225b prostate pathology Flashcards
prostatic base vs apex
base = bladder side apex = pelvic floor musculature
prostatic base vs apex
base = bladder side apex = pelvic floor musculature
prostate zone
PZ = peripheral, cancer zone CZ = central, cone around ejectultory duct TZ = transitional, BPH, around periurtheral zone
normal prostate histo
normal glands have big opening with irregular contours
2 cell layers:
basal cells - outer layer with support role, myo fxn too
acinar cells - inner cells, light stain, low N/C ratio, no nucleoli
prostate fxn
adds nutrients to sperm to form semen
liquefies semen via enzymes
conduit for urine
PSA
secreted by prostatic acinar and ductal epi cells (not basal cells)
glycoproteins (Serine protease), transcription regulated by androgen (affects PSA levels)
fxn - liquefies semen
not cancer specific, prostate specific (elevated in inflammation, cancer, BPH, etc)
prostatitis conditions
acute - PMNs
chronic a/bacterial - lymphocytes
granulomatous - histiocytes, mycobacteria treatment for bladder cancer, fungus
BPH - location and effects
occurs in transitional zone around peri-urethral
median lobe is from transition zone that gets very big form BPH
increases with age
can cause trabeculations and calculi
BPH
occurs in transitional zone around peri-urethral
increases with age
prostate zone
PZ = peripheral, cancer zone CZ = central, cone around ejectultory duct TZ = transitional, BPH, around periurtheral zone
normal prostate histo
normal glands have big opening with irregular contours
2 cell layers:
basal cells - outer layer with support role, myo fxn too
acinar cells - inner cells, light stain, low N/C ratio, no nucleoli
prostate fxn
adds nutrients to sperm to form semen
liquefies semen via enzymes
conduit for urine
PSA
secreted by prostatic acinar and ductal epi cells (not basal cells)
glycoproteins (Serine protease), transcription regulated by androgen (affects PSA levels)
fxn - liquefies semen
not cancer specific, prostate specific (elevated in inflammation, cancer, BPH, etc)
infections of prostate
prostatitis - clinical dx + culture (no biopsy)
normal see inflammation in prostate, doesn’t represent clinical usefulness
prostatitis conditions
acute - PMNs
chronic bacterial - UTI; chronic is lymphocytes
chornic abacterial
granulomatous - histiocytes, mycobacteria treatment for bladder cancer, fungus
BPH
occurs in transitional zone around peri-urethral
increases with age
BPH hormones
DHT for stroma cells
T for epithelial cells
BPH histo
nodular hyperplasia of glands and stroma
2 cell layers of basal + epi, stroma –> large caliber of glands
examine to exclude cancers
PC gleason grading
based on architecture, ignores cytologic features
combines 1st and 2nd most common patterns
shape of glands are important, not cytological (1-5 x 2)
3=small round glands that aren’t fused – 4 is fused without stroma; 5=sheets of cells, necrosis
PC types
acinar adenocarcinoma - vast majority of PC cases
PC risks
Age, AA, Family Hx, Western diet
PC precursor lesion
develops several decades before PC
PIN - prostatic intraepi neoplasia (high grade and low grade)
resemble cancer but retains basal cell layer (hasn’t invaded BM)
PC loses basal cells and invades BM
PC path evaluation (transrectal needle biopsy and prostatectomy)
biopsy - very small samples –> sampling error (20% false negative rate)
seminal vesicles locaiton
posterior and superior of prostate
PC histo
lumen is more round and smaller no basal cells nuclear enlargement nucleoli high N/C ratio dark cytoplasm
PC immunohisto stains
racemase –> HGPIN or cancer
p63 –> nuclear protein in basal cells (HGPIN not PC)
PC gleason grading
based on architecture, ignores cytologic features
combines 1st and 2nd most common patterns
shape of glands are important, not cytological (1-5 x 2)
3=small round glands that aren’t fused – 4 is fused without stroma; 5=sheets of cells, necrosis
where does PC spread?
vertebral bodies –> bones
Osteoblastic metastases
lichen sclerosis
associated with SCC
HSV penis
mutlple shallow nodules
w/ multinucleated cells
molluscum contaginosum
mutple flesh colored papules with central umblicaiton
condyloma cuminatum
genital warts - ofen multifocal HPV 6/11 koliocytes - perinuclear halo with raisin type nuclei NO BASAL LAYER INVOLVEMENT recur but dont progress
penile intraepithelial neoplasia
HPV 16, 18
E6–I p53, e7–I Rb
koliocytosis + BASAL CELL PROLIFERATION
bowen, erthyroplasia, bowenoid and SCC
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