Pathology of the Male GU I: Prostate Flashcards
What type of cells line the urinary tract?
Urothelium
What is the most common cause of hydronephrosis in
children?
Ureteropelvic Junction Obstruction
- von Brunn’s nests with degenerated central cells to form small cystic cavities
- Translucent, submucosal, pearly- yellow cysts, usually up to 5mm
Urethritis (AKA Cystitis Cystica)
Vesicoureteral Reflux
Valve defect that can lead to the reversal of the
urine - can cause pyelonephritis
Exstrophy
Developmental failure in the anterior wall of the abdomen and in the bladder
Interstitial Cystitis (Chronic Pelvic Pain Syndrome)
Non-bacterial form of cystitis seen mostly in females and is associated with allergies and autoimmune diseases and mast cells are often a hallmark
Malakoplakia
Recurrent fever, bladder irritability and pain, hematuria, pyuria, weight loss.
What is seen on cystoscopy with malakoplakia?
Multiple raised soft yellow to brown plaques and nodules
Michaelis-Gutmann Bodies
Blue targeted calcospherules seen on histology in malakoplakia
What is malakoplakia associated with?
Chronic bacterial infection
Leukoplakia
Long-term irritation or chronic infection which appears grossly as gray-white areas and has increased risk of carcinoma of bladder
What is a feature of the treatment of bladder cancer?
It has the highest cost per patient from diagnosis to death
What gender is more affected by bladder cancer?
Males 3:1 - usually older males
What is the clinical presentation of bladder cancer?
- Painless hematuria
- Frequency
- Urgency
What are some major risk factors for bladder cancer?
- Cigarette smoking
- Arylamines
- Chronic cystitis
What are the two pathways for the development of urothelial carcinoma?
Papillary and Non-papillary
What pathway is the most common for the development of urothelial carcinoma?
Papillary Pathway
Papillary Pathway
More common and develops with hyperplasia which is genetically stable with FGFR3 mutations. As it develops, it leads to a low grade carcinoma.
Non-papillary Pathway
Less common and develops with dysplasia and is genetically unstable with some having p53 mutations. It can develop into high grade carcinoma or carcinoma in situ.
What mutation is more likely in a low grade urothelial carcinoma?
FGFR3
What mutation is more likely in a high grade urothelial carcinoma?
p53
BCG Vaccine
Bacillus Calmette-Guérin - Attenuated strain of Mycobacterium tuberculosis and is used to prevent recurrence of bladder cancer
What is the prognosis of low grade bladder cancer?
VERY good
What is the prognosis of high grade bladder cancer?
Pretty good - 75% 10 yr survival rate
Most common cause of Nongonococcal urethritis…
E. coli
What is the most common location for prostate cancer?
Posterior zone
What is the most common location for benign prostatic hyperplasia?
Central Zone
What cell layers it the prostate comprised of?
- Secretory Cells
- Basal Cells
Benign Prostatic Hyperplasia
Hyperplasia of prostatic glands and stroma - extremely common with increasing age
What are some complications of BPH?
- Compression of urethra – difficulties with urination
- Retention of urine in the bladder
What are the main mediators of prostate growth?
Androgens - mainly DHT
How is BPH treated?
Inhibitors of 5-alpha reductase
Nodular Hyperplasia of Prostate
Prostatic enlargement due to presence of nodules in the preprostatic region
What is the most common cancer in males?
Prostate Cancer
Do most men with prostate cancer die from prostate cancer?
No
What race is at increased risk of prostate cancer?
African Americans
What are some mutations in the androgen receptors that increase prostate cancer risk?
X-linked AR gene contains a polymorphic sequence composed of CAG repeats - patients with shortest CAG repeats have the highest androgen sensitivity
What mutation greatly increases prostate cancer risk?
BRCA2 germline mutation on Ch13 - 20 fold increased risk for PCA
What is the most common epigenetic alteration in prostate cancer?
Most common epigenetic alteration in PCA hypermethylation of gluthation S-transferase
What are some biomarkers of prostate cancer?
- PSA
- AMACR
Prostate Specific Antigen (PSA)
Secreted into seminal fluid where dissolves seminal
coagulum. Produced by epithelial cells of normal, hyper plastic and cancerous prostatic tissue and is elevated in prostate cancer.
Prostatic Intraepithelial Neoplasia
Proliferation of neoplastic cells within large ducts
What is the most common morphology of prostate cancer?
Most often - tumor is not grossly visible
What is the best marker to predict prognosis of prostate cancer?
Gleason Score
What is a common metastasis of prostate cancer?
Osteoblastic Tumor Metastases
What is the treatment for localized prostate cancer?
Radical Prostatectomy
What is the treatment for metastatic prostate cancer?
Androgen Deprivation
