L26 Pathology of male genital system Flashcards
Prostatic specific antigen is produced by __________, secreted and hence detected in semen.
Prostatic epithelium
____________ is produced from testosterone via 5a reductase, which enhances the development of prostate.
Dihydrotestosterone
What are the 4 zones of prostate?
- Peripheral
- Transitional
- Central
- Periurethral zone
Which zone is palpable during DRE? Why is this zone significant?
Peripheral zone;
It is the primary site for CA prostate
Which zone is the primary site for glandular component of BPH?
Transitional zone
What is the significance of periurethral zone of prostate?
Primary site for stromal (fibromusclar) component of BPH
> urethral obstruction
Which zone is free of Ca prostate or BPH?
Central zone
What can be seen in a normal prostate histological slide? (4)
- Glandular structures
- Lined by inner columnar (luminal cell) and outer flattened epithelium (basal cells)
- Presence of corpora amylacea, which are small hyaline masses of unknown significance found in the glandular lumen of prostate
_________ is the most common cause of enlarged prostate in > 50 years old and Prostate carcinoma is the 1/2/3 MC cancer in HK adult male?
Benign prostate hyperplasia;
3rd
What are the risk factors of BPH and CA prostate respectively? (4)
BPH
- increased sensitivity of prostate tissue to DHT
Prostatic carcinoma
- Age, smoking, high fat diet
- Hormonal: DHT-dependent
- Genetics: TMPRSS2: ERG fusion gene in 50% of the cases, may disrupt androgen receptor signalling > castration-resistant CA prostate
What is the pathologic changes of BPH? (PP***) (2)
- Nodular hyperplasia of glands and stromal cells in transitional zone
- Nodular hypertrophy of muscles
Microscopic difference between BPH and CA prostate?
BPH
- glandular and fibromuscular proliferate with basal cell intact (+ presence of corpora amylacea)
CA prostate
- Glandular differentiation with lack of basal cells (ie. stromal invasion) > 1 cell type only
What is the MC CA prostate?
Which zone is affected?
Pathological changes?
- Adenocarcinoma;
- Peripheral zone;
- Prostate intraepithelial neoplasia (PIN): precursor lesion; basal cells still intact
What are the clinical symptoms of BPH? (6)
Obstructive (DISH)
- due to bladder outflow obstruction
1. Dribbling
2. Incomplete stream
3. Hesitancy
Irritative (FUN)
- caused by detrusor muscle thickening and instability due to fibrosis and muscle hypertrophy as a result of bladder outflow obstruction
4. Frequency
5. Urgency
6. Nocturia
Which of the following regarding BPH is incorrect?
A. It can cause post-renal azotaemia
B. it can cause cystitis
C. It can cause AROU
D. It is a risk factor for prostate cancer
E. It is diagnosed by transrectal ultrasound (TRUS) ad increased in PSA (30-50%)
D is incorrect
A-C: obstructive uropathy
How is prostate cancer diagnosed?
- Transrectal USG + Transrectal biopsy
- Serum PSA - sensitive but not specific highly predicitive if >10 ng/mL
DRE: negative in 10% cases
What are the treatment options for benign prostate hyperplasia? (3)
- alpha-blockers: tamsulosin
- 5alpha-reductase: finasteride
- Transurethral resection of the prostate
Treatment options of prostate cancer
Early: surgery, radiotherapy
Advanced: hormonal (medical castration), chemotherapy , radiotherapy
If the prostatic cancer is palpable in DRE, it belongs to stage _________ in TNM staging?
T2
Briefly describe what is Gleason score.
For prediction of prognosis in CA prostate.
Gleason grade = histologic pattern
Gleason score = common pattern + highest pattern
Grading is based on the sum of the 2 most prominent histological patterns in prostate biopsy, with the score of 1 (well-differentiated) to 5 (poorly differentiated)
What is the congenital testis disorder named?
Briefly describe.
Cryptorchidism
- failed descent of testes
Which of the following about cryptorchidism is incorrect?
A. It is mostly bilateral
B. if unilateral, complications appear for both cryptorchid +/- normal testis
C. It may cause infertility due to arrest in Ferm cell maturation
D. Testicular atrophy may occur
E. Seminoma may arise
A is incorrect
90% unilateral
Vascular torsion of testis may be due to trauma or cryptorchidism.
Symptoms include? (3)
Tx? (2)
- Acute testicular pain
- Absent cremasteric reflex
- Hemorrhagic infarction
- Due to spontaneous remission, orchidectomy is required
What are the causative agents causing Epididymitis and orchitis? (5)
Specific
- N.gonorrhoeae,
- Chlamydia trachomatis
- TB
- Mumps
Non-specific: secondary to UTI
