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Pathology I > Pathology of the Prostate > Flashcards

Pathology of the Prostate Flashcards

1
Q

Prostate pathologies

A
  • Prostatitis
  • Benign prostatic hyperplasia
  • Adenocarcinoma of the prostate
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2
Q

Anatomical components of prostate pathology

A
  • Peripheral zone
  • Transitional zone
  • Central zone
  • Periurethral zone
  • Prostatic urethra
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3
Q

Histological components of prostate pathology

A
  • Basal layer (low cuboidal epithelium

- Top layer (columnar epithelium)

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4
Q

Bacterial prostatitis

A
  • Acute
  • Chronic
  • Non-specific
  • Granulomatous
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5
Q

Bacterial prostatitis transmission

A
  • UTI (ascending or descending)
  • Reflux (ascending or descending)
  • Sexual (ascending or descending)
  • Direct extension
  • Surgical or procedural manipulation
  • Hematogenous
  • Lymphatic
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6
Q

Clinical (acute) etiological agents of bacterial prostatitis

A
  • E. coli
  • Gram + cocci
  • STD
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7
Q

Symptoms of bacterial prostatitis

A
  • Dysuria
  • Chills
  • Fever
  • Malaise
  • Pain
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8
Q

Pathological manifestations of bacterial nephroprostitis

A
  • Acute Inflammatory Infiltrate

- Composed of neutrophils in the stroma and glands (Acini)

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9
Q

Clinical manifestations of chronic bacterial prostatitis

A
  • Bladder dysfunction from E. coli and gram + cocci
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10
Q

Symptoms of chronic bacterial prostatitis

A
  • Dysuria

- Pain (suprapubic, perineal, lower back)

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11
Q

Pathological manifestations of chronic bacterial prostatitis

A
  • Chronic Inflammatory Infiltrate composed of mononuclear cells (lymphocytes, macrophages)
  • Plasma cells in the stroma
    and glands (Acini)
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12
Q

Grnulomatous prostatitis

A
  • Inflammatory infiltrate contains multinucleated giant cells
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13
Q

Benign prostatic hyperplasia (nodular hyperplasia)

A
  • Proliferation in glands and stroma

- Increased frequency with age

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14
Q

Symptoms of BPH

A
  • Severe abdominal pain and discomfort
  • Mild fever
  • Required catheterization (2.5 L)
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15
Q

Pathology of BPH

A
  • Nodular hyperplasia of the transitional zone (projects upward beneath the urethral mucosa)
  • Urethral obstruction
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16
Q

Manifestations of BPH

A
  • Increased vigor of the urinary stream
  • Increased urinary frequency
  • Nocturia
  • Incontinence
  • Difficulty initiating and stopping urination
  • Rectal exam shows firm, nodular prostate
17
Q

Manifestations of BPH if chronic/untreated

A
  • Acute urinary retention
  • Bladder hypertrophy, trabeculation, diverticula
  • Cystitis, pyelonephritis
  • Hydroureter
  • Hydronephrosis
  • Renal failure
18
Q

Macroscopic pathology of BPH

A
  • Increased weight

- Nodular

19
Q

Microscopic pathology of BPH

A
  • Proliferation of epithelial cells (double layer of cells)
  • Proliferation of smooth muscle cells
  • Stromal fibroblasts
20
Q

Prostate adenocarcinoma incidence

A
  • 20% in men > 50
  • 70% in men 70-80yrs
  • Uncommon in Asians
  • Frequent among men of African descent
21
Q

Pathogenesis of prostate cancer

A
  • Chromosomal rearrangements
  • MYC oncogene
  • Tumor suppressor genes (PNET and TP53)
  • Hypermethylation defects
  • Deletions of RB gene
  • Amplification of androgen receptor gene locus
22
Q

Chromosomal rearrangement in prostate CA

A
  • Transcription factor gene (ETS)

- Androgen regulated promoter (TMPRSS2)

23
Q

Prostate CA precursor Lesion (Prostatic Dysplasia)

A
  • Prostatic intraepithelial neoplasia (PIN)
  • Nuclear and cellular atypia
  • Prominent nucleoli
  • Basal layer is identified
  • Grades I, II, III
24
Q

Prostate CA pathology

A
  • Adenocarcinoma (95%)

- 70% arise from the peripheral zone

25
Q

Prostate CA clinical manifestation

A
  • Depends upon location and size
26
Q

Pathological diagnosis of prostatic adenocarcinoma

A
  • Clinical laboratory diagnosis

- Prostate specific antigen (PSA) interpretation

27
Q

Prostatic specific antigen (PSA) tests

A
  • PSA Density (serum PSA : prostate volume ratio)
  • PSA Velocity (Rate of change with time – 0.75ng/ml↑/yr)
  • Age-Specific Values
  • Bound to free PSA
28
Q

Age specific reference ranges for PSA (ng/mL)

A
  • 2.5 / 40-49
  • 3.5 / 50-59
  • 4.5 / 60-69
  • 6.5 / 70-79
29
Q

Prostate cancer macroscopic findings

A
  • Firm, gritty, poorly defined, yellow-gray lesion

- Undetectable

30
Q

Prostate cancer microscopic findings

A
  • Differentiation

- Prominent nucleoli

31
Q

Well/moderately differentiated prostate findings

A
  • Lined by a single layer of uniform neoplastic epithelial cells
  • Loss of basal layer
32
Q

Poorly differentiated prostate findings

A
  • Solid growth

- Tumor growing in a diffuse fashion

33
Q

Microscopic appearance of prostatic carcinoma

A
  • Well-differentiated tumor composed of medium-sized glands
  • Irregular shape of the glands
  • Presence of intraluminal basophilic secretion
  • Contrast with the non-neoplastic glands present in the field is obvious
34
Q

Microscopic prostate CA patterns

A
  • Variability of gland size and configuration
  • Papillary and cribriform patterns
  • Solid cords of infiltrating neoplastic cells
35
Q

Prostate CA grading and staging

A
  • Grading = Gleason Score/System and histological evaluation

- Staging = TNM

36
Q

Prostatic adenocarcinoma Gleason System (grading) application

A
  • Grade of predominant pattern
  • Grade of 2nd most common pattern
  • 2-6 Well differentiated
  • 7; Moderately differentiated
  • 8-10 Poorly differentiated
37
Q

Prostate CA invasion and metastasis (location is important)

A
  • Perineural invasion
  • Lymphatics
  • Hematogenous
38
Q

Hematogenous prostate CA invasion and metastasis

A
  • Bone
  • Liver
  • Lung

Pathology I (9 decks)

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