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House AMP > Pathology Of The Prostate > Flashcards

Pathology Of The Prostate Flashcards

1
Q

The normal prostate weighs approximately ________.

It is a ____peritoneal organ that is shaped like a ________ or ________ encircling the ________ of the ________ and _______________

A

20grams

retro; walnut or chestnut

neck ; bladder

prostatic urethra.

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2
Q

The prostate can be said to be _________ shaped with _____, an _____, an _____ and ____________ surfaces.

It measures ___cm x ___cm x___cm

A

conically

base, an apex, an anterior and two lateral surfaces.

4cm x 3cm x2cm

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3
Q

The urethra courses through the prostate to become the ________ urethra at the ________ of the prostate.

In the substance of the gland, __________ duct merges with the ________ to form the ______________.

A

membranous urethra

apex of the prostate.

seminal vesicle’s

vas deferens ; ejaculatory ducts.

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4
Q

The paired ejaculatory duct perforates the prostate and opens into the _______ of the __________ at the ____________

A

middle of the prostatic urethra

seminal colliculus

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5
Q

seminal colliculus

Aka

__________

A

verumontanum

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6
Q

In the adult, prostatic parenchyma can be divided into four biologically and anatomically distinct zones or regions:

List them

A

the peripheral,
central,
transitional zones, and
the region of the anterior fibromuscular stroma

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7
Q

The types of proliferative lesions are different in each region.

For example, most hyperplasias arise in the ______ zone, whereas most carcinomas originate in the ______ zone.

A

transitional

peripheral

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8
Q

The prostate is devoid of a distinct capsule
1. Peripheral zone – makes up the _____ of the gland (approx ____%)

  1. Central zone – surrounds the ____________ (approx ____%)
  2. Transitional zone – surrounds the ___________________ and comprises about ___% of the glandular tissue
  3. Anterior fibromuscular stroma – contains ____________ and lies (anteriorly or posteriorly?)
A

bulk; 70

ejaculatory ducts ;20

proximal prostatic urethra; 5%

no glandular tissue ;anteriorly

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9
Q

Normal prosate

It is composed of (simple or complex?) ____________ in a ____________ ————-

The glands are lined by inner ____________ epithelium and an outer ____________ epithelium.

A

complex; branching glands

fibromuscular stroma.

tall columnar epithelium

cuboidal epithelium.

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10
Q

Normal prostate

Prostatic secretion is normally ___________ (important because adenoca secretes ___________) and contains ___________ enzymes that aid in ___________ of the ejaculate to release the sperm deposited in the upper vagina during intercourse.

A

neutral mucin ;acidic mucin

proteolytic ; liquefaction

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11
Q

The prostate consists of about ____ glands with (single or multiple?) ducts, which empty into the __________ (on both sides of the __________ in the __________ urethra)

A

30 glands ; single

prostatic urethra ; Colliculus

prostatic urethra

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12
Q

The prostatic fluid is (thin or thick?) , and forms about ____% of semen volume.

It contains ________ (for the ______ of sperms), _____ (affects _____ metabolism of the prostate), ______ (act as _____), immunoglobulins, ________ and ________

A

thin; 20%

spermine ;motility

zinc ;testosterone

citric acid ;buffer

phosphatases ; proteases

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13
Q

The common pathologic lesions of the prostate include in order of occurrence:

_________
_____________
________________

A

Benign prostatic hypertrophy
Carcinoma
Prostatitis

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14
Q

Prostatic cancer - epidemiology

The adenocarcinoma of the prostate is the most common cancer in ______ males and accounts for ____% of cancer deaths in US

Its commoner above age ______ with incidence increasing from 20% in the fifties to 70% between ____yrs.

A

Nigerian ;10%

50; 70- 80yrs.

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15
Q

Prostatic cancer - epidemiology

The highest rates are from US particularly among (whites or blacks?). It is less common in the ______ and ________

At the Ibadan cancer registry(1981-95), it represented ____% of cancer in both sexes

A

blacks

Chinese ; Japanese

4.7%

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16
Q

Aetiology-risk factors Of prostate cancer

Age- Risk ____eases with age.

While only one in 10,000 men under age _____ will be diagnosed with prostate cancer, one in 15 men in their _____ will be diagnosed with the disease

A

increases

40

60s

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17
Q

Aetiology-risk factors Of prostate cancer

Race-rates among (whites or blacks?) is almost double those among (white or black?) males, less common in ____ & __________.

A

blacks ; white

Japanese & Chinese.

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18
Q

Aetiology-risk factors Of prostate cancer

Geography -For men in the U.S., the risk of developing prostate cancer is ___%. For men who live in rural China, it’s ___%.

However, when Chinese men move to the _____ culture, their risk _____eases substantially.

A

17%.

2%.

western culture

Increases.

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19
Q

Aetiology-risk factors Of prostate cancer

Family history/Genetics: father, brother or son who has had prostate cancer is ___________ times more likely to develop prostate cancer.

______ mutation of the ________ gene _____ is associated with ____ fold increased risk of prostate cancer

A

2 to 3 times

Germline; tumour suppressor gene

BRCA2 ; 20

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20
Q

Aetiology-risk factors Of prostate cancer

diets:
____ease fat consumption
__________(in tomatoes), vit A, D, E, selenium & soy products may _______/______ or _________ prostatic cancer

Obesity- obese patients are more likely to have ________ disease

Lack of exercise and sedentary life style

A

Incr ; Lycopenes

inhibit/prevent or delay prostatic cancer

aggressive

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21
Q

Role of Androgen receptors

Androgens play a ________ role (androgen is necessary for ________ of prostatic ________) as no ____ease levels of testosterone have been found.

A

permissive role

maintenance ; epithelium

increase

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22
Q

Role of Androgen receptors

Evidences include

Is not known in ________ that were ______ before _______ and incidence is low in _________ due to liver cirrhosis

Tumour regresses with ___________

Neoplastic epithelial cells have _______ receptors

A

eunuchs ;castrated ; puberty

hyperoestrogenism

orchidectomy

androgen receptors

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23
Q

There is demonstrable correlation of prostatic cancer with venereal disease, sexual habits, smoking or occupational exposure

T/F

A

F

There is no demonstrable correlation with venereal disease, sexual habits, smoking or occupational exposure

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24
Q

there is convincing evidence that people with BPH or those who have had transurethral resection have increased risk for development of prostate cancer

T/F

A

F

Although BPH can co-exist with cancer, there is no convincing evidence that people with BPH or those who have had transurethral resection have increased risk for development of prostate cancer

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25
Q

BPH can co-exist with prostate cancer

T/F

A

T

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26
Q

Pathologic features of prostate cancer

Based on the presumptive site of origin and morphologic appearance, it can be divided into the following:

________ of _______ ducts and acini arises from the __________ zone.

Other variants
Carcinoma of _____ ducts arises from the ______ zone

Primary ___________ carcinoma

A

Adenocarcinoma ; peripheral ducts

peripheral zone.

large ducts ;peri-urethral zone

Transitional cell carcinoma

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27
Q

_____ of ________ is the most common cancer of the prostate

A

Adenocarcinoma of peripheral ducts

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28
Q

peri-urethral zone is also site for BPH

T/F

A

T

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29
Q

Other histology types of prostate cancer

Carcinoma with _________
_________ carcinoma
_________ carcinoma
_________ carcinoma
_________ cell tumour
_________ carcinoma

A

Carcinoma with endocrine features
Signet ring carcinoma
Adenosquamous carcinoma
Squamous cell carcinoma
Adenoid basal cell tumour
Basaloid carcinoma

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30
Q

Other histologic types of prostate cancer

Large duct carcinoma

These are (more or less?) common and are located in the ________ location

Macro
Seen as _________ or________ tumour on cystoscopy

Microscopically
It presents at a (more or less?? advance stage and has a (lower or higher?) short time survival rate.
It is characterized by _________ change in the _________ ducts PSA, PAP are positive

A

less ; peri-urethral location

polypoid villous ; infiltrative urethral

More; higher; malignant

Large dilated

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31
Q

•Primary transitional cell adenocarcinoma

  • ___% of cases of prostatic cancer.

-Arises from the ——— portion of the prostatic ————- ducts which are lined by ————- epithelium.

•Mixed adenocarcinoma-transitional cell carcinoma

A

-2%

outer ; peri-urethral ducts

transitional epithelium.

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32
Q

Primary transitional cell adenocarcinoma

Microscopy resemble ________ of the bladder.
Must exclude _________ of ________ of the bladder

A

TCC

prostatic extension of TCC

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33
Q

Carcinoma with endocrine features-(poor or good?) prognosis

Mucin secreting adenoca- ___ metastasis rare, lack _____ dependence and is radio(sensitive or resistance?)

Signet ring adenoca- highly (benign or malignant?)

Adenosquamous ca- occur ______, or after ______ or ________therapy.

A

Poor

bone metastasis; hormone

resistance; malignant

de-novo

hormonal or radiotherapy.

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34
Q

Squamous cell ca- (common or rare?) ,occur _______ or after ______ treatment

Adenoid basal cell tumour- resemble ___________ ca of ___________ gland

Basaloid ca- highly (indolent or aggressive?)

Lymphoepithelioma-like adenoca-like that of ___________

A

-rare; de-novo

oestrogen treatment

adenoidcystic ca ; salivary gland

aggressive; nasopharynx

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35
Q

Adenocarcinoma of peripheral ducts

Most of this arise from the ______ zone

May appear as _____ or ______ (well or poorly?) defined (loose or firm?) area

A

peripheral zone

gray or yellowish

poorly; firm area

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36
Q

Morphology of prostate cancer

In approximately 70% of cases, carcinoma of the prostate arises in the ________ zone of the gland, classically in a (anterior or posterior?) location, where it may be palpable on ______ examination

A

peripheral ; posterior

rectal examination

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37
Q

Morphology of prostate cancer

Characteristically, on cross-section of the prostate the neoplastic tissue is _____ and _____, but when embedded within the prostatic substance it may be extremely difficult to _____ and be more readily apparent on _____.

A

gritty and firm

visualize; palpation.

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38
Q

Cytologic features of adenocarcinoma include (enlarged or shrunken?), (flat or round?) , _____chromatic nuclei that have single prominent nucleolus.

___________ suggest carcinoma.

A

enlarged

round; hyper

Mitotic figures

39
Q

Histologic characteristics of prostate cancer

Architectural disturbance
Prostatic adenocarcinomas are composed of (small or large ?) glands that lie ________, with ______ intervening stroma or are _____________ distributed

Stroma
Malignant glands have ______ stroma between them

A

small glands

back-to-back

little or no ; haphazardly

little or no stroma

40
Q

Histologic characteristics of prostate cancer

Gland pattern
The glands in well differentiated adenocarcinomas are ___________ sized

Poorly differentiated tumours _________ glands, rather are seen in ______,_______ or ________ pattern

Moderately differentiated glands are _________

A

Gland pattern

small or medium sized

do not form glands

sheets, solid or trabecular pattern

inbetween

41
Q

Histologic characteristics of prostrate cancer

Tumour cell
The ____________ layer cells are lost. The tumour cells may be (light or dark?) , (clear or turbid?) or _____philic with prominent nucleoli.

Anaplasia and nuclear atypia are generally (mild or severe ?)

Invasion;
is the most important diagnostic feature of malignancy. There may be __________ or __________ invasion

A

outer basal

dark, clear or eosinophilic

mild

lymphovascular or perineural invasion

42
Q

Microscopy of prostrate cancer

The tumour cells can form various patterns:

  1. Medium sized glands- _____ packed glands with (regular or irregular?) outline, with ________ intervening stroma
  2. Small glands- appear as _______ on low power, the individual glands having (round o flat?) (regular or irregular ?) outline and small size
  3. Cribriform pattern-the tumour cells form ______ glands
  4. Diffuse cell infiltration- resembles ______ cancer of the _______ with files of (benign or malignant?) cells infiltrating the stroma
A

closely packed ; irregular

little ; expansive nodules

round; regular

fused glands; lobular

breast ; malignant

43
Q

Microscopy

The well differentiated tumour is composed of _______________ sized glands.

Poorly differentiated carcinomas have _____ glands (______ glands), as well as ________ or ________ of tumor cells, and many tumors have two or more of these patterns.

A

medium and small

fused; cribriform

solid nests or sheets

44
Q

Clinical course of prostate cancer

Localized prostate cancer is (asymptomatic or symptomatic?) , and is usually discovered by the detection of a ______________ on ________ examination or elevated ______________ level.

Most prostatic cancers arise ______________ away from the urethra, and therefore urinary symptoms occur (early or late?).

Patients with clinically advanced prostatic cancer may present with _________ symptoms, such as difficulty in ______________________, dysuria, ______________ or —————-.

A

asymptomatic ; suspicious nodule

rectal ; serum PSA level.

peripherally ; late.

urinary ; starting or stopping the stream

frequency, or hematuria.

45
Q

Clinical course : Prostate cancer

Today it is uncommon for patients to come to attention because of ______ pain caused by ______ metastases.

The finding of _________ metastases by ________ surveys or the much more sensitive ___________ scanning is virtually diagnostic of this form of cancer in men.

A

back pain ; vertebral metastases.

osteoblastic ; skeletal surveys

radionuclide bone

46
Q

Diagnosis of Prostate cancer

The triad of ____________, ____________& serum ____________ serve a good diagnostic tool for early detection

Transurethral ultrasound-appear as ____________ lesion

PSA -prostate cancer produces ___ (more or less?)

A

digital rectal exam, transrectal ultrasound & serum PSA

hypoechoeic

10x more

47
Q

Diagnosis of Prostate cancer

It is sometimes difficult to distinguish clinically from nodular ________, granulomatous ________, ____, infarct

A

hyperplasia

granulomatous prostatitis

TB

48
Q

Diagnosis of Prostate cancer

The PSA is normally less than ___ μg/L. A mildly increased PSA (____ to _____ μg/L) in a patient with a very large prostate can be due to ___________, or to ________, rather than carcinoma.

A rising PSA (more than _____ μg/L per year) is suspicious for _______, even if the PSA is _______________________________

A

4 μg/L.

4 to 10 μg/L

nodular hyperplasia; prostatitis

carcinoma.; 0.75 μg/L

prostatic carcinoma

the normal range.

49
Q

Diagnosis of Prostate cancer

Transrectal core needle biopsy, often guided by ________, is useful to confirm the diagnosis

Incidental carcinomas can be found in ______ resections for ________

_______ section is equally effective

Transrectal FNAC is also effective in detecting ________. Overall accuracy in a study was ______%

_______ examination of ______ is not useful

______ section and _______ of ______ are also useful to detect metastasis

A

ultrasound

transurethral resections ; nodular hyperplasia.

Frozen section; prostatic cancer

85.6%; Cytologic

prostatic fluid; Frozen section

touch imprints ; lymph nodes

50
Q

Diagnosis of Prostate cancer

________________ biopsy
________ carcinomas
_______ section
_________ ———-

________ and __________ are also useful to detect metastasis

A

Transrectal core needle biopsy
Incidental carcinomas
Frozen section
Transrectal FNAC

Frozen section and touch imprints of lymph nodes

51
Q

Spread and metastasis of prostate cancer

Spread occurs by ________,_________, and __________

Extension into the seminal vesicles, prostatic urethra & bladder in __________ tumour. __________ invasion is less common

Common metastatic sites are- __________& __________

A

local invasion, blood stream and lymph

advanced tumour; Rectal invasion

skeletal system & lymph nodes.

52
Q

Spread and metastasis of prostate cancer

Common metastatic sites are- skeletal system & lymph nodes.

bone metastasis is ________ (resembles ________ or ________ on X-ray)

Bone metastasis may precede ________ symptoms

Lumbar, sacrum & pelvis are common sites through the ________ system

________ involvement leads to spinal cord ________

A

osteoblastic

osteosarcoma or Paget’s disease

urologic symptoms

vertebral venous system

Epidural ; compression

53
Q

Lymph node metastasis of prostate cancer

Most common route is the ______ chain of lymph nodes, leading to ______peritoneal

____________ lymph node may also be involved

_______ or ________ lymph node involvement can be a first sign of the disease in poorly differentiated tumours

_____ metastasis may occur

Massive ____________ can occur

A

pelvic ; retroperitoneal

Supradiaphragmatic

Supraclavicular or mediastinal lymph node

Lung ;Massive pleural effusion

54
Q

Prostate Metastatic cancer can be found in ________ specimen rarely

A

orchidectomy

55
Q

Prostate Metastatic cancer Can also spread to breast, often ___lateral particularly in patients ________ and may be confused with ___________

Other sites are liver, adrenal gland, CNS, eye, skin, penis, salivary glands

A

bi; taking oestrogen

gynaecomastia

56
Q

Staging and Grading of prostate cancer

CAP can be divided into

Clinical- cancers that produce ___________, and diagnosis made by ______examination, biopsy and histology

latent- CaP found _________ as a (small or large?) focus in the prostate during autopsy studies in men dying of other causes.

Incidental: __________ done for ______ reveal incidental carcinoma of the prostate

Occult- patient presents with evidence of ________ in clinically ______________tumour

A

clinical symptoms ; rectal examination

unexpectedly ; small

prostatectomies; BPH

metastatic disease

undetected primary tumour

57
Q

TNM staging of Prostate cancer

It takes into account cases with abnormal ______ and findings of __________________

A

PSA and findings of DRE (Digital Rectal Examination)

58
Q

TNM staging of prostate cancer

T1 – Cancer is (absent or present?), but ______________________

T1a – Found ———-, _____________ of sample is malignant and (low or high?) -grade.

T1b – Found _______ , __________ of sample malignant and/or not (low or high?) -grade.

T1c – PSA is _______, (palpable or not palpable?) , found in ________.

A

Present

not detectable in DRE or on imaging.

incidentally ; Less than 5 percent ; low

incidentally; More than 5 percent ; low

elevated; not palpable

needle biopsy.

59
Q

TNM staging of prostate cancer

T2 – Tumor is palpable in _______ ; organ confined.

T2a – Confined to _________________ of the prostate’s two lobes.

T2b – Confined to _______________ gland but ________

T2c – The tumor is _________ but ______

A

DRE

half or less than half in one

more than one half of one lobe of ; not both.

in both lobes ; within the prostatic capsule.

60
Q

TNM staging of prostate cancer

T3 – ________ ———— cancer.

T3a – Penetration of ————- on one or both sides.

T3b – Invasion into the ___________.

A

Locally extensive cancer.

prostate capsule

seminal vesicle.

61
Q

TNM staging of prostate cancer

T4 – Tumor _______ to _______

T4a – Cancer that has invaded the _______ and/or _____ and/or _________

T4b – Cancer that involves other areas ___________

A

extension to other organs.

bladder neck and/or rectum and/or external urinary sphincter.

near the prostate.

62
Q

TNM staging of prostate cancer

N – Lymph node involvement.

NO – _____ cancer detected in the lymph nodes.
N1 – Cancer spread to _______ lymph nodes measuring (more or less?) than _____.
N2 – Cancer spread to ______ lymph nodes measuring _______
N3 – Cancer spread to ______ lymph nodes measuring (more or less?) than ______ .

A

No

one or more ; less than 2cm.

one or more ;2-5cm.

one or more ; more than 5cm.

63
Q

TNM staging of prostate cancer

M – Metastasis to distant sites other than lymph nodes (cancer spread).

MO – Cancer that is _________________________________________________

M1 – Cancer that _________________________________________________

A

confined to the prostate, surrounding tissues and pelvic lymph nodes.

has spread beyond the pelvic area to bones, lungs, etc

64
Q

Gleason’s microscopic grading

Based on degree of glandular architectural pattern formed by tumour cells:

1-(Single or multiple ?) (separate or fused?) (uniform or variable?) (closely or loosely?) packed glands

2- -(Single or multiple ?) (separate or fused?) (more or less?) uniform glands, (closely or loosely?) packed glands with ______ intervening stroma

3 -( Single or multiple ?) (separate or fused?) , much (more or less?) variable glands, (small or large?) glands or tiny cell clusters, sometimes seen in between normal glands

4- (Separate or Fused?) glandular infiltrating tumour forming _______ pattern, ______ outlined

5-(rounded or flattened?) masses of circumscribed solid tumour, _____ masses of ______ tumour

A

Single ; separate ; uniform ; closely

Single; separate; less; loosely ; little intervening stroma

Single; separate ; more ; small

Fused ; cribriform ; raggedly

rounded ; ragged ; anaplastic tumour

65
Q

The prognosis of prostatic adenocarcinoma varies widely with ________ and __________.

The grade and the stage correlate well with each other and with the prognosis.

The poorly differentiated grade 5 carries _____ prognosis while the well differentiated lower grades carry _____ prognosis

A

tumor stage and grade

poor

better

66
Q

Treatment of prostatic cancer

Expectant management (watchful waiting) or ________ for well differentiated tumours.
Surgery.
________ therapy.
____therapy
__________ therapy
_______therapy.

A

active surveillance

Radiation therapy.
Cryotherapy
Hormone therapy
Chemotherapy.

67
Q

Benign Enlargement

Benign _______________ BPH

BPH is an extremely (common or rare?) disorder in men over age ____.

A

Benign Prostatic Hyperplasia BPH

common

50.

68
Q

Benign Enlargement

It is characterized by ________ of prostatic _______ and _______ cells, resulting in the formation of (small or large?), fairly _______ nodules in the _______ region of the prostate.

A

hyperplasia

stromal and epithelial cells

large; discrete

periurethral region

69
Q

BPH

When sufficiently large, the nodules ________ and ________ the urethral canal to cause partial, or sometimes virtually complete, ____________________

A

compress and narrow

obstruction of the urethra.

70
Q

Incidence of BPH

Histologic evidence of BPH can be seen in approximately 20% of men ____ years of age, a figure that increases to 70% by age ____ and to 90% by age ___.

A

40

60

80

71
Q

Classification of BPH

Microscopic BPH

Histologic diagnosis of usual _______ or ________ hyperplasia

Macroscopic BPH
Describes an _______ prostate which can be detected by ___________ or by radiologic means usually _____________

Clinical BPH
Is a diagnosis based on ________ symptoms and _______ dysfunction.

A

glandular or stromal

enlarged; digital rectal examination (DRE)

transrectal ultrasonography (TRUS)

urinary tract symptoms ; bladder dysfunction.

72
Q

Classification of BPH

________ BPH
________ BPH
________ BPH

A

Microscopic BPH
Macroscopic BPH
Clinical BPH

73
Q

Clinical diagnosis of BPH is often made by a combination of assessments for _________ and ______ BPH, which includes evaluation of _______ and ________

A

macroscopic and clinical

prostate size and urinary symptoms

74
Q

Aetiology and pathogenesis Of BPH

Despite the fact that there is ____eased number of epithelial cells and stromal components in the ______ area of the prostate, there is no clear evidence of ____________________________ in human BPH.

It is believed that the main component of the “hyperplastic” process is ________________. It has been proposed that there is an overall _________________, resulting in the accumulation of ________ in the prostate.

A

increased ; periurethral area

increased epithelial cell proliferation in

impaired cell death

reduction of the rate of cell death

senescent cells

75
Q

Aetiology and pathogenesis Of BPH

_______, which are required for the development of BPH, can not only increase ____________, but also ________

A

Androgens

cellular proliferation

inhibit cell death.

76
Q

Aetiology and pathogenesis Of BPH

The main androgen in the prostate, constituting 90% of total prostatic androgens, is __________

It is formed in the prostate from the conversion of _______ by the enzyme type ___, _______

This enzyme is located almost entirely in _______ cells; _______ cells of the prostate do not contain ___________, with the exception of a few _______ cells.

A

dihydrotestosterone (DHT).

testosterone ; type 2, 5α- reductase.

stromal cells; epithelial

type 2 5α reductase

basal cells.

77
Q

Aetiology and pathogenesis Of BPH

DHT binds to the (nuclear or cytoplasmic?) ____ receptor (AR)
present in _______________________ prostate cells.

DHT is (more or less?) potent than testosterone because it has a (lower or higher?) affinity for AR and forms a (more or less?) stable complex with the receptor.

Binding of DHT to AR activates the _______ of __________ genes.

A

Nuclear ; androgen

both stromal and epithelial prostate cells.

more; higher ; more

transcription of androgen-dependent genes.

78
Q

Thus ______ cells of the prostrate are responsible for androgen- dependent prostatic growth.

A

Stromal

79
Q

Aetiology and pathogenesis of BPH

DHT-mediated transcription of genes results in the ____eased production of several growth factors and their receptors eg the ___________ (FGF) family, and particularly FGF-__ (_________________; ).

A

incr

fibroblast growth factor

7

keratinocyte growth factor

80
Q

Aetiology and pathogenesis Of BPH

FGF-7, produced by ______ cells, is probably the most important factor mediating the _______ regulation of ______- stimulated prostatic ______.

Other growth factors produced in BPH are ______ and ______ , and _______, which promote ______ proliferation.

A

stromal ; paracrine

androgen

FGFs 1 and 2, ; TGFβ

fibroblast proliferation.

81
Q

Although the ultimate cause of BPH is _________,
it is believed that DHT-induced growth factors act by increasing the _____________ cells and decreasing the _____________ cells.

A

unknown

proliferation of stromal cells and decreasing the death of epithelial cells.

82
Q

BPH morphology

The prostate weighs between ___________ gm.
Nodular hyperplasia of the prostate originates almost exclusively in the (inner or outer?) aspect of the prostate gland (______ zone).

The early nodules are composed almost entirely of ______ cells, and later predominantly ____________ arise.

The nodular enlargements may encroach on the ______ walls of the ______ to compress it to a _________ orifice.

A

60 and 100 gm

inner ;transition

stromal cells; epithelial nodules

lateral walls ; urethra

a slit-like orifice.

83
Q

BPH morphology

On cross-section, the nodules vary in _____ and ________ .

In nodules that contain mostly glands, the tissue is ________ with a (soft or tough?) consistency, and a ________ prostatic fluid oozes out of these areas.

In nodules composed primarily of fibromuscular stroma, each nodule is ________, is (soft or tough?), does not _______, and is (more or less?) clearly demarcated from the surrounding uninvolved prostatic tissue.

A

color and consistency.

yellow-pink ;soft ; milky-white

pale gray; tough ; exude fluid

less

84
Q

BPH

Although the nodules do not have ________, the compressed surrounding prostatic tissue creates a plane of ______ about them.

A

true capsules

cleavage

85
Q

Microscopically, the hallmark of BPH is _______

A

nodularity

86
Q

Microscopy of BPH

The composition of the nodules ranges from purely __________________nodules to ____________ nodules with a _______ predominance.

Glandular proliferation takes the form of _________ of ______,_______ to _____ dilated glands, lined by ____ layers, an inner ______ and an outer ______ or ______ epithelium.

A

stromal fibromuscular ; fibroepithelial

glandular

aggregations

small, large to cystically dilated glands

two ;columnar ; cuboidal or flattened epithelium.

87
Q

Clinical features of BPH

The smooth muscle-mediated (contraction or relaxation?) of the prostate causes urethral ________.

The increased resistance to _________ leads to bladder ______ and ______, accompanied by urine ________.

The inability to empty the bladder completely creates a ______________ that is a common source of infection.

A

contraction ;urethral obstruction.

urinary outflow ; hypertrophy and distension

urine retention

reservoir of residual urine

88
Q

Clinical features Of BPH

Patients experience increased urinary _______, nocturia, difficulty in ___________ of urine, ____________ , dysuria (_____ micturition), ______uria and they also have an increased risk of developing __________ of the bladder and kidney.

In many cases, sudden, acute urinary retention appears for unknown reasons that requires _____________

A

frequency

starting and stopping the stream

overflow dribbling ; painful

haematuria ;bacterial infections

emergency catheterization.

89
Q

Complications of BPH

Bladder muscle ________, _____, ________ formation

___________
__________
UTI
______,_____
______ retention

A

Bladder muscle hypertrophy, trabeculation, diverticulum formation

Hydroureters

Hydronephrosis

Azotaemia, uraemia

Acute retention

90
Q

Management of BPH

Mild cases of BPH may be treated without medical or surgical therapy, such as by ___________, especially before bedtime; moderating the intake of _______ and ______ containing products.

The most commonly used and effective medical therapy for symptoms relating to BPH are
_________, which decrease prostate ____________________ via inhibition of ____________________ receptors

A

decreasing fluid intake

alcohol and caffeine

α-blockers

smooth muscle tone

α1-adrenergic receptors

91
Q

Medical treatment of BPH

Another common pharmacologic therapy aims to decrease symptoms by ___________ the prostate with an agents that __________________ of _____, inhibitors of _____________________ enzyme.

A

physically shrinking

inhibit the synthesis of DHT

Type 2 5-α- reductase

92
Q

Surgical treatment Of BPH

For moderate to severe cases recalcitrant to medical therapy, ____________ of the prostate (TURP) has been the gold standard in terms of reducing symptoms, improving flow rates, and decreasing post- voiding residual urine.

It is indicated as a first line of therapy in certain circumstances, such as _____________________

A

transurethral resection of the prostate (TURP)

recurrent urinary retention.

93
Q

Alternative procedures of BPH include (low or high?)-intensity focused ———, _____ therapy, _____thermia, transurethral ____________, and transurethral ________ using radiofrequency.

A

High

ultrasound; laser; hyper

electrovaporization; needle ablation

94
Q

Nodular hyperplasia is considered to be a premalignant lesion.

T/F

A

F

Nodular hyperplasia is not considered to be a premalignant lesion.

House AMP (65 decks)

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