prostate and vagina pathology

Question 1

how do you treat BPH?

Answer 1

alpha 1 antagonists like terazosin (works on both blood vessels and prostate- nonselective; good for pts with HTN) or tamsulosin (good for normotensive pts), which cause relaxation of the smooth muscle, or finasteride (which inhibits 5-alpha reductase and prevents formation of DHT. take months to produce results).

Question 2

describe prostate anatomy- where is it, what are the zones, various pathology locations

Answer 2

sits at the base of the bladder and anterior to the rectum. has 2 lateral lobes, an anterior lobe, a middle lobe, and a posterior lobe. urethra runs between the anterior, middle, and lateral lobes.
BPH affects the lateral and middle lobes; cancer affects the posterior lobe.

Question 3

describe normal prostate histology. what is its function?

Answer 3

glands and stroma. the stroma are CT; glands secrete alkaline milky fluid.
glands have inner luminal layer and an outer basal cell layer. both maintained by androgens

Question 4

acute prostatitis: causes, presentation

Answer 4

acute inflammation of prostate, usually d/t bacteria. young adults: c trachomatis and n gonorrhea. in older adults, consider pseudomonas and e coli.
present with dysuria, frequency, urgency, fever and chills. on exam, prostate would be tender and boggy. secretions have WBCs and cultures are positive.

Question 5

chronic prostatitis

Answer 5

chronic inflammation of the prostate that presents with dysuria with pelvic or low back pain. prostatic secretions show WBCs but cultures are negative.

Question 6

BPH: what is histologic components are involved? PSA changes? complications?

Answer 6

hyperplasia of both stroma AND glands. no increased risk for cancer.
PSA is slightly elevated (normal is 0-4, BPH is 4-8).
complications: fluid backs up to kidney –> hydronephrosis. can cause atrophy and dilation of the kidney.

Question 7

prostate adenocarcinoma

Answer 7

malignant proliferation of glands involving the prostate.

Question 8

PSA and free PSA: what is normal? what is worrisome?

Answer 8

PSA normally 0-4. mild elevation 0-10. anything above 10 is worrisome at any age.
decreased percent free-PSA is suggestive of cancer (cancer makes bound PSA)

Question 9

prostate cancer histologic characteristics and grading.

Answer 9

small invasive glands with prominent nucleoli. graded based on architecture alone and not nuclear atypia. multiple regions of the tumor must be assessed becasue architecture varies from area to area. a score (1-5) is assigned to 2 areas and then added to produce a final score. higher score is worse prognosis.

Question 10

prostate cancer mets

Answer 10

often go to lumbar spine. will produce osteoblastic mets that present as low back pain and incr. serum alkaline phosphatase (sign of osteoblastic activity), PSA, and prostatic acid phosphatase.

Question 11

treatment of prostate CA

Answer 11

prostetctomy, continuous GnRH analogs like leuprolide (shut down hypothalamus to reduce LH and FSH), androgen receptor inhibitors like flutamide (prostate CA needs androgens)

Question 12

adenosis: what is it? risk factors for development? complications?

Answer 12

focal persistence of columnar epithelium in the upper vagina (remember, the upper vagina comes from the mullerian duct, and the uterus is columnar epithelium. in vagina, it is usually replaced by stratified squamous epithelium from the lower vagina, which is derived from the urogenital sinus).
incr. incidence in females exposed to DES in utero. adenosis can lead to clear cell adenocarcinoma

Question 13

what are risks of DES exposure?

Answer 13

DES daughter
1. adenosis –> clear cell adenocarcinoma
2. abnormalities of uterine and tube smooth muscle formation –> ectopic pregnancy, infertility, pregnancy loss.
DES sons have no complications.
DES moms have a slightly incr. risk for breast cancer.

Question 14

embryonal rhabdomyoscarcoma: definition, presentation, histo

Answer 14

malignant proliferation of immature skeletal muscle. rare.
presents with bleeding and agrape like mass protruding from the vagina or penis of a child (usually under 5). also called a sarcoma botryoides.
this tumor is formed by a rhabdomyoblast. the rhabdomyoblast will show cytoplasmic cross-striations (like in skeletal muscle). positive staining for desmin (intermediate filament in muscle cells) and myogenin (present in immature skeletal muscle).

Question 15

vaginal carcinoma: causes, spread, precursors,

Answer 15

arises from the squamous epithelium lining the vaginal mucosa. usually HPV 16,18, 31, and 33.
precursor is vaginal intraepithelial neoplasia.
will spread to lymph nodes. lower vagina spreads to superficial inguinal nodes, upper vagina goes to iliac nodes.
usually secondary to cervical SCC; primary vaginal carcinoma is rare.