Pathology of the Prostate Flashcards
Prostate pathologies
- Prostatitis
- Benign prostatic hyperplasia
- Adenocarcinoma of the prostate
Anatomical components of prostate pathology
- Peripheral zone
- Transitional zone
- Central zone
- Periurethral zone
- Prostatic urethra
Histological components of prostate pathology
- Basal layer (low cuboidal epithelium
- Top layer (columnar epithelium)
Bacterial prostatitis
- Acute
- Chronic
- Non-specific
- Granulomatous
Bacterial prostatitis transmission
- UTI (ascending or descending)
- Reflux (ascending or descending)
- Sexual (ascending or descending)
- Direct extension
- Surgical or procedural manipulation
- Hematogenous
- Lymphatic
Clinical (acute) etiological agents of bacterial prostatitis
- E. coli
- Gram + cocci
- STD
Symptoms of bacterial prostatitis
- Dysuria
- Chills
- Fever
- Malaise
- Pain
Pathological manifestations of bacterial nephroprostitis
- Acute Inflammatory Infiltrate
- Composed of neutrophils in the stroma and glands (Acini)
Clinical manifestations of chronic bacterial prostatitis
- Bladder dysfunction from E. coli and gram + cocci
Symptoms of chronic bacterial prostatitis
- Dysuria
- Pain (suprapubic, perineal, lower back)
Pathological manifestations of chronic bacterial prostatitis
- Chronic Inflammatory Infiltrate composed of mononuclear cells (lymphocytes, macrophages)
- Plasma cells in the stroma
and glands (Acini)
Grnulomatous prostatitis
- Inflammatory infiltrate contains multinucleated giant cells
Benign prostatic hyperplasia (nodular hyperplasia)
- Proliferation in glands and stroma
- Increased frequency with age
Symptoms of BPH
- Severe abdominal pain and discomfort
- Mild fever
- Required catheterization (2.5 L)
Pathology of BPH
- Nodular hyperplasia of the transitional zone (projects upward beneath the urethral mucosa)
- Urethral obstruction
Manifestations of BPH
- Increased vigor of the urinary stream
- Increased urinary frequency
- Nocturia
- Incontinence
- Difficulty initiating and stopping urination
- Rectal exam shows firm, nodular prostate
Manifestations of BPH if chronic/untreated
- Acute urinary retention
- Bladder hypertrophy, trabeculation, diverticula
- Cystitis, pyelonephritis
- Hydroureter
- Hydronephrosis
- Renal failure
Macroscopic pathology of BPH
- Increased weight
- Nodular
Microscopic pathology of BPH
- Proliferation of epithelial cells (double layer of cells)
- Proliferation of smooth muscle cells
- Stromal fibroblasts
Prostate adenocarcinoma incidence
- 20% in men > 50
- 70% in men 70-80yrs
- Uncommon in Asians
- Frequent among men of African descent
Pathogenesis of prostate cancer
- Chromosomal rearrangements
- MYC oncogene
- Tumor suppressor genes (PNET and TP53)
- Hypermethylation defects
- Deletions of RB gene
- Amplification of androgen receptor gene locus
Chromosomal rearrangement in prostate CA
- Transcription factor gene (ETS)
- Androgen regulated promoter (TMPRSS2)
Prostate CA precursor Lesion (Prostatic Dysplasia)
- Prostatic intraepithelial neoplasia (PIN)
- Nuclear and cellular atypia
- Prominent nucleoli
- Basal layer is identified
- Grades I, II, III
Prostate CA pathology
- Adenocarcinoma (95%)
- 70% arise from the peripheral zone
Prostate CA clinical manifestation
- Depends upon location and size
Pathological diagnosis of prostatic adenocarcinoma
- Clinical laboratory diagnosis
- Prostate specific antigen (PSA) interpretation
Prostatic specific antigen (PSA) tests
- PSA Density (serum PSA : prostate volume ratio)
- PSA Velocity (Rate of change with time â 0.75ng/mlâ/yr)
- Age-Specific Values
- Bound to free PSA
Age specific reference ranges for PSA (ng/mL)
- 2.5 / 40-49
- 3.5 / 50-59
- 4.5 / 60-69
- 6.5 / 70-79
Prostate cancer macroscopic findings
- Firm, gritty, poorly defined, yellow-gray lesion
- Undetectable
Prostate cancer microscopic findings
- Differentiation
- Prominent nucleoli
Well/moderately differentiated prostate findings
- Lined by a single layer of uniform neoplastic epithelial cells
- Loss of basal layer
Poorly differentiated prostate findings
- Solid growth
- Tumor growing in a diffuse fashion
Microscopic appearance of prostatic carcinoma
- 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
Microscopic prostate CA patterns
- Variability of gland size and configuration
- Papillary and cribriform patterns
- Solid cords of infiltrating neoplastic cells
Prostate CA grading and staging
- Grading = Gleason Score/System and histological evaluation
- Staging = TNM
Prostatic adenocarcinoma Gleason System (grading) application
- Grade of predominant pattern
- Grade of 2nd most common pattern
- 2-6 Well differentiated
- 7; Moderately differentiated
- 8-10 Poorly differentiated
Prostate CA invasion and metastasis (location is important)
- Perineural invasion
- Lymphatics
- Hematogenous
Hematogenous prostate CA invasion and metastasis
- Bone
- Liver
- Lung
