Male Pelvis Pathology Flashcards
How many kinds of prostate and SV cysts
six categories
Parenchymal degenerative cysts
Most common
Hyperplastic nodules in transition zone
Insignigant unless large and causing obstruction
Unilocular or thinly septated
Retention Cysts
Focal
result from duct obstruction
firm and mimic cancerous nodule
surface mostly
Congenital cysts
In or close to midline
related to Wolffian or Mullerian ducts
Usually asymptomatic unless infected/large
Where are congenital abnormalities
Common in and around the seminal vesicle and protstate
Utericle cysts
Dilation of prostatic utricle May be seen with unilateral renal agenesis Always midline (small and contained within the prostate, may be large)
Mullerian duct cysts
Remnants of paramesonephric duct
Mostly midline an extends from midline
If big, can extend above the prostate
Teardrop shaped pointed towards the verumontanum, can have calcifications
Ejaculatory duct cysts
Small
cystic dilatation of ejaculatory ducts from ?obstruction; can also be diverticula of duct; assoc. with infertility; can cause perineal pain in patients
Prostate abscesses
Thick, irregular walls, debris contaning cysts resemble abscess
E-Coli
Predisposing factors: Diabetes, instrumentation, immunodeffcny, aspiration TRUS
Cystic neoplasms
Rare
Cystadenoma
Cystadenocarcinoma
Seminal Vesicle cysts are…
rare
usually solitary, asymptomatic, can aspirate if large, associated with renal anomalies like agenesis and APKD
Exophytic cyst
Exterior
Prostatitis
Chronic pain syndrome
Prostatitis does not mean….
Infection, inflammation or protstatic involvement
Prostatitis is
Leading cause of urologist visits in men <50-years of age
>50 1. BPH; 2. Cancer: 3. Prostatitis
What are classifications of prostatitis
Acute bacterial prostatitis
Chronic bacterial prostatitis
Chronic prostatitis/chronic pelvic pain syndrome
Inflammatory
cute prostatitis
UTI ,epididymitis /orchitis may cause infection of prostate
Main causative agents are
Proteus,Klebsiella species, Escherichia coli,chlamydia and gonorrhea.
PSA will be high(protien produced by prostate)
Acute prostatitis treatment
IV antibiotics
Acute prostatitis clinical
Pt presnets with fever, chills,pelvic pain,difficulty in urination or ejaculation
Foul smell in urine / blood in semen
What are risk factors for acute prostatitis
Surgical intervention like bx , catheterization are risk factors
Acute bacterial prostatitis
least common
Symptoms acute urinary or systemic infection
Infection from gram-negative organisms i.e. E-Coli
Acute bacterial prostatitis sonographically
Edema, enlargement, hyperemia, venous engorgement, hypoechoic peripheral halo, patchy echo changes
Chronic bacterial prostatitis
Uncommon
Usually have bacterial urinary infection and febrile
E-Coli most often
No ultrasound findings
Chronic prostatitis (CP)
Most common form of prostatic inflammation
Difficult to treat
Type A (diag. by leukocytes in prostate secretions, urine, semen) and Type B (no evidence of inflammation)
Type B aka Prostatodynia
Sonographic features of chronic prostatitis
normal, or peripheral hypoechoic areas, calcifications, venous congestion, increased arterial flow, bladder neck thickening, hypoechoic prostatic rim, periurethral hypogenicity
Asymptomatic inflammatory prostatitis
Men with hx genitourinary pain with histological inflammatory changes
Often increased PSA = bx where they identify these inflammatory cells
Granulomatous prostatitis
Idiopathic
often following instrumentation
Causes of granulomatous prostatitis
Bacteria ex. TB, histoplasmosis, … and parasites ex. Schistosomiasis, …
North America causes: bacille Calmette-Guerin (BCG)commonly instilled in bladderto treat TCC leaks to prostate
what are sonographic findings of granulomatous prostatitis
On ultrasound, in general, inflamed prostates are hypoechoic. Often it has several hypoechoic, hypervascular areas.
prostatic abscess
0.5-2.5% of cases with bacterial prostatitis
More prevalent diabetes mellitus & immunosuppressed
Large abscessed can be drained (TRUS)
Benign prostatic hyperplasia
Lower urinary tract symptoms
50% men over age 60; 90% men over age 70
Weight normal young=20 g; >50 doubles every 10 years
>40g weight considered enlarged in older men
Might be related to hormone changes? unclear
What does BPH look like
Hyperplasia and hypertrophy of fibrousmusucular and glandular
Transition and periutheral zones
BPH
Hypertrophy of the transitional zone
Obstruction to flow of urine
Signs and symptoms of BPH
Nocturia ,sense of urinary urgency, frequency and constant feeling of having full bladder.
PSA ( protein produced by prostate ) will be high
Sonographically prostate shows diffusely heterogeneous texture, calcifications and cystic changes .
TURP / Hormone is treatment
Prostatism and bladder outlet obstruction
can relate to increases in prostate size and muscular tone which = urethral constriction
Prostatism and bladder outlet obstruction symptoms
Frequency, nocturia, weal stream, hesitancy intermittence, incomplete emptying, urgency
PVR
Post void residual volume
Prostatism and bladder outlet
Causes retained urine
TRUS
Prostate sonogram or endorectal ultrasound
Examine more detailed prostate and surrounding tissues
why are turps done
Relieve urinary obstruction
TURP
Enlargement of transition zone (inner gland)
Can exhibit hyperechoic, hypoechoic, isoechoic nodules
More distinct nodular margins than in cancerous (poorly marginated)
Hyperplasia in median lobe (periurethral glandular area) = bulging into the bladder
Infertility and transrectal ultrasound
Male solely responsible 20% of the time
TRUS to view ejaculatory ducts
Hematospermia
Macroscopic blood in the semen
TRUS can show
prostatic calcifications, ejaculatory duct calculi, dilated ejaculatory duct, BPH, dilated seminal vesicles, SV calcifications, ejaculatory duct cysts, prostatitis (in 74-95% of cases of TRUS done for infertility)
Prostatic calcifications
Normal finding
Bright echogenic foci
can shadow
Will shadow, wide, deep shadow
Calcifications of seminal vesicle
Diabetes: tram tracks on wall (-ray)
Infection
Infection/Inflammatory: luminal/segmental; assoc. with SV calcifications
Corpora Amylacea
Proteinacious debris in prostatic ducts Often in periurethral glands Can be anywhere in prostate Twinkle on colour Doppler Possible causes: subclinical infections, inflammation, and atrophy
Prostate cancer
Peripheral zone is most common location
Most common cancer in men
Mostly is adenocarcinoma .
Can cause enlarged prostate
PSA
Normally occurring enzymes
Excess leakage
Elevated: cancer, BPH, prostatitis, many other causes of elevation
Normal PSA
Normal less than 4ng/ml
PSA density (more reliable
less than 0.1
Grater than 10 PSA
Always sent for bx due to cancerous
Age specific PSA
Increases normally with age 40-49-years0.0-2.5 ng/mL 50-59-years0.0-3.5 ng/mL 60-69-years0.0-4.5 ng/mL 70-79-years0.0-6.5 ng/mL
PSA _______with age
Increases normally
prostate cancer demographic
Mainly men >50-years of age
Long course up to 10-years from asymptomatic to diagnosis
Prostate cancer is the most common cancer in
men
Treatments for prostate cancer
Varied and personalized
Many men have
Mcro-tumors that won’t affect longevity
Adenocarcinoma
Most common protstae carcinoma
90%
other prostate cancers
TCC of prostate, sarcomas, lymphomas
Prostate can also be affected by
local malignancies from bladder and rectum
How does proustite cancer spread
Spread to bones via sacrum
Prostate volumes in prostate cancer
Best with TRUS
Age 50-754.0 ng/mL
How is prostate cancer graded
T-local tumour
N-Node status
M-Non-lymph node distant Mets
Sono appearance of prostate cancer
Varying sonographic appearance
Hypoechoic mass in peripheral zone
May be hyper vascular.
Diagnosis confirmed by trans rectal biopsy.
10 to 12 blind biopsies recommended if PSA is high or PSA density is more than 0.1 even if no suspicious lesion in prostate visible
Treatment for prostate cancer
Treatment depends upon Gleason scoring which include only surveillance, or surgery , radiotherapy, hormone therapy, or combined modalities
Higher the Gleason score
Lower cure rate
TRUS for prostate cancer
Help with diagnosis of Prostate Cancer Increased PSA levels Detect abnormal areas on prostate Needle guidance for TRUS BX Look at size and shape
