Prostate/ Male Pathology Flashcards
1
Q
BPH (presentation, comp, histo)
A
- COMMON; typically in older men
- Centrally - located nodules (transitional zone»_space; central zone) due to proliferation of both glands and stroma
- Present w/ obstructive symptoms; UTI, urinary retention, urinary frequency
- Chronic complications = bladder distention, smooth muscle hypertrophy, hydronephrosis, infections
- Histo - can only appreciate at low power to see that there are nodules and can see compression of nearby tissues (nearby glands become only slits b/c compressed)
2
Q
BPH Tx
A
- TURP - resect some pieces around urethra
- Prostatectomy
- Androgen antagonists
- 5-alpha reductase inhibitors - dec DHT stimulates prostate tissue
3
Q
Prostate Cancer Basics (occurence, risk factors, etc)
A
- Most common cancer in men (excluding skin) but 2nd most common cancer death in men
- Risk Factors - age, family hx, race (blacks highest)
- Peripheral zone most common
- Most common histological type is adenocarcinoma (makes sense b/c glandular tissue)
4
Q
How is prostate cancer diagnosed?
A
- Clinical
- Digital rectal exam - palpate peripheral zone
- Serum PSA (prostate specific antigen); not cancer-specific but prostate-tissue specific; now mainly used after prostatectomy to screen for recurrence
- **Worried if > 10 and if more bound than free
-Must BIOPSY
5
Q
Histo of High Grade PIN
A
- blue, hyperchromic, enlarged nuclei
- small hyperplastic lumen papillae
- lumen look more star-like
- pre-cursor lesion - 33% chance carcinoma
6
Q
Histo of Prostate Adenocarcinoma
A
- haphazard infiltrating glands (invade stroma)
- back-to-back glands
- single layer of cells around glands (no basal cell layer - cytokeratin negative)
- Perineural invasion is common; see glands around nerve bundle
7
Q
Gleason Scores and Grading Groups
A
- (add 2 most common scores from various slices)
- More differentiated glands = lower score
- 1- small donut glands; rarely used
- 2- larger donuts; rarely used
- 3- larger glands but still well - circumscribed
- 4- back to back glands and looks like swiss cheese
- 5- cells infiltrating; do not form actual glands; single cells - Now 1 or 2 not assigned so lowest practical score is 6 (3+3) SO use new grading scheme for prognosis (to dec over-treatment of score 6)
- Grade Group I: < 6
- Grade Group II: 3 + 4 (7)
- Grade Group III: 4 + 3 (7)
- Grade Group IV: 8
- Grade Group V: 9-10
8
Q
T in TMN Staging of Prostate Cancer
A
- T1c - non-palpable tumor but elevated PSA (may not be able to feel tumor on digital exam so still worry)
- T2 - palpable tumor confined to prostate
- T3a - thru capsule of prostate
- T3b - tumor invades seminal vesicles
- T4 - tumor invades adjacent structures
9
Q
Prostate Cancer Mets
A
- Bone - osteoblastic (fibrous and proliferation around them NOT lytic; very white on imaging)
- Lung/pleura
- Lymph nodes
- Most are androgen sensitive so hormone therapy can be helpful
10
Q
Prostate Cancer Tx
A
- Watchful waiting - esp if older pt or co-morbidities; check PSAs
- Surgical prostatectomy (infertile b/c remove seminal vesicles; careful of nerves for erection)
- Irradiation - radioactive seeds (brachytherapy) or external beams
- Hormone therapy - suppress testosterone (in adv disease) - Leuprolide or androgen receptor blockade
- Castration - remove testicles or meds to reduce testosterone in adv disease
- Chemo - docetaxel if castration-resistant adv disease
11
Q
2 Other Poss Prostate Cancers
A
1 - Urothelial Carcinoma
- Looks like bladder cancer - Dense layers of cells in circles - GATA3 / p63 / uroplakin +
2 - Sarcoma (cancer of fibromuscular stroma)
- Very pleomorphic and haphazard proliferation of cells w/o gland formation
12
Q
Causes and Appearance of Testicular Atrophy
A
- Causes - old age, uncorrected cryptorchidism or radiation
- BM thickens and less cellular (no more germ cells or spermatid)
13
Q
Testicular Torsion
A
- twisting of spermatic cord –> vascular and lymphatic obstruction
- Common in utero or shortly after birth
- Can happen in adolescents or adults if have bell clapper deformity (longer stalk than normal –> inc mobility –> cord can get twisted on self)
- Lymph blockage –> swelling and vein blockage (b/c thin walls) –> no venous drainage –> infarction and hemorrhagic necrosis
- MEDICAL EMERGENCY acute pain, swelling, red (50% chance that testis will be lost if lasts 8 hrs)
- Doppler US - if no blood flow then know obstruction
- Tx - urgent scrotal exploration; orchiopexy (pin testis up to dec mobility) or removal if infarcted
14
Q
Cryptorchidism
A
- Undescended testis seen in 1% 1 yo boys
- Fail of intra-abdominal testis to descend into scrotal sac
- Higher the location in abdomen = greater risk of cancer
- Often descend on own but may be surgically corrected by 4-10 yo; otherwise may become atrophic if remain in abdomen (infertility b/c inc heat too)
15
Q
Testicular Cancer in General
A
- Mostly young males (20-30 yo)
- Malignant (do not biopsy to avoid seeding scrotum; assume malig)
- Presents as painLESS testicular mass (as opp. to torsion)
- Subtypes = germ cell (95%) and sex cord/stromal (5%)
- Infants - RARE; more pure pattern (teratoma, yolk sac)
- Adults - less pure/ 60% are mixed
- Genetics - Iso-chromosome 12p is highly specific for testicular cancer (lose q arm and duplicate small p arm)
16
Q
Intratubular Germ Cell Neoplasia
A
- (in situ variant)
- looks like seminoma confined to seminiferous tubules (germ cells fill entire space of tubules w/ no maturation or spermatids)
- 50% progress to germ cell tumor in 5 yrs
- Cells have clearing / egg yolk appearance
17
Q
Seminoma
A
(most common pure type)
- Good prognosis; 95% cure rate; very radiosensitive (respond well to radiation)
- Young adult men
- Fried egg appearance w/ central nucleolus (cleared out cytoplasm is glycogen - PAS stain then diastase digests glycogen)
- Histo - immature germ cells (fried eggs) now outside seminiferous tubules (invasive); associated w/ lymphocytes and granulomatous inflammation
- Gross - tan, bulging, homogeneous (NO HEMORRHAGE)
18
Q
Spermatocytic Seminoma
A
- Older men
- Only in descended testis
- Not associated w/ lymphocytes or granulomatous
inflammation - Not associated w/ precursor IGCN
- 3 cell types
- Lymphocyte small cells
- Intermediate cells
- Large, multi-nucleated giant cells
19
Q
Embryonal Carcinoma
A
- Histo - more pleomorphic, mitotic figures, large nucleoli; immature epithelial cells that can form primitive glands; CD30+
- AGGRESSIVE and heme spread early
- Can be hCG and AFP +
20
Q
Yolk Sac Tumor (endodermal sinus tumor)
A
- Most common in boys < 3 yo
- Usually pure and good prognosis
- Histo: Schiller-duval body (cells radiating around dark red central vessel); “glomeruloid”
- AFP+
21
Q
Choriocarcinoma
A
- Rarely pure
- Mets to lung, bone, brain (hematogenous); VERY hemorrhagic mets
- Very high serum hCG or hCG stain
- 20-30 yo
- Histo: bizarre trophoblasts w/ blood lakes and VERY pleomorphic (looks a lot like placenta tissue)
22
Q
Teratomas
A
- Diff than in ovary (malignant and not as much hair, glands, etc)
- Mature = malignant and painful (Men Mature Malignant)
- Immature if see neuroepithelial cells; also malignant
- More common in kids < 3 yo (good prognosis in kids) v. 25-40% mature teratomas in young adults metastasize
23
Q
Male Sex Cord - Stromal Tumors (4)
A
1 - Leydig Cell Tumor-
- Secrete testosterone - Round cells w/ eosinohilic cytoplasm (Reinke crystals - eosinophilic crystals also in normal Leydig cells) - Grossly yellow - Pos for inhibin
2 - Sertoli Cell Tumor
- Round, oval nuclei (no grooves or Call-Exner bodies like granulosa cell tumors)
3- - Granulosa Cell Tumors (RARE)
4- Fibro-thecoma (RARE)
24
Q
Charcott Bottcher Crystals
A
- formed from intermediate filaments
- characteristic of sertoli cell tumors
25
Q
Testicular Lymphoma
A
- Older men (most common testicular mass in males > 60 yo)
- 20% bilateral
- Almost all diffuse large B cell type
- Gross - tan, fleshy (very similar to pure seminoma)
- Histo - discohesive cells
