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Renal 3 > Prostate Pathology > Flashcards

Prostate Pathology Flashcards

1
Q

What is the weight of a normal adult prostate?

A

20gm

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2
Q

Describe some general features of the prostate?

A
  • Retroperitoneal organ
  • Encircles the neck of the bladder and urethra
  • Devoid of a distinct capsule
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3
Q

What are 4 biologic/anatomic distinct zones of the prostate?

A
  1. Peripheral: Most carcinomas
  2. Central
  3. Transitional: Most hyperplasia
  4. Region of the anterior fibromuscular stroma
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4
Q

What 3 pathological processes can happen in the prostate?

A
  1. Inflammation
  2. Benign nodular enlargement (hyperplasia): This is most common and can be part of the normal aging process
  3. Tumors
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5
Q

What are the 2 forms of bacterial prostatitis?

A

Acute and chronic

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6
Q

What does acute bacterial prostatitis result from?

A

Bacterial similar to those that cause UTI

  • Various strains of E. Coli
  • Gram - Rods
  • Enterococci
  • Staphylococci
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7
Q

What can acute bacterial prostatitis be secondary to?

A

Surgical manipulation of the urethra or prostate from catheterization, cystoscopy, urethral dilation, resection procedures on the prostate (these can all cause inflammation and become infected)

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8
Q

What is clinically assocaited with acute bacterial prostatitis?

A

Fever, chills, and dysuria

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9
Q

What is chronic bacterial prostatisis assocaited wtih?

A

A history of recurrent UTIs (cystitis and urethritis)

-This is difficult to diagnose and treat

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10
Q

What are the symptoms of chronic bacterial prostatitis?

A

Low back pain, dysuria, and perineal and suprapubic discomfort

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11
Q

How is chronic bacterial prostatitis diagnosed?

A

-Demonstration of leukocytosis (leukocytes and lymphocyres) in expressed prostatic secretions (massage the prostate) and positive bacterial culutes

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12
Q

What is the most common form of prostatitis?

A

Chronic abacterial prostatitis

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13
Q

Is chronic abacterial prostatitis clinically distinguishable from chronic bacterial prostatitis?

A

NO

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14
Q

What is seen in chronic abacterial prostatitis?

A
  1. No history of recurrent UTIs
  2. Expressed prostatic secretions contain more than 10 leukocytes per high power field (inflammation of prostate)
  3. Bacterial cultures are uniformly negative*** CULTURE SHOWS NOTHING
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15
Q

What is the most common cause of granulomatous prostatits related to?

A

Instillation of BCG with in the bladder

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16
Q

What is BCG?

A

AN attenuated mycobacterial strain

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17
Q

Why would you put BCG in a bladder?

A

It can help treat superficial bladder cancer

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18
Q

So, if you are putting a mycobacteria into the bladder, what will probably be seen in the bladder?

A

GRANULOMAS

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19
Q

When do you see fungal granulomatous prostatitis?

A

Only in immunoscompromised hosts

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20
Q

What is nonspecific granulomatous prostatitis?

A

It represents a reaction to secretions from ruptured prostatic ducts and acini (secreting into surrrounding tissue)… this is relative common and no “solid” reason

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21
Q

What is the morphology of acute prostatitis?

A
  • Minute, disseminated abscesses (small collection of neutrophils)
  • Large, coalescent focal areas of necrosis
  • Diffuse edema, congestion, and boggy suppuration of the entire gland
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22
Q

Why is biopsy of a man with acute prostatitis contraindicated?

A

Because it would HURT

and it can lead to sepsis when you drag the infection out

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23
Q

What is another name for benign prostatic hyperplasia?

A

Nodular hyperplasia

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24
Q

Is BPH common?

A

Yes very

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25
Q

Who does BPH affect?

A

Men over 50

26
Q

What is BPH?

A
  • Hyperplasia of prostatic stromal and epithelial cells
  • Formation of large discrete nodules: Periurethral region of the prostate
  • Large nodules compress and narrow the urethral canal: Partial, or sometimes virtually complete, obstruction of the urethra
27
Q

What is the weight of the prostate in BPH?

A

Between 60-100gm

28
Q

Where does nodular hyperplasia originate?

A

In the inner aspect (transition zone)

*Remember, carcinoma is in the peripheral zone

29
Q

What are early nodules composed of?

A

Stromal cells

30
Q

What are later nodules composed of?

A

Epithelial nodules

31
Q

What can nodular enlargements cause?

A
  • May encroach on the lateral walls of the urethra: Compress it to a slit like orifice
  • May project up into the floor of the urethra: Hemispheric mass directly beneath mucosa of the urethra –> Median lobe hypertrophy
32
Q

Describe the gross appearance of nodules that contain mostly glands?

A
  • Tissue is yellow-pink with a soft consistency

- Milky-white prostatic fluid oozes out

33
Q

Describe the gross appearance of nodules that are compoased primarily of fibromuscular stroma?

A
  • Pale gray, tough, and doesn’t exude fluid

- Less clearly demarcated from uninvolved prostatic tissue

34
Q

What is the hallmark of BPH?

A

Nodularity

35
Q

What 3 things are seen on microscopic examination of BPH?

A
  1. Purely stromal fibromuscular nodules
  2. Fibroepithelial nodules with a glandular predominance
  3. Glandular proliferation: Aggregations of small to large to cystically dilated glands lined by two layers (Inner columnar and an outer cuboidal epithelium)
36
Q

Can the diagnosis of BPH be made with needle biopsy?

A

NO

37
Q

Why can’t you diagnose BPH with a needle biopsy?

A
  • Histology of BPH nodules cannot be appreciated in limited samples (it is too small of a piece…you need a bigger piece to see nodules)
  • Needle biopsies do not typically sample the transition zone, BPH occurs here
38
Q

What are clinical features of BPH?

A
  • Increased size of the gland
  • Smooth muscle-mediated contraction of the prostate: Cause uretheral obstruction
  • Increased resistance to urinary outflow: Bladder hypertrophy and distension, Urine retention
  • Inability to empty the bladder completely: Creates a reservoir of residual urine which is a common source of infection
39
Q

What are some symptoms of BPH?

A
  • Increased urinary frequency, Nocturia, Difficulty in starting and stopping urine, Overflow dribbling (hard time controlling urine flow)
  • Dysuria (painful micturition)
  • Increased risk of bacterial infections (Bladder and kidney)
40
Q

What is the most common form of CA in men?

A

Adenocarcinoma of the prostate

41
Q

Who does adenocarcinoma of the prostate affect?

A

Men over the age of 50

42
Q

If you are increased risk due to family history, when should you start screening for prostate cancer?

A

At age 40

43
Q

What ethnicities is adenocarcinoma of the prostate more or less common in?

A
  • Uncommon in Asians

- Most frequent in African Americans

44
Q

Where is the common or acinar variant of prostate cancer found?

A

In the peripheral zone of the gland, classically in a posterior location

45
Q

How can you detect the common or acinar variant of prostate cancer?

A

It may be palpable on rectal examination (screening) or you can use the prostate specific antigen blood test

46
Q

Where do metastases from prostate cancer spread?

A
  • First via lymphatics
  • Then hematogenous spread (Batson’s plexus)
  • Then bones (axial skeleton)
47
Q

What is seen on gross examination of prostate cancer?

A
  • It is gritty and firm

- It can have local extension to periprosatic tissue, seminal vesicles, and the base of the urinary bladder

48
Q

What is seen on microscopic examination of prostate cancer?

A
  • Well-defined gland patterns
  • Absent outer basal cell layer (prostate usually has 2 layers lining its glands)
  • Cytoplasm of the tumor cells is pale-clear as seen in benign glands to a distinctive amphophilic appearance
  • Nuclei are large; contain one or more large nucleoli
  • Pleomorphism is not marked
  • Mitotic figures are uncommon
49
Q

What are the gland patterns seen in prostate cancer?

A
  1. Smaller than benign glands
  2. Single uniform layer of cuboidal or low columnar epithelium
  3. Crowded
  4. Lack branching and papillary infoldings
50
Q

What grading system is used for prostate cancer?

A

The gleason system

51
Q

What is the gleason system stratified into and how?

A

5 grades on the basis of glandular patterns of differnetiation

52
Q

Describe Gleason Grade 1

A
  • Most well-differentiated tumors
  • Neoplastic glands are uniform and round in appearance
  • Packed into well-circumscribed nodules
  • This looks like adenocarcinoma
53
Q

Describe Gleason Grade 5

A
  • No glandular differentiation
  • Infiltration of the stroma (cords, sheets, and nests)
  • This is poorly differentiated and almost solid-looking with cells all over the place
54
Q

Do most tumors contain more than 1 pattern?

A

Yes

55
Q

What is the primary grade?

A

The dominant pattern

56
Q

What is the secondary grade?

A

The second most frequent pattern

57
Q

What do you do with the primary and secondary grade?

A

You add them together to get a combined Gleason grade or score

58
Q

What is the highest gleason score?

A

10 (5+5), but you rarely have this because most tumors have areas of other patterns

59
Q

What are the best prognostic predicators?

A

Grade and stage

60
Q

If you see crowded glands that almost look malignant on biopsy, but there are some yellow/tan brown colored areas, what are you looking at?

A

The seminal vesicle (it could be mistaken for adenocarcinoma

61
Q

What are the nucleoli like in adenocarcinoma of the prostate?

A

Prominent and cherry red

Renal 3 (17 decks)

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