Male Reproductive System I(b) Flashcards
Most hyperplastic lesions arise in?
inner transitional zone
Most carcinomas (70-80%) arise
in?
the peripheral zones
Categories of Prostatitis
- 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
Microscopic features of Acute vs Chronic Prostatitis
CF of Acute Bacterial Prostatitis
Fever, chills and dysuria
Complications of Acute Bacterial Prostatitis
Sepsis
What syndrome presents w/ fever, chills and dysuris.
Rectal examinations: Tender and boggy organ?
Acute Bacterial Prostatits
CF of Chronic Bacterial Prostatits
Low back pain, dysuria, perineal and suprapubic discomfort
Epi of Benign prostatic hyperplasia
Incidence: 90% –> 80yrs of age
causes/ pathogenesis of Benign prostatic hyperplasia
- 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
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?
Benign Prostatic hyperplasia
CF of benign prostatic hyperplasia
- Difficulty starting or stopping urine stream
- straining while urinating
- Urinary Urgency
- Nocturia (increased urination frequency at night)
Complications of Benign Prostatic hyperplasia
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
Treatment of benign prostatic hyperplasia
1) Inhibit DHT formation
2) Block alpha-adrenergic blockers → Relaxation of smooth muscles
Subcalssification of intra-epithelial neoplasia
1) Low-Grade PIN (LGPIN) and
2) High-Grade PIN (HGPIN)
how can you distinguish between LGPIN and HGPIN
Finding of prominent nucleoli in HGPIN
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 ?
LGPIN
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?
HGPIN
Types of HGPIN
1) Flat pattern
2) Tufting pattern
3) Micro-papillary
4) Cribrifrom pattern
Epi of prostatic carcinoma
Men >50 years
* Most common form of cancer in men
behaviour of prostatic carcinoma
Ranges from aggressive and rapidly fatal to indolent
(‘latent”) disease of no clinical significance
70-80% of prostatic cancers arise in the —————
peripheral zone
Patho of Prostatic carcinoma
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
Who doesn’t deveolp prostatic cancer?
males castrated before puberty
Who is at Risk of developing Prostatic cancer
1) Increased incidence in blacks and Scandinavians
2) family History of prostate cancer
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?
Prostatic carcinoma
what does the presence of Cribriform glands, sheets of cells ,or individual infiltrating cells in microscopic findings of a prostatic carcinoma indicate?
High-grade tumour
Prostatic Carcinoma is ass. w?
Co-existence of HGPIN (80% of cases)
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
Gleason pattern 1
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
Gleason pattern 2
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
Gleason pattern 3
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
Gleason pattern 4
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
Gleason pattern 5
Clinical features of Prostatic carcicoma
small, non-palpable asymptomatic lesions
Progression of Prostatic carcinomas
- 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
Prostatic carcinomas are Histollogicaly graded using?
Gleason grading pattern
Labratory findings of Prostatic Carcinoma
↑ total PSA w/ ↓ free PSA
(notes Free PSA: Total PSA is lower in men w/ prostatic cancer than men w/ being prostatic disease)
PSA level >2.5ng/mL –> [Abnormal/Normal]
Abnormal
Treament of prostatic CA?
Radical prostatectomy and
radiotherapy
“Watchful waiting” for Cancers in?
- Older men
- Patients with substantial comorbidity
- Young patients, with low serum PSA and small low grade cancers
