Male Reproductive System I(b)

Question 1

Most hyperplastic lesions arise in?

Answer 1

inner transitional zone

Question 2

Most carcinomas (70-80%) arise
in?

Answer 2

the peripheral zones

Question 3

Categories of Prostatitis

Answer 3

• Acute Bacterial Prostatitis (2-5% of cases)
• Chronic Bacterial Prostatitis (2-5% of cases)
• Chronic non-Bacterial Prostatitis or Chronic Pelvic Pain Syndrome (90-95% of cases)
• Asymptomatic Inflammatory Prostatiti

Question 4

Microscopic features of Acute vs Chronic Prostatitis

Answer 4

Question 5

CF of Acute Bacterial Prostatitis

Answer 5

Fever, chills and dysuria

Question 6

Complications of Acute Bacterial Prostatitis

Answer 6

Sepsis

Question 7

What syndrome presents w/ fever, chills and dysuris.
Rectal examinations: Tender and boggy organ?

Answer 7

Acute Bacterial Prostatits

Question 8

CF of Chronic Bacterial Prostatits

Answer 8

Low back pain, dysuria, perineal and suprapubic discomfort

Question 9

Epi of Benign prostatic hyperplasia

Answer 9

Incidence: 90% –> 80yrs of age

Question 10

causes/ pathogenesis of Benign prostatic hyperplasia

Answer 10

• Excessive androgen (oestrogen) dependent growth of stromal and glandular elements
• Synthesis of Dihydrotestosterone (DHT) in the prostate, from circulating testosterone → DHT binding to nuclear androgen receptors (causes cell proliferation) → Regulation of growth of prostatic epithelium and stromal cells

Question 11

Macroscopic Features:
* Large organ (weight: 60-100gr)
* Numerous well-circumscribed nodules, with solid and cystic areas
* Slit-like appearance of the urethra, due to compression by the hyperplastic nodules

Microscopic features:
* Proliferating glandular elements and fibromuscular stroma
* Lining of hyperplastic glands -> Inner layer of tall columnar epithelial cells and outer layer of flattened basal cells
* Intraluminal presence of corpora amylacea (proteinaceous secretory material)

features of?

Answer 11

Benign Prostatic hyperplasia

Question 12

CF of benign prostatic hyperplasia

Answer 12

• Difficulty starting or stopping urine stream
• straining while urinating
• Urinary Urgency
• Nocturia (increased urination frequency at night)

Question 13

Complications of Benign Prostatic hyperplasia

Answer 13

1) Residual urine in the bladder, due to chronic obstruction → Increased risk for urinary tract infections
2) Complete urinary obstruction → Painful bladder distention and Hydronephrosis

Question 14

Treatment of benign prostatic hyperplasia

Answer 14

1) Inhibit DHT formation
2) Block alpha-adrenergic blockers → Relaxation of smooth muscles

Question 15

Subcalssification of intra-epithelial neoplasia

Answer 15

1) Low-Grade PIN (LGPIN) and
2) High-Grade PIN (HGPIN)

Question 16

how can you distinguish between LGPIN and HGPIN

Answer 16

Finding of prominent nucleoli in HGPIN

Question 17

Microscopic Features
✓Glands darker and more complex than normal
✓Cellular crowding
✓ Pseudostratification with irregular spacing
✓ Enlarged neclei with increased variability in nuclear size and nuclear hyperchromasia
✓ Indistinct and rare nucleoli
✓ Amphophilic or eosinophilic cytoplasm

features of ?

Answer 17

LGPIN

Question 18

Microscopic Features
✓Glands separated by a modest amount of stroma, and with a
normal overall architectural pattern; resemblance to benign glands
✓Enlarged and overlapping nuclei
✓Nuclear hyperchromatism
✓Amphophilic cytoplasm
✓Epithelial hyperplasia
✓Prominent nucleoli

features of?

Answer 18

HGPIN

Question 19

Types of HGPIN

Answer 19

1) Flat pattern
2) Tufting pattern
3) Micro-papillary
4) Cribrifrom pattern

Question 20

Epi of prostatic carcinoma

Answer 20

Men >50 years
* Most common form of cancer in men

Question 21

behaviour of prostatic carcinoma

Answer 21

Ranges from aggressive and rapidly fatal to indolent
(‘latent”) disease of no clinical significance

Question 22

70-80% of prostatic cancers arise in the —————

Answer 22

peripheral zone

Question 23

Patho of Prostatic carcinoma

Answer 23

1) Androgen –> increases the growth of prostatic cancer
2) Activation of oncogenic PI3K/AKT and inactivating mutations of PTEN
3) TMPRSS2-ETS fusion genes (as result of gene re-arrangements) -> 40-50% of prostate cancers

Question 24

Who doesn’t deveolp prostatic cancer?

Answer 24

males castrated before puberty

Question 25

Who is at Risk of developing Prostatic cancer

Answer 25

1) Increased incidence in blacks and Scandinavians 2) family History of prostate cancer

Question 26

Microscopic Findings: * **Small glands, crowded together (“back-to-back” appearance)** * Glands lined by a **single layer of cuboidal or low columnar cells** * Absence of the basal cell layer * pale-clear or typical amphophilic Cytoplasm * **Enlarged nuclei, with prominent nucleoli** Macroscopic Features: * Firm, gray-white lesions * **Not well-defined** margins * **Infiltrative growth** into the adjacent prostatic parenchyma features of?

Answer 26

**Prostatic carcinoma**

Question 27

what does the presence of **Cribriform glands, sheets of cells ,or individual infiltrating cells** in microscopic findings of a prostatic carcinoma indicate?

Answer 27

**High-grade tumour**

Question 28

Prostatic Carcinoma is ass. w?

Answer 28

Co-existence of **HGPIN** (80% of cases)

Question 29

**Which Gleason pattern best corresponds to the following histopatho findings?** * Tumour cells w/ abundant pale cytoplasm found anteriorly in the prostate within the transition zone. * Circumscribed nodule of closely packed discrete uniform glands * Glands are **large**

Answer 29

**Gleason pattern 1**

Question 30

**Which Gleason pattern best corresponds to the following histopatho findings?** * Tumour cells w/ abundant pale eosinophilic cytoplasm, found anteriorly within the transition zone * Fairly circumscribed nodule of malignant glands showing minimal infiltration at the edges * Glands are not as uniform * Glands are **large**

Answer 30

**Gleason pattern 2**

Question 31

**Which Gleason pattern best corresponds to the following histopatho findings?** * Variably sized discrete glands * **Glands are small** w/ regular contours and uniform round lumens * Focus is not circumscribed; cancer glands infiltrate in between benign glands

Answer 31

**Gleason pattern 3**

Question 32

**Which Gleason pattern best corresponds to the following histopatho findings?** * Fused , **Cribifrom glands** w/ irregular or ragged contours * Ill-defined, poorly-formed glands with slit-like lumens * Glands with intraluminal glomerulations

Answer 32

**Gleason pattern 4**

Question 33

**Which Gleason pattern best corresponds to the following histopatho findings?** * Tumour cells infiltrating as small nests, cords or individual cells * focally, Solid nests of tumour w/ **"Comdeo"** necrosis

Answer 33

**Gleason pattern 5**

Question 34

Clinical features of Prostatic carcicoma

Answer 34

**small, non-palpable asymptomatic lesions**

Question 35

Progression of Prostatic carcinomas

Answer 35

* Locally advanced cancers →** Infiltration of the seminal vesicles and, adjacent soft tissues and organs** (i.e. bladder and rectum) * **Osteoblastic metastases to the axial skeleton**

Question 36

Prostatic carcinomas are Histollogicaly graded using?

Answer 36

Gleason grading pattern

Question 37

Labratory findings of Prostatic Carcinoma

Answer 37

**↑ total PSA w/ ↓ free PSA** (notes Free PSA: Total PSA is lower in men w/ prostatic cancer than men w/ being prostatic disease)

Question 38

PSA level >2.5ng/mL --> **[Abnormal/Normal]**

Answer 38

**Abnormal**

Question 39

Treament of prostatic CA?

Answer 39

Radical prostatectomy and radiotherapy

Question 40

“Watchful waiting” for Cancers in?

Answer 40

* Older men * Patients with substantial comorbidity * Young patients, with low serum PSA and small low grade cancers