Module Five: Applied Clinical Pathology Flashcards
What are the 4 zones of the prostate?
Transitional zone
Central zone
Peripheral zone
Anterior fibromuscular stroma
What is the normal histology of the prostate?
Epithelial cells
Basal cells
Stroma
What are the theories of the cause of nodular hyperplasia?
Imbalance of oestrogen/testosterone/dihydrotestosterone
What zone does Nodular Hyperplasia affect?
Tz - compresses the urethra => difficulty passing urine
Symptoms of nodular hyperplasia
Frequency, nocturia, urgency and incontinence, slow and weak stream, difficulty initiating and stopping flow, dribbling
Histopathology of nodular hyperplasia
Proliferation of epithelial cells of the glands and ductules
Proliferation of the smooth muscle cells and fibroblasts within the stroma
Complications of Nodular Hyperplasia
Chronic obstruction
Hypertrophy of the bladder, urinary stasis, recurrent UTI’s
Back pressure if obstruction is prolonged, causing hydroureter, hydronephrosis, renal failure and death
What is the most frequently diagnosed carcinoma in males?
Prostate adenocarcinoma
Risk factors for prostate adenocarcinoma
Increasing rate with age
Racial differences: rare in Asian males, most common in black males
Family history: risk increases two fold when first degree relative diagnosed
Genetic factors: e.g. BRCA2
Obesity, high fat diet
How do you screen for prostate cancer
Measure serum PSA levels
Causes for elevated PSA
Nodular hyperplasia
Prostate carcinoma
Prostatitis
Perineal trauma
What is melanoma?
Malignant tumour derived from melanocytes
What are the risk factors for melanoma?
Family history Large numbers of benign or atypical naevi Previous melanoma Immunosuppressive Sun sensitivity Exposure to UV
What are the clinical and histological features of a benign naevus?
Clinical: small, well circumscribed, even coloration
Histological: symmetrical, cells predominantly in nests, round to oval, nuclei, maturation as cells get deeper
What are the common types of naevus?
Sptiz naevus
Blue
Features of a dysplastic naevus
Less symmetrical Larger Irregular borders Fibrosis in upper dermis Some larger darker nuclei
Clinical features of melanoma
Asymmetrical Border irregularity Colour variability Diameter (>6mm) Evolving
Microscopic features of melanoma?
Asymmetrical Poorly circumscribed Single cells predominate over nests Growth in continuity from one rete ridge to another Extension into upper levels of epidermis Cytolological atypical
What are the growth phases of melanoma?
Radial growth phase - lacks any significant metastatic potential
Vertical growth phase - implies capacity for metastatic spread
What are the prognostic indicators?
Tumour thickness Level of invasion Ulceration Mitotic rate Lymphovascular or perinureal invasion Satellite lesions
Mutations in melanoma that disrupt cell cycle control genes?
CDKN2A
CDK4
Mutations in melanoma that activate pro-growth signalling?
BRAF
NRAS
KIT
Melanoma mutations that activate telomerase?
TERT promoter mutations?
Where is CDKN2 located?
Chromosome 9p21
CDK2N encodes for:
P16INK4A
P14ARF
BRAF is what?
Serine threonine kinase
What is the common BRAF mutation
V600E substitution of Glutamate for valine