Pathology (Sections 16-20) Flashcards
Most common form of intestinal atresia
Imperforate anus
Most common type of tracheoesophageal fistula
Distal TEF with proximal esophageal atresia
Posterolateral diaphragmatic hernia
Bochdalek
Anteromedial diaphragmatic hernia
Morgagni
Pathophysiology: Omphalocoele
Failure of bowel to return during physiologic herniation (6th to 10th week AOG)
Pathophysiology: Gastroschisis
Abnormal closure of the abdominal wall, usually to the right of the umbilicus
True diverticulum, antimesenteric
Failed involution of vitelline/omphalomesenteric duct
Rule of 2's: 2% of population 2ft from ileocecal valve 2x in males Symptomatic by 2 years of ages
Meckel’s Diverticulum
Teratogens associated with pyloric stenosis
Erythromycin, Azithromycin
Types of Esophageal Diverticula
Zenker (Pharyngoesophageal)
(Above the UES)
Epiphrenic
(Above the LES)
Iron deficiency Anemia
Glossitis
Cheilosis
Esophageal Webs
Plummer-Vinson Syndrome
Circumferential narrowng of the esophagus brought about by thickening of mucosa and muscle
Schatzki Ring
Type A:
Above Gastroesophageal Junction
Type B:
Squamocolumnar Junction of lower esophagus
Triad of Achalasia
- Incomplete LES Relaxation
- Increased LES Tone
- Esophageal Peistalsis
Longitudinal tears near GEJ from retching
Mallory-Weiss
Vascular anastomosis involved in esophageal varices
Esophageal branch of Left Gastric Vein
And
Azygos Vein
Intestinal metaplasia of the squamous esophageal epithelium
Complication of chronic GERD
Barrett Esophagus
Common site of SCCA in the esophagus
Middle third
versus AdenoCA: Distal Third
Proximal duodenal ulcers associated with severe burns and trauma
Curling Ulcers
Esophageal, gastric, or duodenal ulcers in patients with elevated ICP (direct vagal stimulation and increased acid secretion)
Cushing Ulcers
Most common cause of diffuse, acute chronic gastritis
Autoimmune gastritis
H. Pylori virulence factors
- Lophotrichus flagella
- Adhesins
- Urease
- CagA Toxin
Type 4 HSR causing destruction of gastric parietal cells directed against the H/K ATPase Pump
Spares the Antrum
Autoimmune Gastritis
Histologic change associated with autoimmune gastritis
Endocrine Cell Hyperplasia
versus Intestinal Metaplasia in H. pylori
Most common complication of PUD
Bleeding
Most common form of PUD
Antral/Duodenal
H. pylori associated
Mucosal atrophy Corpus-predominant Decreased gastric acid secretion Pain with meals No nocturnal awakening
Gastric Ulcer
Triad of Zollinger-Ellison Syndrome
- Pancreatic Cell Tumor
- Gastric Hypersecretion
- Peptic Ulcer Disease
Hypertrophic gastropathy with resulting hypoproteinemia due to protein-losing enteropathy
Menetrier Disease
Type of gastric polyp
Lined with flattened chief/parietal cells
Absent a nflammation
No dysplasia
Fundic gland polyp
Most common type of gastric polyp
Inflammatory/Hyperplastic (85%)
Most common malignancy of the stomach
Adenocarcinoma
Most common site of extranodal lymphomas
Stomach
Most common abdominal mesenchymal tumor
Gastrointestinal stromal tumor
Most common site of gastric adenocarcinoma
Antral, Lesser Curvature
Gastric adenocarcinoma
Abnormality in WNT signalling
Exophytic, ulcerative lesions
Intestinal Type
Gastric adenocarcnoma Loss of E-Cadherin Infiltrative lesions with desmoplasia Leather bottle appearance (lintis plastica) Poorly cohesive cells
Diffuse Infiltrative
Most common inducer of MALT lymphoma
H. pylori Infection
Most important prognosticating factor for GI Carcinoids
Location
*Midgut tumors often multiple and aggressive
Most common site of GI Carcinoids
Small Intestine (40%)
Arise from Cajal Cells cKIT Mutation (75-80%)
Gastrointestinal Stromal Tumor
Most common cause of intestinal obstruction
Hernias
*in less than 2 years: intussusception
Most common sites of ischemic bowel disease
Splenic Flexure
Sigmoid
Rectum
Hallmark of malabsorptive syndromes
Steatorrhea
Cell-mdiated immune reponse to gliadins
CD8+ T-Cells in villi
Diagnostic: Transglutaminase antibodies
Increased risk of Enteropathy-associated T-Cell Lymphoma
Celiac Disease
Most common bacterial enteric pathogen
Campylobacter jejuni
Associated with Whipple Disease
Ssx of GITB, but AFB (-)
Trophyrema whippeli
Common cause of severe childhood diarrhea; associated with diarrheal mortalities worldwide
Rotavirus
Causes almost half of gastroenteritis outbreaks worldwide
Norwalk Virus
Inflammatory bowel disease
Transmural involvement
Any part of the GIT
Hallmark: Non-caseating granuloma
Crohn’s Disease
Inflammatory bowel disease
Mural Involvement
Involves colon and rectum
Ulcerative Colitis
Most common site of diverticular disease
Sigmoid
Absent in False Diverticula
Muscularis propria
Single most important factor that relates to malignancy risk in GIT adenomas
Size
> 4cm
Elephant-feet Glands
Sessile serrated adnoma
high malignant potential
Multiple hamartomatous polyps, mucocutaneous hyperpigmentation along GIT
Arborizing networks of smooth muscle
Autosomal Dominant
Peutz-Jegher Polyps
Multiple (at least 100) colorectal adenomas during teenage years
APC Mutation
Pathgenesis: Hyperactive WNT signalling
Familial Adenomatous Polyposis
Familial clustering of the following tumors: Colorectal Endometrial Ovarian GIT, HBT Neurologic Skin
Pathogenesis: Defective DNA Repair
Hereditary nonpolyposis colon cancer
Diagnostic criteria used for HNPCC
Amsterdam Criteria
Drug considered protective against GIT adenocarcinoma
NSAID
decreased PGE2
Most common site of metastases for GIT malignancies
Liver
Gross description of colon cancers
Proximal: Exophytic, Bulky
Distal: Annular
Vascular plexuses involved in hemorrhoid formation
Internal:
Superior Hemorrhoidal Plexus
External:
Inferior Hemorrhoidal Plexus
Most common cause of appendiceal obstruction
Children:
Lymphoid Hyperplasia
Adults:
Fecalith
Mucinous ascites due to peritoneal seeding of mucinous tumors
Pseudomyxoma Peritonei
Most common appendiceal tumor
Carcinoid
Pathophysiology: Ormond Disease
IgG mediated retroperitoneal sclerosis
Functions of hepatic stellate cells
Vitamin A Storage
Scar formation in hepatic injury
Etiology of rapid hepatic necrosis in ALF without evidence of repair
Drug-induced
Pathophysiology: Hepatorenal Syndrome
Decreased GFR due to afferent arteriole vasoconstriction (c/o RAAS) from renal hypoperfusion
Initiating Event: Systemic Vasodilation
Most common cause of portal hypertension
Cirrhosis
Pathologic derangements of portal hypertension
Sinusoidal remodelling and intrahepatic shunting
Hyperdynamic pulmonary circulation
Councilman Bodies
Eosinophilic inclusions in viral hepatitis
Autoimmune hepaitis
Middle aged and older
ANA, Anti-SMA autoantibodies
Better prognosis
Type 1
Autoimmune hepatitis
Children and teenagers
Anti-LKM-1 autoantibody
Less favorable prognosis
Type 2
Drugs that trigger an immune response via binding of large molecules
Hapten
Alcohol consumption associated with ALD
80g/day
Morphologic patterns of ALD
Hepatocellular steatosis
(Lipid droplets; reversible)
Alcoholic steatohepatitis
(Swelling and necrosis)
Steatofibrosis
(Chicken-wire Fibrosis)
Mallory-Denk Bodies
Amorphous, eosinophilic material seen in ALD
Most common metabolic liver disease
Non-alcoholic fatty liver disease
Triad of Hemochromatosis
- Micronodular cirrhosis
(mediated by activation of stellate cells by iron) - DM
(pancreatic fibrosis) - Skin pigmentation
(Slate gray skin)
Impaired copper excretion in bile
ATP7B mutation
Putaminal atrophy (movement disorders)
Kayser-Fleisher Ring (corneal limbus)
Wilson Disease
Autosomal ecessive PiZZ genotype Panlobular emphysema (elevated elastase) Liver damage (misfolded CHON accumulation)
Alpha-1-antitrypsin Deficiency
Conditions associated with impaired uridine diphosphate glucoronyltransferase
Criggler-Najar Type 1
(AR, absent activity)
Criggler-Najar Type 2
(AD, decreased activity)
Gilbert
(AR, decreased activity)
Conjugated hyperbilirubinemia
MRP2 Mutation
Impaired biliary excretion
Dublin-Johnson Syndrome
Conjugated hyperbilirubinemia Mechanism unknown #PinoyPride
Rotor Syndrome
Most common cause of bilde duct obstructions
Adults:
Gallstones
Children:
Biliary Atresia
Charcot Triad
- Fever
- Jaundice
- RUQ Pain
Complete or partial obstruction of the extrahepatic BT within first 3 months of life
Single most common cause of hepatic mortality in early childhood
Extrahepatic biliary atresia
Types of Biliary Atresia
Fetal
(Malformation)
Perinatal
(Postnatal destruction)
Median age 50 Female Associated with Sjogren Syndrome (70%) AMA positive (95%) Loss of small ducts
Florid duct lesion
Mallory-Denk Bodies
Primary Biliary Cirrhosis
Median Age 30 Male Associated with IBD (70%) ANCA positive(65%) Involvement of all sizes of hepatic ducts
Primary Sclerosing Cholangitis
Triad of Choledochal Cysts
- Pain
- Jaundice
- Abdominal Mass
Congenital cystic dilatation of intrahepatic bile ducts
Associated with choledochal cysts
Caroli disease
Congenital bile duct hamartomas
Associated with polycystic kidney disease
Von Meyenbrg Complex
Infarct of Zahn
Intrahepatic thrombosis
Sinusoidal dilatation due to impediment in hepatic blood outflow
Peliosis hepatis
Thrombotic obstruction of more than 2 hepatic veins
Hemorrhagic centrilobular necrosis
Budd-Chiari Syndrome
Sinusoidal remodelling secondary to toxic endothelial injury
Sinusoidal Obstruction Syndrome
Components of Nutmeg Liver
Centrilobular Congestion
(RSHF)
Centrilobular Ischemic Coagulative Necrosis
(LSHF)
Centrilobular fibrosis in long-standing congestion
Cardiac sclerosis
Most common benign hepatic tumor
Cavernous Hemangioma
Most common liver tumor in early childhood
Hepatoblastoma
Most common tumor of the liver
Metastasis
Most common primary malignant tumor pf the liver
Hepatocellular Carcinoma
Second most common primary malignancy of the liver
Cholangiocarcinoma
Tumor marker for HCC
Alpha-fetoprotein
Pattern and site of metastasis for HCC
Hematogenous to the Lungs
HCC Variant
Oncocytes in clusters
Parallel lamellae of dense connective fiber
Fibrolamellar HCC
Common location of Cholangiocarcinoma
Perihilar (Klatskin Tumor)
Most common congenital anomaly of the gallbladder
Folded fundus
Phrygian Cap
Most common biliary tract disease
Cholelithiasis
Types of acute cholecystitis
Acute calculous (90%)
Acute acalculous (ischemic)
Rochitansky-Aschoff Sinuses
Mucosal outpouching of the gallbladder
Extensive, dystrophic calcification of the gallbladder
Porcelain Gallbladder
Atrophic, dilated GB with clear secretions
Hydrops
Failure of fusion of fetal pancreatic duct systems
Most common congenital anomaly of the pancreas
Pancreatic divisum
Most common site of ectopic pancreatic tissue
Stomach, Duodenum
Mutation involved in pancreatic agenesis
PDX1
Most frequntly mutated oncogene in pancreatic cancer
KRAS
Most common location of pancreatic cancer
Head
Tumor marker for pancreatic cancer
CA 19-9
Common site of metastasis for pancreatic cancer
Liver, Lungs
Acute Kidney Injury
- Increase in SCr by 0.3 in 48 hrs
- Increase in SCr by 1.5x baseline within 7 days
- Urine < 0.5mL/kg/hr for 6 hrs
Nephritic Syndrome
Type 3 HSR
EM: Subepithelial bumps
IF: IgG, C3 positve
Most common cause of nephritic syndrome in children
PSGN
Histologic hallmark of RPGN
Crescent formation
Electron Microscopy and Immunofluorescence in RPGN
Type I
EM: Ruptured GBM
IF: Linear deposits
Type II
EM: Lumpy-Bumpy deposits
IF: Granular deposits
Type III
EM, IF: No deposits
Males in their 20’s
Smokers
Hemoptysis and Renal Failure
Antibodies against Collagen type 4
Goodpasture Syndrome
Nephrotic Syndrome
EM: Effaced foot processes
Responsive to steroids
Most common cause in children
Minimal Change Disease
Nephrotic Syndrome
EM:”Spike and Dome” subepithelial deposits
IF: Granular deposits
Second most common cause in adults
Membranous Nephropathy
Nephrotic Syndrome Associated with HIV, Heroin LM: Mesangial proliferation, hyalinosis EM: Effacement of foot processes IF: Non-specific trapping in hyalinosis
Most common cause in adults
Focal Segmental Glomerulonephritis
Difference between MPGN Type 1 and 2
Type 1
Classical and alternative complement activation
WITH Immune Complex Deposition
Type 2
Also known as Dense Deposit Disease
Alternative complement activation
WITHOUT Immune Complex Deposition
Nephrotic Syndrome
IgA deposition localized to kidneys (mesangial)
Gross hematuria post-infection (GI, Pulmo)
IF: Mesangial deposit of IgA
Most common GN worldwide
IgA Nephropathy
Berger Disease
Nephrotic Syndrome
Systemic IgA Deposition
Purpuric skin lesions, GI Bleed, Arthralgias
IF: Mesangial deposit of IgA
Henoch-Schonlein Purpura
Defective assembly of Type 4 Collagen
Isolated Hematuria
EM: Diffuse thinning of GBM
Thin Basement Membrane Lesion
Defective assembly of Type IV collagen Posterior Lens dislocation Hearling Loss Hematuria EM: Basket-Weave Appearance
Alport Syndrome
Top causes of AKI
- Pyelonephritis
2. Drug-induced TIN
Pathophysiology: Adult Polycystic Kidney Disease
PKD1 (85%, more severe) and PKD2 (15%) Mutations
Pathophysiology: Childhood Polycystic Kidney Disease
PKHD1 Mutation
Most commn stones in urolithiasis
Calcium Oxalate, Calcium Phosphate (70%)
Types of Renal Stones
Calcium Oxalate
(Acidic, Opaque)
Struvite
(Basic, Opaque)
Uric Acid
(Acidic, Lucent)
Cystine
(Acidic, Opaque)
Renal tumor associated with Tuberous Sclerosis
Angiomyolipoma
Benign renal tumor arising from the intercalated cells of the collecting duct
Oncocytoma
Benign renal tumor arising fr, tubular epithelial cells in a palm frond configuration
Renal Papillary Adenoma
Most common renal malignancy
Renal Cell Carcinoma
Second most common renal malignancy
Wilms Tumor
Third most common renal malignancy
Urothelial carcinoma of the pelvocalyceal system
Common in:
Males
60’s-70’s
Smoker
Most common renal malignancy
Renal Cell Carcinoma
Sites of predisposition: Renal Cell Carcinoma
Renal Cell:
Proximal Tubule
Papillary:
Distal Tubule
Chromophobe:
Intercalated cells of the Collecting Ducts
Triad of Renal Cell Carcinoma
- Hematuria
- Flank Pain
- Palpable Mass
Renal malignancy associated with Lynch Syndrome and Analgesic Nephropathy
Urothelial Carcinoma of the Renal Pelvis
Metastatic spread by Renal Cell Carcinoma
Hematologic to the Lungs, Bones
Most common cause of hydronephrosis in children
Ureteropelvic Junction Obstruction
Most common primary malignancy in the Ureters
Urothelial Carcinoma
Most common and serious congenital anomaly of the ureters
Vesicoureteral Refux
Consequences of a patent Urachus
Fistula between umbilicus and urinary bladder (total patency)
Urachal Cyst (partial patency)
Most common bacterial pathogens of acute cystitis
Escherichia coli
Klebsiella
Proteus
Enterobacter
Viral cause of hemorrhagic cystitis
Adenovirus
Cytotoxic drug associated with hemorrhagic cystitis
Cyclophosphamide
Triad of Acute Cystitis
- Frequency
- Lower abdominal pain’
- Dysuria
Common in women
Intermittent, severe suprapubic pain
Frequency, urgency, hematuria, dysuria
Cystoscopy: Punctate hemorrhages, fissures, Hunner Ulcers
May mimic carcinoma-in-situ
Chronic Pelvic Pain Syndrome
Interstitial Cystitis
Hunner Ulcers
Chronic mucosal ulcers found in patients with Interstitial Cystitis
Seen in cases of chronic E. coli and Proteus infections
Defect of phagocyte function
Michaelis-Guttman Bodies
Malakoplakia
Michaelis-Guttman Bodies
Macrophages with abundant lysosomal calcium deposits
Seen in Malakoplakia
Form of cystitis that mimics Urothelial carcinoma both clinically and histologically
Arises from irritation secondary to catheterization
Polypoid Cystitis
Brunn nests (urothelial cells) grow downward into lamina propria; presents as glandular metaplasia or cyst formation
Cystitis Cystica et Glandularis
Implantation of renal tubular cells at sites of injured urothelium
Nephrogenic Adenoma
Males Smokers 5th to 8th decade of life Mediated by 9p and 9q deletions/monosomy Presents as painless hematuria, frequency, urgency
Most common histologic type: Urothelial
Bladder Cancer
Infectious cause of SCCA in the bladder
Schistosoma haematobium
Denuding Cystitis
Few malignant cells on a largely denuded basement membrane with inflamed stroma.
Seen in carcinoma-in-situ of the urinary bladder
Intravesically administered vaccine used as treatment for non-invasive urothelial carcinomas
Attenuated strain of Mycobacterium bovis
Bacille-Calmette-Guerin
Most important prognostic factor in invasive urothelial carcinoma of the bladder
Staging
Most common benign tumor of the bladder
Leiomyoma
Most common sarcoma in children
Embryonal Rhabdomyosarcoma (Sarcoma Botryoides)
Most common sarcoma in adults
Leiomyosarcoma
Most common cause of urinary bladder obstruction in males
Nodular prostatic hyperplasia
Most common cause of urinary bladder obstruction in females
Cystocoele of the bladder
Non-infectious cause of urethritis
Reiter Syndrome
Inflamed granulation tissue in the urethra, covered by a friable mucosa
Urethral Caruncle
Distribution of Urethral Malignancies
Proximal:
Urothelial Carcinoma
Distal:
Squamous Cell Carcinoma
Pathophysiology:
Hypospadias, Epispadias
Malformation of the urethral groove
Most common cause of phimosis
Scarring from infection
Infection of the glans and the prepuce
Balanoposthitis
Pathogen responsible for Condyloma Acuminatum
HPV 6, HPV 11
HPV 16 Infection
Solitary gray-white, opaque plaque
Progresses to SCCA in 10% of cases
Bowen Disease
HPV 16 infection
Solitary, shiny, red, velvety plaque
Erythroplasia of Queyrat
HPV 16 Infection
Multiple reddish-brown papules
Does not progress to SCCA
Bowenoid Papulosis
Locally invasive, but rarely metastatic verrucous tumor of the penis
Buschke-Lowenstein Tumor
Giant Condyloma Acuminatum
Most important prognostic factor in penile malignancy
Staging
Most common site of cryptorchidism
Inguinal Canal
Most common phase of arrest in Cryptorchidism
Inguinoscrotal
4th to 7th month AOG
Anatomic predisposition of the various patholog processes in male gonads
Epididymis:
Inflammation, Gonorrhea (initially), EPTB (initially)
Testes:
Tumors, Syphilis (initially)
Pathogenesis of orchitis and epidydimitis
Ascending or lymphatic spread of UTI
Testicular mass with or without fever
Non-caseating granulomas in spermatic tubules
Granulomatous / Autoimmune Orchitis
Acute interstitial orchitis following a previous PAROTITIS
Unilateral testicular involvement
Not associated with infertility
Mumps Orchitis
Urologic emergency
Hemorrhagic infarction from twisting of the spermatic cord
Golden period: 6 hours
Testicular Torsion
Adult-type testicular torsion results from this bilateral anatomic defect in adolescents
Bell-clapper Deformity
increased mobility of testes
Most common cause of painless testicular enlargement
Testicular neoplasia
Histologic types of Testicular Tumors
Germ Cell (95%, aggressive)
Sex cord-stromal (5%, less aggressive)
Prescursor lesion of most Testicular Germ Cell Tumors
Intratubular germ cell neoplasia
Most common route of lymphatic spread by Germ Cell Tumors
Retroperitoneal para-aortic lymph nodes
Most common route of hematogenous spread by Germ Cell Tumors
Lungs
Liver
Brain
Bones
Clinical division of GCT Diagnosed at Stage I (70%) Lymphatic Spread Radiosensitive Cells resemble primordial germ cells
Seminomatous
Clinical division of GCT Diagnosed at Stage II or III (60%) Hematogenous spread Radioresistant Undifferentiated Cells
Non-seminomatous
Staging of GCT
Stage I
Confined to testes, epididymis, or spermatic cord
Stage II
Spread to subdiaphragmatic LN
Stage III
Spread to retroperitoneal LN or those above diaphragm
Seminomatous GCT Occurs after puberty Precursor lesion: ITGCN Ovarian equivalent: Dysgerminoma Gray-white, lobulated mass
Most common GCT
Seminoma
Seminomatous GCT Occurs at 6th decade of life and beyond No precursor lesion No ovarian equivalent Well-circumscribed, pale-gray, multinodular mass
Spermatocytic Seminoma
Types of Seminoma
Typical/Classic
(Large polyhedral cells, clear cytoplasm, central nucleus)
Anaplastic
(Same as typical, with atypia)
20's to 30's Precursor lesion: ITCGN Common component of Mixed GCT's (80%) More aggressive than Seminomas Small, poorly demarcated masses with foci of hemorrhage
Embryonal Carcinoma
<3 years old
No precursor lesions
Excellent prognosis
Non-encapsulated, solid, homegnous, yellow-white mass
Schiller-Duval Bodies, Hyaline-like Globules
(+) AFP is highly characteristic
Most common testicular tumor in children less than 3 years
Yolk Sac Tumor
Infantile Embryonal Carcinoma, Endodermal Sinus Tumor
Highly malignant
Hematogenous Spread with Brain metastases
Clinically, normal sized testes and/or small nodule
Tumor Marker: HCG
Histology: Cytotrophoblasts and Syncytiotrophoblasts
Choriocarcinoma
Complex tumor with various components derived from more than 1 germ cell layer
Second most common testicular tumor in infants and children
Teratoma
Best prognostic factor for Teratomas
Age
Post-puberty: All considered malignant
Differentiates Immature from Mature Teratomas
Degree of Differentiation
Less in Immature
Malignant transformation of a Teratoma
Non-germ cell malignancy arising from within a teratoma
Usually chemoresistant
Retains i(12p) Mutation from Teratoma precursors
Schiller-Duval Bodies
Central blood vessels enveloped by tumor cells within a space lined by tumor cells
Seen in Yolk Sac Tumors
Second most common GCT in adults (60%)
Mixed GCT
Sex Cord-Stromal Tumor 2nd to 6th decade of life Gynecomastia, Precocious Puberty Benign Well-differentiated polygonal cells with abundant granular cytoplasm; with Crystalloids of Reinke (rod-shaped)
Leydig Cell Tumor
Sex Cord-Stromal Tumor First 4 decades of life Hormonally silent Most are benign Trabeculae and cords recemble seminiferous tubules
Sertoli Cell Tumor
Most common form of testicular neoplasm in males greater than 60 years of age
Testicular Lymphoma
Fever, chills, and dysuria Tender, boggy prostate on DRE Caused by E. coli, Enterococci, Staphylococci Chronic: History of recurrent UTI Prostatic secretions: >15 WBC/hpf
Bacterial Prostatitis
Painful ejaculation
Caused by Chlamydia, Trichomonas, Ureaplasma, and Mycoplasma
Prostatic secretions: >10 WBC/hpf
(-) Bacterial Cultures
Abacterial Prostatitis
Most common site of prostatic intraepithelial neoplasia (PIN), and prostatic malignancy
Peripheral Zone
Most common site of nodular prostatic hyperplasia (NPH)
Transitional Zone
Prostatic neoplasia
Mediated by Dihydroxytestosterone (DHT)
Fibromuscular and glandular hyperplasia leading to nodule formation
NOT a premalignant lesion
Nodular Prostatic Hyperplasia
> 50 years High fat diet, Obesity, Alcoholism Adenocarcionoma without basal layer Presents as dysuria (most common) Direct local extension to seminal vesicles and bladder Hematogenous spread to Lumbar Spine
Diagnostics: PSA (Non-specific)
Prostatic Adenocarcinoma
PTEN Mutation in Prostatic CA
Gives resistance to anti-androgen therapy
ERG-ETV1-TMPRSS2 Mutation in Prostatic CA
Associated with invasiveness; very common mutation
Diagnostic used in the context of elevated PSA given a normal prostate biopsy
PCA3
Prostate CA scoring system based on the two most dominant glandular patterns on histology
Gleason Scoring System
Best prognostic factor for Prostate CA
Stage and Grade
Most common cause of renal artery stenosis
Atherosclerosis