Transcript Pictorial Lessons in Genitourinary Cancers

Pictorial Lesson in
Genito-urinary Cancers
Prostate Cancer
Gleason pattern scores
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This is one of the
standard grading
systems for prostate
adenocarcinomas.
Five histological
patterns are
identified. Patterns 1
and 2 correspond to
well-differentiated
cancers.
Pattern 3 marks a
moderately
differentiated cancer
and patterns 4 and 5
correspond to poorly
differentiated or
anaplastic lesions.
Gleason grade
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Grade 1. This
lesion forms a
sharply
circumscribed
aggregate of
small, uniform
glands
Gleason grade
5 A seminal
vesicle has
been invaded
by single
tumour cells of
a high-grade
lesion.
Staging of Prostate Cancer
MRI Ix
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Two axial T2-weighted
images from a prostate
MR using an endorectal
coil.
The normal
differentiation between
the lower signal central
zone (CZ) and the higher
signal peripheral zone
(PZ) is evident. The
rectum (R) is distended
by the coil.
At a lower position in the
prostate, a focal area of
low signal in the left
peripheral zone is seen
(black arrows) indicating
an area of infiltration
with tumour. The
margins of the prostate
capsule (white arrows)
appear intact. The
rectum (R) and pubic
symphysis (PS) are
marked for orientation.
Bone metastases
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Bone mets are common
Bone scans in metastatic
prostate cancer exhibit a
'Christmas tree' pattern of
radionuclide uptake, with
multiple rib, vertebral and
long bone metastases.
Osteoblastic metastases in
the pelvis and ribs may be
confused with metastases
from another site.
An immunohistochemical
PSA determination on
tumour tissue (or a serum
level) can confirm the
diagnosis.
Bone metastases
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Pelvic
metastases
on bone
scan
Bone metastases
Liver metastases
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In unusual
instances,
prostate cancer
can metastasize
to the liver.
Discrete
nodularity is the
most common
pattern
Anti-androgen therapy
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Gynecomastia in a
man treated with
antiandrogen
monotherapy, a
common treatment
modality in this
angdrogen driven
tumour
Prophylactic breast
irradiation may
inhibit growth of
breast tissue.
Prostate sarcoma
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35-year-old man
with a very
unusual sarcoma
of the prostate.
Vasogram shows
dilated seminal
vesicle due to
obstruction from
the tumour.
CT
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CT scan shows
large sarcoma of
the prostate
displacing the
urinary bladder
and rectum .
Bladder Cancer
Staging Bladder Cancer
Carcinoma in situ
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Diffuse mucosal
erythema with
redness not
confined within
blood vessels is
seen in the
foreground of this
cystoscopic view.
This is one
appearance of a
diffuse in situ
lesion
Hemorrhagic cystitis
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This 70-year-old woman
had recurrent episodes of
hemorrhagic cystitis over
many years related to
chronic use of
cyclophosphamide.
Cystectomy was required
for control of symptoms.
Note markedly thickened
bladder wall. In some
cases, the metabolites
(especially acrolein) of
cyclophosphamide can
result in bladder
carcinoma.
Transitional cell carcinoma
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Cystoscopic
findings are
frequently
predictive of the
histologic grade of
tumour and are
useful in assessing
adjacent
urothelium.
This discrete grade
II papillary lesion
(TA or T1) is
surrounded by
normal mucosa.
Transitional cell carcinoma.
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The two large, round
masses evident in
this cystogram
represent papillary
tumours.
The contrast
material enters the
crypts, causing a
fuzzy, ill-defined
appearance at the
edges of the
masses.
Transitional cell carcinoma
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This high-grade
tumour exhibits
focal squamous
differentiation
(centre).
It should not be
misdiagnosed as
a squamous cell
carcinoma, which
usually shows
intercellular
bridging and
keratin pearls.
Macrocsopic specimen
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The ulcerated,
necrotic
tumour in this
cystectomy
specimen has
raised edges
that appear
sharply
demarcated
from the
surrounding
mucosa.
Several
bladder calculi
are present.
Bone metastases
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Plain film of the tibia
shows osteolytic
metastases in the mid
shaft in a patient with
advanced transitional
cell carcinoma of the
bladder.
Surprisingly, these
lesions can undergo
healing with intensive
combination
chemotherapy.
If the lesion is isolated
and small, it can be
surgically resected.
Renal Tumours
Staging of Renal Tumours
Renal cell carcinoma
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Calcifications in
both renal beds
are suggestive of
renal carcinoma,
especially in this
patient with von
Hippel-Lindau
disease, a
genetic disorder
which
predisposes to
renal cancer
Renal cell carcinoma
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Grossly
enlarged right
kidney on CT
Renal cell carcinoma
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In addition to
renal vein
invasion, this
arteriogram
shows
neovascularity
in the tumour,
as well as in
the course of
the renal vein.
Renal cell carcinoma
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With massive
invasion by
tumour, the renal
vein may become
occluded by
adherent tumour
thrombus
Renal cell carcinoma histology
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The classic clear
cell variant of
renal cell
carcinoma is
composed of
cells with
abundant
cytoplasm
containing lipid
and glycogen
Renal cell carcinoma
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Soft tissue
metastases in
the lower
chest and
flank
developed in
this 57-yearold woman, 1
year after
nephrectomy.
Testicular Cancer
Staging of Testicular Cancer
Leydig cell tumor
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This tumour
forms a
small,
circumscribed
yellow nodule
(arrow)
within the
testis.
Seminoma
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A lymphatic infiltrate
is typical in
seminomas.
Multinucleate
histiocytes (giant
cells) may be seen in
seminomas and
should not be
confused with
syncytiotrophoblastic
cells.
The nuclei of the
giant cells have a
uniform vesicular
appearance identical
to that of
mononuclear
histiocytes.
Mature teratoma
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.A 24-year-old
patient with
metastatic
mixed
embryonal
cell
carcinoma,
and a
persistent
mass in the
abdomen and
lung
Pulmonary metastases
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Chest film shows
numerous metastatic
deposits of testicular
embryonal cell carcinoma.
A dramatic response can
be seen following
combination chemotherapy
containing cisplatin.
This chemotherapeutic
protocol achieves over a
90% cure rate for
metastatic disease.
Penile Cancer
Staging of penile cancer
Carcinoma in situ
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This lesion
presents clinically
as a welldemarcated,
slightly elevated
erythematous
plaque.
Squamous cell carcinoma
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This
resection
specimen
shows a
small lesion
arising in
the coronal
sulcus.
HPV association
 Tumours
are related to human
papilloma virus, which is
carcinogenic.
 Treatment is surgical, or with
radiotherapy