattern and measures greater than 5 mm in size. Chromophobe RCC (5%) consists of layers of big cells characterized by well-defined cell boundaries. The tumor's vasculature is characterized by thick walls. The remaining components consist of a combination of uncommon subtypes, including collecting duct carcinoma and mucinous tubular and spindle cell carcinoma.
Prognosis • The overall five-year survival rate is around 60%. • Stage and grade are the primary prognostic determinants. • The prevalent grading system utilized is the four-tiered Fuhrman system, which assesses nuclear size, shape, chromatin structure, and nucleolar prominence. Grade 1 exhibits the most favorable outlook, while grade 4 demonstrates the least favorable.
TNM 7 pathological staging of renal cell carcinomas
Primary tumour (T)
pT1a: tumour d 4cm, limited to the kidney.
pT1b: tumour > 4cm, but d 7cm, limited to the kidney.
pT2a: tumour > 7cm, but d 10cm, limited to the kidney.
pT2b: tumour > 10cm, limited to the kidney.
pT3a: tumour extends into perinephric fat or renal veins.
pT3b: tumour extends into the vena cava below the diaphragm.
pT3c: tumour extends into the vena cava above the diaphragm.
pT4: tumour directly invades the adrenal gland or beyond the Gerota fascia.
Regional lymph nodes (N)
pN0: no regional lymph node metastasis.
pN1: metastasis in regional lymph node
