225b prostate pathology Flashcards by Daniel Reinhardt

prostatic base vs apex

base = bladder side
apex = pelvic floor musculature

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prostatic base vs apex

base = bladder side
apex = pelvic floor musculature

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prostate zone

PZ = peripheral, cancer zone
CZ = central, cone around ejectultory duct  
TZ = transitional, BPH, around periurtheral zone

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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

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prostate fxn

adds nutrients to sperm to form semen
liquefies semen via enzymes
conduit for urine

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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)

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prostatitis conditions

acute - PMNs

chronic a/bacterial - lymphocytes

granulomatous - histiocytes, mycobacteria treatment for bladder cancer, fungus

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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

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BPH

occurs in transitional zone around peri-urethral

increases with age

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prostate zone

PZ = peripheral, cancer zone
CZ = central, cone around ejectultory duct  
TZ = transitional, BPH, around periurtheral zone

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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

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prostate fxn

adds nutrients to sperm to form semen
liquefies semen via enzymes
conduit for urine

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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)

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infections of prostate

prostatitis - clinical dx + culture (no biopsy)

normal see inflammation in prostate, doesn’t represent clinical usefulness

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prostatitis conditions

acute - PMNs

chronic bacterial - UTI; chronic is lymphocytes

chornic abacterial

granulomatous - histiocytes, mycobacteria treatment for bladder cancer, fungus

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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