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patho II > Male Reproductive System I(b) > Flashcards

Male Reproductive System I(b) Flashcards

1
Q

Most hyperplastic lesions arise in?

A

inner transitional zone

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2
Q

Most carcinomas (70-80%) arise
in?

A

the peripheral zones

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3
Q

Categories of Prostatitis

A
  • 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
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4
Q

Microscopic features of Acute vs Chronic Prostatitis

A
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5
Q

CF of Acute Bacterial Prostatitis

A

Fever, chills and dysuria

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6
Q

Complications of Acute Bacterial Prostatitis

A

Sepsis

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7
Q

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

A

Acute Bacterial Prostatits

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8
Q

CF of Chronic Bacterial Prostatits

A

Low back pain, dysuria, perineal and suprapubic discomfort

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9
Q

Epi of Benign prostatic hyperplasia

A

Incidence: 90% –> 80yrs of age

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10
Q

causes/ pathogenesis of Benign prostatic hyperplasia

A
  • 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
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11
Q

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?

A

Benign Prostatic hyperplasia

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12
Q

CF of benign prostatic hyperplasia

A
  • Difficulty starting or stopping urine stream
  • straining while urinating
  • Urinary Urgency
  • Nocturia (increased urination frequency at night)
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13
Q

Complications of Benign Prostatic hyperplasia

A

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

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14
Q

Treatment of benign prostatic hyperplasia

A

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

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15
Q

Subcalssification of intra-epithelial neoplasia

A

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

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16
Q

how can you distinguish between LGPIN and HGPIN

A

Finding of prominent nucleoli in HGPIN

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17
Q

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 ?

A

LGPIN

18
Q

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?

A

HGPIN

19
Q

Types of HGPIN

A

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

20
Q

Epi of prostatic carcinoma

A

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

21
Q

behaviour of prostatic carcinoma

A

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

22
Q

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

A

peripheral zone

23
Q

Patho of Prostatic carcinoma

A

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

24
Q

Who doesn’t deveolp prostatic cancer?

A

males castrated before puberty

25
Q

Who is at Risk of developing Prostatic cancer

A

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

26
Q

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?

A

Prostatic carcinoma

27
Q

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

A

High-grade tumour

28
Q

Prostatic Carcinoma is ass. w?

A

Co-existence of HGPIN (80% of cases)

29
Q

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
A

Gleason pattern 1

30
Q

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
A

Gleason pattern 2

31
Q

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
A

Gleason pattern 3

32
Q

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
A

Gleason pattern 4

33
Q

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
A

Gleason pattern 5

34
Q

Clinical features of Prostatic carcicoma

A

small, non-palpable asymptomatic lesions

35
Q

Progression of Prostatic carcinomas

A
  • 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
36
Q

Prostatic carcinomas are Histollogicaly graded using?

A

Gleason grading pattern

37
Q

Labratory findings of Prostatic Carcinoma

A

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

38
Q

PSA level >2.5ng/mL –> [Abnormal/Normal]

A

Abnormal

39
Q

Treament of prostatic CA?

A

Radical prostatectomy and
radiotherapy

40
Q

“Watchful waiting” for Cancers in?

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

patho II (29 decks)

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