- Published on
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%.
- Published on
Pathology - Paratesticular disorders
Epididymal cyst • Benign cystic lesion of the epididymis. • Typically manifests as a tiny paratesticular swelling that may exhibit tenderness. • Macroscopically, it presents as a thin-walled translucent cystic lesion. • Histologically, the cyst is lined by a thin, attenuated layer of non-descript epithelial cells.
Epididymitis • Typically arises from an ascending infection originating in the lower urinary tract. In males under 35 years, the etiology is typically a sexually transmitted infection, such as Chlamydia trachomatis or Neisseria gonorrhoeae. In males over 35 years, the predominant cause is Escherichia coli.
Varicocele • A chronic abnormal enlargement of the pampiniform venous plexus within the spermatic cord. • More prevalent on the left side due to the drainage of the testicular vein into the renal vein. • Typically manifests as nodularity on the lateral aspect of the scrotum. • May induce a dull ache, particularly after extended periods of standing or towards the day's conclusion. • May lead to male subfertility due to elevated blood flow, which increases scrotal warmth and hinders spermatogenesis.
Hydrocele • An abnormal accumulation of fluid in the interstitial space between the two layers of the tunica vaginalis. • A prevalent etiology of scrotal swelling. • Typically induced by trauma or a response to an underlying ailment such as epididymitis, orchitis, or a neoplasm.
Adenomatoid tumor • The predominant benign neoplasm of the paratesticular region. • Can manifest in the epididymis, spermatic cord, and tunica albuginea. • Predominantly observed in young people. • Grossly, they appear as small, solid, firm grey/white tumors often measuring less than 3 cm. • Histologically, they consist of dilated tubular structures lined with attenuated mesothelial cells.
Paratesticular sarcomas • Infrequent yet well-documented paratesticular neoplasms. The two predominant varieties are well-differentiated liposarcoma in adults and embryonal rhabdomyosarcoma in children and adolescents.
Epididymal cyst • Benign cystic lesion of the epididymis. • Typically manifests as a tiny paratesticular swelling that may exhibit tenderness. • Macroscopically, it presents as a thin-walled translucent cystic lesion. • Histologically, the cyst is lined by a thin, attenuated layer of non-descript epithelial cells.
Epididymitis • Typically arises from an ascending infection originating in the lower urinary tract. In males under 35 years, the etiology is typically a sexually transmitted infection, such as Chlamydia trachomatis or Neisseria gonorrhoeae. In males over 35 years, the predominant cause is Escherichia coli.
Varicocele • A chronic abnormal enlargement of the pampiniform venous plexus within the spermatic cord. • More prevalent on the left side due to the drainage of the testicular vein into the renal vein. • Typically manifests as nodularity on the lateral aspect of the scrotum. • May induce a dull ache, particularly after extended periods of standing or towards the day's conclusion. • May lead to male subfertility due to elevated blood flow, which increases scrotal warmth and hinders spermatogenesis.
Hydrocele • An abnormal accumulation of fluid in the interstitial space between the two layers of the tunica vaginalis. • A prevalent etiology of scrotal swelling. • Typically induced by trauma or a response to an underlying ailment such as epididymitis, orchitis, or a neoplasm.
Adenomatoid tumor • The predominant benign neoplasm of the paratesticular region. • Can manifest in the epididymis, spermatic cord, and tunica albuginea. • Predominantly observed in young people. • Grossly, they appear as small, solid, firm grey/white tumors often measuring less than 3 cm. • Histologically, they consist of dilated tubular structures lined with attenuated mesothelial cells.
Paratesticular sarcomas • Infrequent yet well-documented paratesticular neoplasms. The two predominant varieties are well-differentiated liposarcoma in adults and embryonal rhabdomyosarcoma in children and adolescents.
- Published on
Pathology - Non-germ cell tumors of the testis
Testicular lymphomas • Approximately 5% of all testicular tumors. • Predominantly observed in older males. The testis is typically substituted by a substantial gray or tan mass that may extend into the cord. The predominant histological type is diffuse large B-cell lymphoma).Prognosis for survival is typically unfavorable.
Leydig cell tumor • A sex-cord stromal neoplasm comprising approximately 3% of all testicular tumors. • Can manifest at any age. • Prepubertally, they typically exhibit indicators of precocious puberty resulting from androgen production. • Post-puberty, they exhibit a testicular mass. Macroscopically, these tumors are well-defined, frequently exhibiting a brown cut surface. Histologically, they consist of sheets or nests of polygonal cells characterized by eosinophilic cytoplasm and round nuclei containing a single nucleolus. Reinke's crystals, characterized by their rhomboid shape and intracytoplasmic location, may be observed. • Most Leydig cell tumors exhibit benign characteristics; however, approximately 10% demonstrate malignant behavior. • Histological analysis is not consistently dependable in forecasting aggressive tumor behavior; nonetheless, concerning indicators include tumor size exceeding 5 cm, necrosis, vascular invasion, cellular pleomorphism, and elevated mitotic activity
Sertoli cell tumor • A sex-cord stromal neoplasm constituting approximately 1% of all testicular tumors. • Predominantly manifests as a testicular mass in young and middle-aged males. Macroscopically, they typically present as solid yellow or white tumors. Histologically, they consist of oval cells that create hollow or solid tubular structures. Approximately 10% of tumors are malignant; analogous histological parameters are employed to anticipate malignant behavior as with Leydig cell tumors.
Testicular lymphomas • Approximately 5% of all testicular tumors. • Predominantly observed in older males. The testis is typically substituted by a substantial gray or tan mass that may extend into the cord. The predominant histological type is diffuse large B-cell lymphoma).Prognosis for survival is typically unfavorable.
Leydig cell tumor • A sex-cord stromal neoplasm comprising approximately 3% of all testicular tumors. • Can manifest at any age. • Prepubertally, they typically exhibit indicators of precocious puberty resulting from androgen production. • Post-puberty, they exhibit a testicular mass. Macroscopically, these tumors are well-defined, frequently exhibiting a brown cut surface. Histologically, they consist of sheets or nests of polygonal cells characterized by eosinophilic cytoplasm and round nuclei containing a single nucleolus. Reinke's crystals, characterized by their rhomboid shape and intracytoplasmic location, may be observed. • Most Leydig cell tumors exhibit benign characteristics; however, approximately 10% demonstrate malignant behavior. • Histological analysis is not consistently dependable in forecasting aggressive tumor behavior; nonetheless, concerning indicators include tumor size exceeding 5 cm, necrosis, vascular invasion, cellular pleomorphism, and elevated mitotic activity
Sertoli cell tumor • A sex-cord stromal neoplasm constituting approximately 1% of all testicular tumors. • Predominantly manifests as a testicular mass in young and middle-aged males. Macroscopically, they typically present as solid yellow or white tumors. Histologically, they consist of oval cells that create hollow or solid tubular structures. Approximately 10% of tumors are malignant; analogous histological parameters are employed to anticipate malignant behavior as with Leydig cell tumors.
- Published on
Pathology – Testicular Germ Cell Tumors
Testicular germ cell neoplasms: A group of malignant tumors of the testis derived from germ cells. Epidemiology More than 90% of testicular cancers are categorized as germ cell tumors, predominantly affecting young men between the ages of 20 and 45.
Aetiology The principal risk factor is cryptorchidism, which increases the risk by three to fivefold. Additional prenatal risk factors include low birth weight and being tiny for gestational age. No reliable risk factors for adulthood have been discerned.
Carcinogenesis: Most germ cell malignancies arise from a precursor condition known as intratubular germ cell neoplasia (ITGCN), characterized by neoplastic germ cells localized within the seminiferous tubules. The disease process likely begins in fetal development, with ITGCN observable in childhood and young adulthood, during which further genetic abnormalities lead to malignant transformation. A commonly identified structural chromosomal aberration is the gain of 12p sequences.
Presentation • Most individuals present with a non-painful testicular tumor. Approximately 10% have symptoms indicative of metastatic disease, primarily back pain attributed to retroperitoneal lymph node metastases or cough/dyspnea stemming from pulmonary metastases. Serum neoplastic biomarkers Alpha-fetoprotein (AFP) is frequently associated with the presence of yolk sac elements. Beta human chorionic gonadotrophin (B HCG) is associated with the presence of syncytiotrophoblastic cells, which may appear individually in a pure seminoma or as a key component of choriocarcinoma. Macroscopy: Pure seminomas generally exhibit lobulated tan lesions. Teratomas often have both cystic and solid components. Mixed cancers generally have diverse morphological characteristics. Histopathology
Seminoma comprises sheets or clusters of polygonal cells distinguished by translucent or eosinophilic cytoplasm and spherical nuclei containing one or two nucleoli. A lymphocytic infiltration is commonly detected within the tumor.
Teratoma comprises tissues that mimic either undeveloped fetal tissues or mature adult tissues.
Embryonal carcinoma comprises anaplastic cells distinguished by large vesicular nuclei featuring prominent nucleoli. The tumors may manifest in solid sheets or form glandular structures.
The yolk sac tumor comprises small, somewhat pleomorphic cells that display various architectural configurations, primarily reticular and microcystic.
Choriocarcinoma has a mixture of syncytiotrophoblastic and cytotrophoblastic cells. Profuse bleeding and necrosis often transpire. Germ cell cancers may comprise entirely one subtype or a mixture of multiple kinds.
Prognosis: Excellent, with 5-year survival rates of 98% in the majority of countries. This indicates the high sensitivity of germ cell cancers to modern platinum-based chemotherapy protocols.
TNM 7 pathological staging of testicular germ cell
tumours
Primary tumour (T)
pT1: tumour limited to the testis without lymphovascular invasion.
pT2: tumour limited to the testis with lymphovascular invasion or
tumour extending through the tunica albuginea with involvement of the
tunica vaginalis.
pT3: tumour invades the spermatic cord with or without lymphovascular
invasion.
pT4: tumour invades the scrotum with or without lymphovascular
invasio
Testicular germ cell neoplasms: A group of malignant tumors of the testis derived from germ cells. Epidemiology More than 90% of testicular cancers are categorized as germ cell tumors, predominantly affecting young men between the ages of 20 and 45.
Aetiology The principal risk factor is cryptorchidism, which increases the risk by three to fivefold. Additional prenatal risk factors include low birth weight and being tiny for gestational age. No reliable risk factors for adulthood have been discerned.
Carcinogenesis: Most germ cell malignancies arise from a precursor condition known as intratubular germ cell neoplasia (ITGCN), characterized by neoplastic germ cells localized within the seminiferous tubules. The disease process likely begins in fetal development, with ITGCN observable in childhood and young adulthood, during which further genetic abnormalities lead to malignant transformation. A commonly identified structural chromosomal aberration is the gain of 12p sequences.
Presentation • Most individuals present with a non-painful testicular tumor. Approximately 10% have symptoms indicative of metastatic disease, primarily back pain attributed to retroperitoneal lymph node metastases or cough/dyspnea stemming from pulmonary metastases. Serum neoplastic biomarkers Alpha-fetoprotein (AFP) is frequently associated with the presence of yolk sac elements. Beta human chorionic gonadotrophin (B HCG) is associated with the presence of syncytiotrophoblastic cells, which may appear individually in a pure seminoma or as a key component of choriocarcinoma. Macroscopy: Pure seminomas generally exhibit lobulated tan lesions. Teratomas often have both cystic and solid components. Mixed cancers generally have diverse morphological characteristics. Histopathology
Seminoma comprises sheets or clusters of polygonal cells distinguished by translucent or eosinophilic cytoplasm and spherical nuclei containing one or two nucleoli. A lymphocytic infiltration is commonly detected within the tumor.
Teratoma comprises tissues that mimic either undeveloped fetal tissues or mature adult tissues.
Embryonal carcinoma comprises anaplastic cells distinguished by large vesicular nuclei featuring prominent nucleoli. The tumors may manifest in solid sheets or form glandular structures.
The yolk sac tumor comprises small, somewhat pleomorphic cells that display various architectural configurations, primarily reticular and microcystic.
Choriocarcinoma has a mixture of syncytiotrophoblastic and cytotrophoblastic cells. Profuse bleeding and necrosis often transpire. Germ cell cancers may comprise entirely one subtype or a mixture of multiple kinds.
Prognosis: Excellent, with 5-year survival rates of 98% in the majority of countries. This indicates the high sensitivity of germ cell cancers to modern platinum-based chemotherapy protocols.
TNM 7 pathological staging of testicular germ cell
tumours
Primary tumour (T)
pT1: tumour limited to the testis without lymphovascular invasion.
pT2: tumour limited to the testis with lymphovascular invasion or
tumour extending through the tunica albuginea with involvement of the
tunica vaginalis.
pT3: tumour invades the spermatic cord with or without lymphovascular
invasion.
pT4: tumour invades the scrotum with or without lymphovascular
invasio
- Published on
Pathology - Prostate Carcinoma
Definition: A malignant epithelial tumor originating in the prostate. Epidemiology: The predominant malignant neoplasm in males. • Increasing prevalence attributed to prolonged life expectancy and enhanced detection methods. • A less significant contributor to cancer-related mortality, as numerous instances have a rather indolent progression.
Aetiology: Racial background and genetic predispositions are significant, with a 5–10-fold elevated risk in males possessing two or more affected first-degree relatives. • Dietary correlation with animal-derived items, especially red meat.
Carcinogenesis • Originates from a precursor lesion termed prostatic intraepithelial neoplasia (PIN), distinguished by the neoplastic transformation of the epithelial lining of the prostatic ducts and acini. • Contains mutations in several genes, including GST-pi, PTEN, AMACR, p27, and E-cadherin (notably, these are not conventional tumor suppressor genes or oncogenes). The majority of prostate cancers are asymptomatic and are detected when a needle biopsy is conducted due to an elevated prostate-specific antigen (PSA) level or a suspicious finding during a digital rectal examination (DRE). • LUTS may be evident. • Infrequently, patients exhibit symptoms indicative of metastatic disease.
Macroscopy • Initial instances of latent prostate cancer are improbable to be discernible macroscopically. • Larger tumors may present as firmer regions that contrast in color with the adjacent prostatic tissue.
Histopathology • Nearly all prostate carcinomas are glandular epithelial neoplasms, specifically adenocarcinomas. • A principal diagnostic characteristic of prostate cancer is the atypical architecture of the malignant glands, which exhibit crowding and a disorganized growth pattern relative to adjacent normal acini. • Malignant epithelial cells exhibit enlarged nuclei with conspicuous nucleoli and denser amphophilic cytoplasm. • Malignant glands frequently contain intraluminal crystalloids (dense crystalline structures), pink secretions, or blue-tinged mucin. • A morphological diagnosis or suspicion of prostate carcinoma can be immunohistochemically validated by the absence of basal cells encircling the malignant glands. Typical basal cell markers employed for this purpose encompass p63 and high molecular weight keratins.
Prognosis • The primary determinant is the histological grade, referred to as the Gleason score, named after the pathologist who initially developed the system. • The Gleason score varies from 2 to 10 and is derived by summing two integers between 1 and 5, reflecting the architectural growth patterns of the tumor. In actuality, patterns 1 and 2 are rarely identified, resulting in nearly all prostate tumors having a Gleason score ranging from 6 to 10. A higher score correlates with inferior tumor differentiation and adverse outcomes. Additional significant factors include the PSA level and the illness stage.
Prostate cancer screening • The utilization of serum PSA for screening is a contentious issue. • Currently, the majority of countries lack a systematic prostate screening program. Current research indicates that screening may lead to overdiagnosis and overtreatment of numerous men with prostate tumors that are unlikely to exhibit aggressive behavior.
TNM 7 pathological staging of prostatic carcinomas
Primary tumour (T)
pT1a: tumour incidental histologic fi nding in 5 % or less of TURP tissue.
pT1b: tumour incidental histological fi nding in more than 5 % of TURP
tissue.
pT1c: tumour identifi ed by needle biopsy (e.g. because of elevated PSA).
pT2a: tumour involves one half of one lobe or less.
pT2b: tumour involves more than half of one lobe, but not both lobes.
pT2c: tumour involves both lobes.
pT3a: extracapsular extension or microscopic bladder neck invasion.
pT3b: tumour invades seminal vesicle(s).
pT4: tumour invades adjacent structures other than seminal vesicles.
Regional lymph nodes (N)
pN0: no regional lymph node metastasis.
pN1: regional lymph node metastasis
Definition: A malignant epithelial tumor originating in the prostate. Epidemiology: The predominant malignant neoplasm in males. • Increasing prevalence attributed to prolonged life expectancy and enhanced detection methods. • A less significant contributor to cancer-related mortality, as numerous instances have a rather indolent progression.
Aetiology: Racial background and genetic predispositions are significant, with a 5–10-fold elevated risk in males possessing two or more affected first-degree relatives. • Dietary correlation with animal-derived items, especially red meat.
Carcinogenesis • Originates from a precursor lesion termed prostatic intraepithelial neoplasia (PIN), distinguished by the neoplastic transformation of the epithelial lining of the prostatic ducts and acini. • Contains mutations in several genes, including GST-pi, PTEN, AMACR, p27, and E-cadherin (notably, these are not conventional tumor suppressor genes or oncogenes). The majority of prostate cancers are asymptomatic and are detected when a needle biopsy is conducted due to an elevated prostate-specific antigen (PSA) level or a suspicious finding during a digital rectal examination (DRE). • LUTS may be evident. • Infrequently, patients exhibit symptoms indicative of metastatic disease.
Macroscopy • Initial instances of latent prostate cancer are improbable to be discernible macroscopically. • Larger tumors may present as firmer regions that contrast in color with the adjacent prostatic tissue.
Histopathology • Nearly all prostate carcinomas are glandular epithelial neoplasms, specifically adenocarcinomas. • A principal diagnostic characteristic of prostate cancer is the atypical architecture of the malignant glands, which exhibit crowding and a disorganized growth pattern relative to adjacent normal acini. • Malignant epithelial cells exhibit enlarged nuclei with conspicuous nucleoli and denser amphophilic cytoplasm. • Malignant glands frequently contain intraluminal crystalloids (dense crystalline structures), pink secretions, or blue-tinged mucin. • A morphological diagnosis or suspicion of prostate carcinoma can be immunohistochemically validated by the absence of basal cells encircling the malignant glands. Typical basal cell markers employed for this purpose encompass p63 and high molecular weight keratins.
Prognosis • The primary determinant is the histological grade, referred to as the Gleason score, named after the pathologist who initially developed the system. • The Gleason score varies from 2 to 10 and is derived by summing two integers between 1 and 5, reflecting the architectural growth patterns of the tumor. In actuality, patterns 1 and 2 are rarely identified, resulting in nearly all prostate tumors having a Gleason score ranging from 6 to 10. A higher score correlates with inferior tumor differentiation and adverse outcomes. Additional significant factors include the PSA level and the illness stage.
Prostate cancer screening • The utilization of serum PSA for screening is a contentious issue. • Currently, the majority of countries lack a systematic prostate screening program. Current research indicates that screening may lead to overdiagnosis and overtreatment of numerous men with prostate tumors that are unlikely to exhibit aggressive behavior.
TNM 7 pathological staging of prostatic carcinomas
Primary tumour (T)
pT1a: tumour incidental histologic fi nding in 5 % or less of TURP tissue.
pT1b: tumour incidental histological fi nding in more than 5 % of TURP
tissue.
pT1c: tumour identifi ed by needle biopsy (e.g. because of elevated PSA).
pT2a: tumour involves one half of one lobe or less.
pT2b: tumour involves more than half of one lobe, but not both lobes.
pT2c: tumour involves both lobes.
pT3a: extracapsular extension or microscopic bladder neck invasion.
pT3b: tumour invades seminal vesicle(s).
pT4: tumour invades adjacent structures other than seminal vesicles.
Regional lymph nodes (N)
pN0: no regional lymph node metastasis.
pN1: regional lymph node metastasis
- Published on
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
- Published on
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.
- Published on
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.
- Published on
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
- Published on
Pathology - Non-malignant kidney neoplasms
Papillary adenoma • Benign renal epithelial neoplasm exhibiting a papillary or tubulopapillary structure, measuring 5mm or less. • Commonly identified accidentally in nephrectomy specimens or during autopsy. Macroscopically, they are well-defined cortical nodules measuring 5 mm or smaller. Histologically, they consist of non-atypical epithelial cells exhibiting papillary or tubulopapillary arrangements.
Oncocytoma • Benign oncocytic renal epithelial tumor typically identified incidentally in adults. • The majority of instances are sporadic; nevertheless, certain occurrences are linked to hereditary abnormalities (e.g., Birt–Hogg–Dubé syndrome). Macroscopically, they are well-defined tumors exhibiting a mahogany brown hue, frequently accompanied by core scarring. Histologically, they are distinguished by cells possessing rich granular eosinophilic cytoplasm, proliferating in nests inside an edematous stroma. Oncocytomas are benign tumors that lack the ability for metastatic dissemination. Nonetheless, substantial tumors are frequently resected. • The infiltration of tumor cells into perinephric fat may occur, and this has no detrimental effect.
Angiomyolipoma • A benign mesenchymal tumor of the kidney consisting of varying quantities of adipose tissue, smooth muscle, and robust blood arteries. • Predominantly occurring sporadically in adults, a minor percentage is linked to tuberous sclerosis. These are more likely to be many and bilateral. • While most are discovered inadvertently, they may occasionally manifest with flank pain resulting from hemorrhage into the tumor. Macroscopically, they present as lobulated kidney masses that may exhibit a yellow appearance if their fat content is elevated. Histologically, they consist of a combination of adipose tissue, smooth muscle bundles, and thick-walled blood arteries in varying proportions.
Cystic nephroma • Benign cystic renal tumor with a significant preference for women. • Macroscopically, they are enclosed multicystic lesions devoid of a solid component. The cysts are microscopically bordered by a singular layer of flattened cuboidal epithelial cells. The septa may exhibit cellular regions that resemble ovarian stroma, and notably, the nuclei of the cells within the septa frequently respond to antibodies targeting estrogen and progesterone receptors
Leiomyoma • Benign leiomyomas typically originating from the renal capsule. • The majority manifest in adults as incidental, tiny, well-defined capsular tumors. • Histologically, they exhibit bundles of unremarkable smooth muscle cells.
Renomedullary interstitial cell tumor • Frequently observed benign renal tumors that are sometimes discovered inadvertently during autopsy examinations of the kidneys. Macroscopically, they are little (1–5mm) white nodules located at the center of a medullary pyramid. Histologically, they consist of tiny stellate or polygonal cells embedded in a loose stroma. Entrapped tubules may be located near the periphery of the lesion.
Papillary adenoma • Benign renal epithelial neoplasm exhibiting a papillary or tubulopapillary structure, measuring 5mm or less. • Commonly identified accidentally in nephrectomy specimens or during autopsy. Macroscopically, they are well-defined cortical nodules measuring 5 mm or smaller. Histologically, they consist of non-atypical epithelial cells exhibiting papillary or tubulopapillary arrangements.
Oncocytoma • Benign oncocytic renal epithelial tumor typically identified incidentally in adults. • The majority of instances are sporadic; nevertheless, certain occurrences are linked to hereditary abnormalities (e.g., Birt–Hogg–Dubé syndrome). Macroscopically, they are well-defined tumors exhibiting a mahogany brown hue, frequently accompanied by core scarring. Histologically, they are distinguished by cells possessing rich granular eosinophilic cytoplasm, proliferating in nests inside an edematous stroma. Oncocytomas are benign tumors that lack the ability for metastatic dissemination. Nonetheless, substantial tumors are frequently resected. • The infiltration of tumor cells into perinephric fat may occur, and this has no detrimental effect.
Angiomyolipoma • A benign mesenchymal tumor of the kidney consisting of varying quantities of adipose tissue, smooth muscle, and robust blood arteries. • Predominantly occurring sporadically in adults, a minor percentage is linked to tuberous sclerosis. These are more likely to be many and bilateral. • While most are discovered inadvertently, they may occasionally manifest with flank pain resulting from hemorrhage into the tumor. Macroscopically, they present as lobulated kidney masses that may exhibit a yellow appearance if their fat content is elevated. Histologically, they consist of a combination of adipose tissue, smooth muscle bundles, and thick-walled blood arteries in varying proportions.
Cystic nephroma • Benign cystic renal tumor with a significant preference for women. • Macroscopically, they are enclosed multicystic lesions devoid of a solid component. The cysts are microscopically bordered by a singular layer of flattened cuboidal epithelial cells. The septa may exhibit cellular regions that resemble ovarian stroma, and notably, the nuclei of the cells within the septa frequently respond to antibodies targeting estrogen and progesterone receptors
Leiomyoma • Benign leiomyomas typically originating from the renal capsule. • The majority manifest in adults as incidental, tiny, well-defined capsular tumors. • Histologically, they exhibit bundles of unremarkable smooth muscle cells.
Renomedullary interstitial cell tumor • Frequently observed benign renal tumors that are sometimes discovered inadvertently during autopsy examinations of the kidneys. Macroscopically, they are little (1–5mm) white nodules located at the center of a medullary pyramid. Histologically, they consist of tiny stellate or polygonal cells embedded in a loose stroma. Entrapped tubules may be located near the periphery of the lesion.
