Overview: GU Pathology Flashcards
Bladder
Noninvasive Papillary Neoplasms
Bladder
- Benign
- Simple papillary architecture (fibrovascular cores)
- Lined by cytologically normal urothelium (no atypia)
Histology
Papilloma
Bladder
Most common urinary tract tumor; 90% of all primary bladder tumors
UC
Bladder
- Industrial exposure to aniline dye
- Cigarette smoking
- Long-term treatment with cyclophosphamide
- Schistosomiasis
- Analgesic abuse
- Sex: M > F
- Age: >50 years
Risk Factors
UC
Bladder
- More common: ~80%
- Progresses to LGUC
- Genetically stable
- Recurrence rate: high
- Low risk of progression: <1-5% (nonaggressive)
- Genetic abnormalities:
* CDKN2A deletion (encodes p16 protein)
* FGFR3 alterations (activating point mutations; ~80%)
UC Pathogenesis
Hyperplasia pathway
Bladder
Most common urothelial tumor
LGUC
Bladder
- Less common: ~20%
- Leads to HGUC
- Genetically unstable
- Recurrence: high
- High risk of progression
- Genetic abnormalities
* RAS mutation
* p53 mutation (60%)
UC Pathogenesis
Dysplasia pathway
Bladder
- Papillary architecture
- Normal / increased epithelial thickness (layers)
- Mild cytologic atypia & infrequent mitotic figures
Histology
LGUC
Bladder
- Papillary architecture
- Marked cytologic atypia & frequent mitotic figures
- Necrosis common
Histology
HGUC
Bladder
- Flat high-grade lesion (no mass)
- Poorly cohesive cells often shed into urine & appear velvety on cytoscopy
- 20-80% progress to invasion
Histology
Flat urothelial CIS
Bladder
Diffuse thin, finger-like, hyperchromatic cords forming tentacular pattern
Histology
Invasive UC
Bladder
Low-grade UC
Treatment
- Tumor resection
- Follow-up: biopsy / urine cytology
Bladder
High-grade non-invasive / superficially invasive UC
Treatment
- Tumor resection
- Biotherap: BCG, interferon
- Chemotherapy
Bladder
High-grade with deep (muscle) invasion
Treatment
- Cystectomy
Bladder
- Most frequent in Middle East & along Nile Valley
- Associated with chronic inflammatory processes:
* Chronic bacterial infection
* Schistosomiasis - Can be associated with renal calculi
Bladder SCC
Bladder
Squamous differentiation:
* Intraceullar keratin
* Keratin pearls
* Intercellular bridges
Histology
Bladder SCC
Bladder
- Associated with intestinal metaplasia & bladder exstrophy
- Combination of glands, mucinous pools & signet-ring cells
Histology
Bladder adenocarcinoma
Prostate
Site of origin for most BPH
Transitional zone
Prostate
Major site of prostatic cancer
Peripheral zone
Prostate
- Proliferation of stromal & glandular elements leading to prostatic enlargement
- Very common (50% of males at age 50; 80% at age 80)
- Involves central gland –> urinary obstruction
BPH
Prostate
- Irregular, nodular
- Gland may be distorted
- Weight may be >100 g (normal = 20-30g)
Gross Appearance
BPH
Prostate
- Nodules may be pure glands, pure stroma, or mixture
- Compresses adjacent tissue
Histology
BPH
Prostate
BPH
Treatment
- Symptomatic Tx:
- Decrease fluid intake before bed
- Avoid alcohol & caffeine
- Medical Tx:
- Decrease muscle tone: a-Blockers
- Shrink prostate: 5-a-Reductase inhibitors
- Surgical Tx: transurethral resection of prostate (TURP)
- First-line Tx w/ recurrent urinary retention
Prostate
- Most common form of cancer in men (27%)
- Only causes ~10% of cancer deaths in US
- Most pts >60 yrs of age (incidence increases w/ age)
- More common in African-Americans
- More common in Western hemisphere
Epidemiology
Prostatic adenocarcinoma
Prostate
- Age
- Androgens
- Environmental factors:
- Increase risk: high fat intake
- Decrease risk: lycopenes, Vit A, Vit E, soy
- Genetic factors:
- 1 first-degree relative = 2x risk
- 2 first-degree relatives = 5x risk
- Acquired somatic mutations:
- 40-60% have TMPRSS2-ETS fusion genes
- LOF mutations involving PTEN (TSG)
Risk Factors
Prostatic adenocarcinoma
Prostate
- Urinary obstruction
- Firm, irregular nodules / masses on digital rectal exam
- Elevated PSA (>10 or greater)
Clinical Presentation
Prostatic adenocardinoma
Prostate
BPH vs. Prostate Cancer
Gross Appearance
Cancer: peripheraly located; ill-defined border; yellow discoloration
BPH: transitional zone / periurethral; nodular; whitish
Prostate
- Abnormal architectural pattern
- Single luminal cell layer (loss of basal cells)
- Enlarged nuclei
- Nuclear hypochromasia
- Prominent nucleoili
- Mitoses / apoptosis
- Amphophilic cytoplasm
- Blue mucinous secretions
- Pink amorphous secretions
- Crystalloids
Histology
Prostatic adenocarcinoma
Prostate
Often metastasizes to lumbar spine
Prostatic adenocarcinoma
Osteoblastic metastases
Prostate
Spread to lymph nodes (usually obturators) is eventually fatal
Prostatic adenocarcinoma
Prostate
PIN-4 immunostain
Histology
Basal cells are absent in invasive prostate cancer
If basal cells are present, prostatic cancer = in situ
Prostate
Basal cell markers
PIN-4 immunostain
- p63 = nuclear
- CK903 = cytoplasmic
If positive, non-invasive tumor
Prostate
Racemase (P504S, AMACR)
PIN-4 immunostain
Cytoplasmic marker overexpressed in prostate cancer (both in situ & invasive) but is absent in benign cells
If positive, prostate cancer (PIN or invasive); if negative, benign
Prostate
- Basal cell markers = +
- Racemase = -
PIN-4 immunostain results
Benign cells
Prostate
- Basal cell markers = +
- Racemase = +
PIN-4 immunostain results
Prostate cancer: PIN (in situ)
Prostate
- Basal cell markers = -
- Racemase = +
PIN-4 immunostain results
Prostate cancer: invasive
Prostate
- Lobular arrangement
- Tightly packed glands
Gleason’s Score
Gleason’s Score: 1
Lowest grade prostatic adenocarcinoma; very rare
Prostate
- Loose lobular arrangement
- Larger glands
Gleason’s Score
Gleason’s Score: 2
Very rare
Prostate
- Small infiltrative individual glands
- Well-formed glands
Gleason’s Score
Gleason’s Score: 3
Most common prostatic adenocarcinoma
Prostate
- Fused or poorly formed glands
- Cribriform pattern
Gleason’s Score
Gleason’s Score: 4
Prostate
- Solid sheets with central necrosis
- Individual cells
Gleason’s Score
Gleason’s Score: 5
Highest grade prostatic adenocardinoma
Grading Prostatic Adenocarcinomas
Total Gleason Score
X + Y = Total Gleason Score
* X = Dominant Score Pattern
* Y = 2nd Score Pattern
If there is no 2nd pattern, X + X = Total Score
Prostate
- Prostatic duct retains myoepithelial layer
- Ductal epithelium is atypical & hyperplastic with papillary projections into lumen
Histology
Prostatic intraepithelial neoplasia (PIN)
Prostate
Prognosis of prostatic adenocarcinoma
90% survival for 15 years
Testis
- Failure of testis to complete normal descent into scrotum
- Most commonly unilateral, slight predilection for right testis
- May result in infertility or germ cell neoplasms
Cryptorchidism
Congenital Anomaly