|Year : 2019 | Volume
| Issue : 8 | Page : 82-86
Spectrum of urogenital tumors in males in Sub-Himalayan region: An institutional experience
Rakesh Panwar1, Anchana Gulati1, Rajni Kaushik1, Vijay Kaushal1, Pamposh Raina2
1 Department of Pathology, Indira Gandhi Medical College, Shimla, Himachal Pradesh, India
2 Department of Urology, Indira Gandhi Medical College, Shimla, Himachal Pradesh, India
|Date of Web Publication||22-Mar-2019|
Dr. Anchana Gulati
Department of Pathology, Indira Gandhi Medical College, Shimla - 171 001, Himachal Pradesh
Source of Support: None, Conflict of Interest: None
Aims: The clinical presentation and frequency of urogenital tumors varies in different regions of the world. This study was undertaken to analyze the frequency, clinical presentation, and the histopathological spectrum of the various male urogenital tumors diagnosed over a period of 3 years in a tertiary care institute.
Materials and Methods: Three-year data were collected from the histopathology laboratory, which included all the cases of male urogenital tumors which were diagnosed histopathologically between November 2012 and October 2015.
Results: A total of 10,297 surgical specimens of male patients were received in 3 years, of which 1749 were tumors of various organs in males. Of 1749 surgical specimens, 455 were genitourinary tumors. Frequency of urogenital tumors in males was 13.05%. Malignant tumors comprised the majority (99.53%). The age of the patients ranged from 19 to 98 years. The maximum number of patients was in the 5th–7th decade and the mean age of presentation was 64 years. Urinary bladder was the most common site for urogenital tumors (61.09%), with urothelial carcinoma being the most common histological type. Prostatic adenocarcinoma, renal cell carcinoma, and penile squamous cell carcinoma accounted for a significant number of cases. Testicular tumors were the least common and included predominantly mixed germ cell tumors.
Conclusion: This study can be taken as a small step toward making the registry of patients with urogenital tumors providing valuable information regarding the frequency, clinical presentation, and histological spectrum. Large population-based studies for a longer duration of time across both males and females are needed in the ever-changing trends of urogenital tumors.
Keywords: Male Urogenital tumors, penis and testis, prostate, renal, urinary bladder
|How to cite this article:|
Panwar R, Gulati A, Kaushik R, Kaushal V, Raina P. Spectrum of urogenital tumors in males in Sub-Himalayan region: An institutional experience. J Can Res Ther 2019;15, Suppl S1:82-6
|How to cite this URL:|
Panwar R, Gulati A, Kaushik R, Kaushal V, Raina P. Spectrum of urogenital tumors in males in Sub-Himalayan region: An institutional experience. J Can Res Ther [serial online] 2019 [cited 2020 Nov 28];15:82-6. Available from: https://www.cancerjournal.net/text.asp?2019/15/8/82/244221
| > Introduction|| |
Urogenital tumors account for significant morbidity and mortality worldwide. In males, since the urinary and reproductive systems merge and utilize common ducts to allow passage of products outside the body, their lesions are best studied together. Their frequency and clinical presentation varies in different regions of the world.
It is important to understand the epidemiological features and improve our knowledge of cancer incidence so as to assess the effects of diagnostic screening and intervention measures. Although numerous studies have been carried out in various parts of the country, there is paucity of literature on the histopathologic data and frequency of these tumors from our state. Hence, this study was planned.
| > Materials and Methods|| |
All male patients who underwent biopsy for suspected urogenital tumor and tumor resection in the Department of Urology and Surgery, Indira Gandhi Medical College, Shimla, Himachal Pradesh, between November 2012 and October 2015 were included in the study.
The samples for histopathology were collected for 1 year (November 2014–October 2015), and 2-year retrospective data were retrieved from the records of histopathology laboratory. The cumulative total of the cases from the 3-year data was taken into consideration for analysis.
Consent was taken from the patients and the study was approved by the Institutional Ethics Committee.
| > Results|| |
A total of 10,297 surgical specimens of male patients were received in 3 years, of which 1749 were tumors of various organs in males. Of 1749 surgical specimens, 455 genitourinary tumors were diagnosed. Of these, 396 were small biopsies and 59 were large specimens. Frequency of urogenital tumors in males was 13.05%. Malignant tumors comprised 99.53% of the total urogenital tumors. Only two benign tumors were encountered in the study including angiomyolipoma of kidney and inverted papilloma of urinary bladder.
The age of the patients ranged from 19 to 98 years. The maximum number of patients was recorded in the age group of 50–70 years, with the mean age of presentation being 64 years. The youngest patient diagnosed with bladder tumor was 19 years old.
Urinary bladder was the most common site for urogenital tumors (61.09%), followed by prostate (24.20%) and kidney (8.80%). Penile and testicular tumors accounted for 3.70% and 2.21% cases, respectively. Site-wise distribution and mean age of presentation of various urogenital tumors are shown in [Table 1].
|Table 1: Distribution of male benign and malignant urogenital tumors with mean age of presentation at different sites|
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Clinically, most of the patients with urogenital tumors presented with urinary frequency, hesitancy, urgency, and hematuria. Few patients had back pain, erectile dysfunction, fever, and anemia. In some patients, abdominal mass, ascites, jaundice, and loin pain were the presenting symptoms. Different clinical features associated with urogenital tumors are shown in [Table 2].
Among urinary bladder tumors, papillary urothelial (transitional cell) carcinoma was the most common accounting for 92.80% cases with high-grade lesions comprising the majority [Figure 1] and [Figure 2]. Renal cell carcinoma of clear cell type comprised majority (76%) of renal tumors with lesser number of other variants [Figure 3]. Prostate tumors constituted 24.20% of cases, and prostatic adenocarcinoma was the most common (88.18%) [Figure 4]. Majority of these prostatic adenocarcinoma cases (65.9%) showed moderate differentiation with Gleason's score of 5–7. Penile tumors were 17 in number (3.70%) and majority (88.24%) were squamous cell carcinoma. Testicular tumors were only 10 in number (2.21%) and mixed germ cell tumor (GCT) was the most common type.
|Figure 2: High-grade transitional cell carcinoma, urinary bladder (H and E, ×400)|
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|Figure 3: Renal cell carcinoma, conventional clear cell type (H and E, ×100)|
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The histopathological spectrum of various urogenital tumors is shown in [Table 3] and [Table 4].
| > Discussion|| |
Cancer is a major public health problem worldwide. Urogenital tumors account for a significant number of cases. A rapid rise has been observed over a period of time, resulting in increased morbidity and mortality. In our 3-year study of urogenital tumors in males, we found an incidence of 13.05% which was comparable to that of Sharma et al. who reported an incidence of 14.19% in their 6-year study.
Various studies have been done globally in the past and are being done to reflect the incidence of these tumors and evaluate the efficacy of preventive measures taken. The urogenital tumors usually occur in the elderly age group, except for testicular tumors, most of which occur in younger age group. Maximum patients in our study were in the 5th–7th decade and the mean age of presentation was 64 years. On organ-wise analysis, age of the patients with prostate and penile cancer was similar to that observed by Chandra et al. and Klufio.
Urogenital tumors encompass a wide spectrum of lesions and can have varied presentation. In the present study, 43.5% of patients presented with urinary frequency, 38.46% with hematuria, and 32.96% with weight loss. These were concordant with observations of Chandra et al. In other studies, clinical presentation of the patients has not been analyzed.
These tumors may show varied frequency in different regions of the world. We observed bladder cancer as the most common urogenital malignancy (69.09%), followed by prostate carcinoma (24.02%). Similar observations were made by Sugandi, Sharma et al., and Akbari et al. However, Chandra et al., Bowa et al., Klufio, and Magoha and Kaale. found prostate cancer to be the most common. Increased frequency of urinary bladder tumors in our study is possibly because most of our patients were smokers and cigarette smoking is one of the established risk factors of this malignancy.
Renal cell carcinoma is considered to be the malignancy of 6th–7th decade of life based on data from developed countries. In India, more patients are presenting at younger age with advanced stage. In this study, renal tumors accounted for 8.80% cases which were similar to the findings of Sharma et al. (10.3%) and Klufio (10.4%). Renal cell carcinoma accounted for 80% of cases and was the most common. This was concordant to the observations by Chandra et al. and Agnihotri et al. Sharma et al., Klufio, and Isah et al. found nephroblastoma as the most common type probably because they had more number of patients in the younger age group. Conventional clear cell carcinoma was the most common histological type (76%), and frequency of the variants observed by us was comparable to Agnihotri et al.
Among bladder tumors, transitional cell carcinoma accounted for 95.3% of cases, which was similar to observations by most workers.,,, Bowa et al. from Zambia had reported increased incidence of squamous cell carcinoma due to the presence of schistosomiasis, HIV infection, and bladder stones. Klufio also found higher frequency of squamous cell carcinoma due to associated schistosomiasis.
Prostate cancer is the second most frequently diagnosed cancer among men after lung cancer. In the present study, prostate tumors accounted for 24.20% cases comparable to 21.13% reported by Sharma et al. The mean age of presentation was 70 years comparable to Chandra et al. and Aslam et al. Adenocarcinoma accounted for 88.18% of cases; 10.91% cases of Prostatic intraepithelial neoplasia (PIN) and one case of transitional cell carcinoma (TCC) were also found. Majority of the cases were of moderate differentiation with Gleason's score 5–7 comparable to the studies by Chandanwale et al. and Wadgaonkar et al.
Cancer of the penis is a rare disease worldwide. It has lower prevalence in most developed countries. It is a more serious health problem in less-developed countries, especially in Asia, Africa, and South America. In the present study, 17 (3.70%) patients with penile cancer were recorded. Frequency was in range with Klufio and Chandra et al., but lower in comparison to other studies. The mean age of presentation in our patients was 57.5 years, which was comparable to that of Chandra et al. and Klufio. Majority of cases revealed squamous cell carcinoma (82.35%). This is similar to other studies.,,,,
Although the incidence of testicular tumors is low, it is one of the most common malignancies occurring in young adults. They exhibit heterogeneity in histological pattern which varies with age. In our study, testicular tumors were the least common, found in 10 (2.21%) patients. The frequency of tumors in our study is less as compared with Chandra et al. and Sharma et al., though comparable to that of Bowa et al. and Klufio. The mean age of presentation in this study was 40 years. Sharma et al., Deore et al., Gupta et al., and Chandra et al. had found GCT as the most common tumor which is concordant with our study.
We observed that patients from the remote areas presented late to the hospital leading to increased severity and late detection of tumors. This study being hospital based does not give the exact incidence of urogenital tumors, but it can be used to estimate the disease burden in this region.
| > Conclusion|| |
The present study provides valuable information to clinicians and pathologists about frequency, clinical presentation, and histopathological types of male urogenital tumors in the Sub-Himalayan region which can further be used to chalk out management strategies for these tumors.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| > References|| |
Singh I. Urogenital system. In: Human Embryology. 10th
ed. New Delhi: Jaypee Brothers Medical Publishers (P) Ltd ; 2014. p. 282-96.
Sharma S, Nath P, Srivastava AN, Singh KM. Tumours of the male urogenital tract: A clinicopathologic study. J Indian Med Assoc 1994;92:357-60, 372.
Chandra S, Chandra H, Gaur DS. Male Genitourinary Tumors. 14 Years of Experience in Garhwal Region. Martin and Harris Private Ltd: Thacker Calcutta: The Indian Medical Gazette; 2014. p. 1-5.
Klufio GO. A review of genitourinary cancers at the korle-bu teaching hospital Accra, Ghana. West Afr J Med 2004;23:131-4.
Sugandi S. Referral pattern of urological malignancy in Indonesia. Br J Urol 1989;63:1-3.
Akbari ME, Hosseini SJ, Rezaee A, Hosseini MM, Rezaee I, Sheikhvatan M, et al
. Incidence of genitourinary cancers in the Islamic republic of Iran: A survey in 2005. Asian Pac J Cancer Prev 2008;9:549-52.
Bowa K, Kachimba JS, Labib MA, Mudenda V, Chikwenya M. The pattern of urological cancers in Zambia. Afr J Urol 2009;15:84-7.
Magoha GA, Kaale RF. Epidemiological and clinical aspects of carcinoma of penis at Kenyatta national hospital. East Afr Med J 1995;72:359-61.
Agnihotri S, Kumar J, Jain M, Kapoor R, Mandhani A. Renal cell carcinoma in India demonstrates early age of onset & a late stage of presentation. Indian J Med Res 2014;140:624-9.
] [Full text]
Isah RT, Sahibi SM, Adamu SN, Muhammad AT, Mungadi IA. Histopathological pattern of renal tumors seen in Usmanu Danfodio university teaching hospital Sokoto Nigeria. Afr J Cell Path 2013;1:9-13.
Selhi PK, Bansal H, Kaur H, Sood N, Malhotra V. Pathological spectrum of urinary bladder. Natl J Integr Res Med 2014;5:25-9.
Beniwal K, Goel S, Rana P. Clinicopathological analysis of urinary bladder tumors in a tertiary care institute in North India. Int J Sci Study 2015;2:95-9.
Joshi HN, Makaju R, Karmacharya A, Karmacharya RM, Shrestha B, Shrestha R, et al
. Urinary bladder carcinoma: Impact of smoking, age and its clinico-pathological spectrum. Kathmandu Univ Med J (KUMJ) 2013;11:292-5.
Aslam HM, Shahid N, Shaikh NA, Shaikh HA, Saleem S, Mughal A, et al.
Spectrum of prostatic lesions. Int Arch Med 2013;6:36.
Chandanwale S, Jadhav PS, Anwekar C, Kumar H, Buch AC, Chaudhari US. Clinicopathological study of benign and malignant lesions of prostate. Int J Pharm Bio Sci 2013;3:162-78.
Wadgaonkar AR, Patil AA, Mahajan SV, Yengantivar RP. Correlation of serum prostate specific antigen (PSA) level in various prostate pathology in elderly men. Int J Basic Appl Med Sci 2013;3:274-81.
Pahwa M, Girotra M, Rautela A, Abrahim R. Penile cancer in India: A clinicoepidemiological study. Gulf J Oncolog 2012;(12):7-10.
Greenlee RT, Murray T, Bolden S, Wingo PA. Cancer statistics, 2000. CA Cancer J Clin 2000;50:7-33.
Deore KS, Patel MB, Gohil RP, Delvadiya KN, Goswami HM. Histopathological analysis of testicular tumors: A 4 year experience. Int J Med Sci Pub Health 2015;4:554-7.
Gupta A, Gupta S, Gupta Y. Study into the pattern of urogenital tumors. Jk Sci 2011;13:185-9.
[Figure 1], [Figure 2], [Figure 3], [Figure 4]
[Table 1], [Table 2], [Table 3], [Table 4]