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Reproduction Week 1 > Lecture 8: Prostate Pathology > Flashcards

Lecture 8: Prostate Pathology Flashcards

1
Q

What is the function of the prostate gland?

A

It is the exocrine compound tubule-alveolar gland
Function is to secrete a slightly ALKALINE fluid (to counter acidic vagina)
Milky, or white in appearance
Usually constitutes 20-30% of semen volume along with spermatozoa and seminal vesicle fluid
Sprematozoa that is expelled in prostatic fluid have better motility, longer survival and better protection of DNA

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2
Q

What is the McNeal Anatomic model for prostate?

A
  1. Glandular Compartments

2. Non-glandular compartments

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3
Q

What are in the GLANDULAR compartments for the Mcneal Anatomic model for the prostate?

A
  1. Peripheral Zone (PZ)
  2. Central Zone (CZ)
  3. Transitional Zone (TZ)
  4. Periurethral gland Region (PU)
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4
Q

What are in the non-glandular compartments?

A
  1. Anterior fibromuscular stroma

2. Preprostatic Sphincter

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5
Q

What is the “lobe” classification of prostate used in?

A 
Used for anatomy NOT for pathology
Anterior lobe (isthmus) = part of transitional zone
Posterior lobe = peripheral zone
Lateral lobe spans all zones
Median lobe = part of central zone
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6
Q

What does PUGR stand for?

A

Periurethral gland region

One of the 4 zones

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7
Q

What does PU stand for? Significance?

A

Prostatic urethra

Used by McNeal as key anatomic landmark

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8
Q

What does UP stand for?

A

Proximal prostatic urethra

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9
Q

What does UD stand for?

A

Distal prostatic urethera

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10
Q

What does SV stand for?

A

Seminal vesicle

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11
Q

Where do the ejaculatory ducts pass?

A

The central zone

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12
Q

What are the key characteristics of the peripheral zone?

A

Approximately 70% of normal gland in young men
Sub-capsular portion of the POSTERIOR aspect of the gland that surrounds the distal urethra
70-80% of prostatic cancers originate from the peripheral zone

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13
Q

What is the key characteristics of Central zone?

A

25% of normal gland
Surrounds the ejaculatory duct
Secondary involvement in prostatic cancers

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14
Q

What are the key characteristics of the transition zone?

A

5% of normal gand
Responsible for BENIGN PROSTATIC HYPERPLASIA
10-20% of prostate cancers
Surrounds proximal urethra

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15
Q

What are the key characteristics of the anterior fibro-muscular zone?

A

5%
Devoid of glandular components
Composed only of muscle and fibrous tissue

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16
Q

What part of the prostate is responsible for benign prostatic hyperplasia (BPH)?

A

Transitional zone (TZ)

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17
Q

What are the two layers of cells in the prostate?

A
  1. Basement membrane

2. Epithelial layer

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18
Q

What does the normal microscopic anatomy of prostate look like?

A
  1. branching tubuloalveolar system
  2. originate from urethra in curvilinear pattern
  3. apical and basal layer in glands
  4. FEW endocrine cells
  5. glands sit in fibromuscular stroma
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19
Q

What types of cells in prostate?

A
  1. secretory cells
  2. Basal cells
  3. Endocrine-paracrine cells
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20
Q

What does PSA stand for?

A

Prostate specific antigen
…could also be misconstrued as prostate-specific
actin

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21
Q

What is the definition of BPH?

A

Nodular prostate enlargement due to cellular proliferation of prostatic glands and stroma associated with lower UTI symptoms
LUTS = lower urinary tract symptoms

22
Q

What is the etiology of BPH?

A

Pathophysiology remains poorly understood

Perhaps hormonal alterations play a major role (accumulation of testosterone?)

23
Q

What are risk factors of BPH?

A

Aging
Family history
Estrogen

24
Q

What is the prevalence of BPH?

A

50% of men in 50s

80% men in their 80s

25
Q

What is the most common cause of non cancerous rise in PSA?

A

BPH

PSA – prostate-specifc antigen

26
Q

What is the significance of LUTS features?

A

Without lower urinary tract symptoms, glandular and stromal proliferation is NOT BPH

27
Q

What is the hallmark of BPH?

A

Nodular prostatic enlargement
Hyperplastic nodules
-mainly centered on proximal prostatic urethra
-involve transition zone and submucosal compartment

28
Q

When do you biopsy patients who are asymptomatic??

A

Increased serum PSA
Abnormal digital rectal exam
Peripheral zone is enlarged (posterior)
This is prostate carcinoma

29
Q

What is PCA?

A

Prostate carcinoma

30
Q

What is DRE?

A

Digital Rectal exam

31
Q

What is the epidemiology of PCA?

A

6th most common cancer in world
PCA is the MOST COMMON malignancy in men
Affects AFRICAN-AMERICANS much more
2nd most lethal cancer after lung cancer

32
Q

What are risk factors for PCA?

A 
Red meat
Animal products (heterocyclic amine content?)
33
Q

What are the two types of PCA?

A
  1. Asymptomatic

2. Symptomatic

34
Q

What are the characteristics of Symptomatic Prostate carcinoma?

A
  1. Obstructive bladder symptoms
    • transition zone cancer therefore may have had cancers before
  2. Pelvic pain
    • local extension
  3. Bone pain
    • bone metastasis
35
Q

What does the term PCA include?

A
  1. acinar adenocarcinoma
  2. ductal adenocarcinoma
  3. adenosquamous and squamous cell carcinoma
  4. basaloid and adenoid cystic carcinoma
  5. small cell carcinoma
  6. sarcomatoid carcinomas
36
Q

What produces prostate specific antigen? Purpose?

A

It is synthesized by secretory cells of the epithelium
Increased diffusion into serum when basement membrane is breached by PCA
Liquefies semen and increases motility

37
Q

What are the macroscopic features of PCA?

A

Lack of necrosis or hemorrhage
No sharp borders
Indurated yellow mass

38
Q

Is there a PSA cut off at which a man can be guaranteed to be free from prostate cancer?

A

No

39
Q

Where do PCA usually arise from?

A

Peripheral zone (75-80%)
Tranistional zone responsible for 15-25%
50% are multifocal

40
Q

What are the categories of microscopic features of PCA?

A
  1. Architectural featuers
  2. Nuclear and cytoplasmic features
  3. Intraluminal features
  4. Pathognomic features
41
Q

What are the pathognomonic features of PCA?

A
  1. Circumferential perineural invasion
  2. collagenous micronodules
  3. glomerulations
  4. growth within adipose tissue
42
Q

What is corpora amylacea?

A

Prostatic concretions…suggests benign cancer
Hyaline masses of unknown significance found in prostate gland, neuroglia and pulmonary alveoli
-derived from secretions and increase with age

43
Q

What is the verumontanum?

A

AKA seminal colliculus
An important landmark near the ENTRANCE of the seminal vesicles
Means mountain ridge in Latin

44
Q

What is Gleason Grade 1?

A

Tightly cohesive nodule of WELL FORMED glands

45
Q

What is Gleason Grade 2?

A

Loosely cohesive nodule of well formed glands

46
Q

What is Gleason Grade 3?

A

Haphazard infiltration of irregular glands

47
Q

What is Gleason Grade 4?

A

Large cribriform plates and small sheets of cells with glandular lumens
No space where the glands should be..

48
Q

What is Gleason Grade 5?

A

Sheets of cells WITHOUT any gland formation

49
Q

What is the gleason score?

A

GS 5-6 = lower progression rates
GS 7-10 = worse prognosis
Predictive value of GS enhanced when combined with PSA level and DRE findings

50
Q

What are the genes implicated in prostate cancer?

A 
Deletions in 
8p
PTEN
P53
RB1

Reproduction Week 1 (13 decks)

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