Prostate Pathology Flashcards
1
Q
Basic prostate anatomy
A
2
Q
What portion of the prostate does BPH typically occur?
A
- Periurethral zone
- Can compress the ureter causing problems w/ urination
3
Q
Where does prostate cancer typically start?
A
- In the posterior portion of the prostate near the rectum
*is noticeable during a DRE
- Typically wont give any noticeable signs
4
Q
Benign prostate gland with basal and secretory cell layer
A
5
Q
Prostatitis
A
- Acute bacterial prostatitis
- Chronic bacterial prostatitis
- Chronic abacterial prostatitis
- Granulomatous prostatitis
6
Q
Acute bacterial prostatitis bacteria
A
- Results from bacteria similar to those seen in urinary tract infections
- E. coli
- Gram (-) rods
- Enterococci
- Staphylococci
- May result form intraprostatic reflux of urine
- May seed the prostate via the lymphohematogenous route
- Surgical manipulation and instrumentation
- Fever, chills and dysuria
- Diagnosis made by urine cultures and clinical features
7
Q
Chronic bacterial prostatitis
A
- More difficult to diagnose
- May present w/ more vague symptoms, low back pain, dysuria, perineal and suprapubic discomfort
- May be asymptomatic
- Need to document pos. bacterial cultures and leukocytes in expressed prostatic secretions
- Difficult to treat b/c antibiotics penetrate the prostate poorly
8
Q
Chronic abacterial prostatitis
A
- Most common form of prostatitis
- It is indistinguishable from chronic bacterial prostatitis clinically
- No history of recurrent infections
- Expressed prostatic secretions contain more than 10 leukocytes pre high power field
- Bacterial cultures are neg.
9
Q
Granulomatous prostatitis
A
- An infectious agent may or may not be identified
- In US a common cause is the instillation of BCG in the bladder for treatment of bladder ca
- BCG is an attenuated mycobacterial strain that give rise to a histologic picture similar to systemic tuberculosis
- In granulomatous prostatitis in that case the presence of the granumomas are of no significance and need no treatment
- Fungal granulomatous prostatitis is seen mostly in immunocompromised pts
10
Q
Prostatic infarct
A
- Seen mostly in large prostates w/ nodular hyperplasia
- May be caused from infection or indwelling catheters or trauma
- Grayish yellow and streaked w/ blood
- Peripheral margins are sharp and hemorrhagic
- Infarcts are of ischemic type w/ coagulative necrosis involving glands and stroma
- Most are clinically silent but may cause urinary retention due to edema
- May cause increase in PSA (prostatic specific antigen)
11
Q
Prostatic calculi
A
- Calculi can form in glands
- Blood clots, epithelium and bacteria may be found in some stones
- Main inorganic components are phosphated salts, calcium carbonate and calcium oxalate
- Radiopaque and can be seen on x-rays
- Large stones may mimic carcinoma on palpation
12
Q
Benign prostatic hyperplasia presentation
A
- Common disorder in men >50
- Assoc. w/ many symptoms including freq., urgency, inability to empty the urinary bladder, difficulty starting and stopping the urinary stream
- Clinically can mimic prostate cancer and may be seen in conjunction w/ prostate ca
13
Q
BPH histology
A
- Have an increased number of epithelial and stromal cells especially in the periurethral zone which gives rise to the clinical symptoms
- However there is no clear evidence of epithelial cell proliferation; their just not dying off, resulting in accumulation
14
Q
BPH pathophysiology
A
- DHT formed in stromal cells binds to the nuclear androgen receptor (AR) in stromal and epithelial cells
- Binding of DHT to AR activates the transcription of androgen-dependent genes which result in the production of several growth factors and their receptors
*therefore stromal cells are responsible for androgen dependant prostatic growth
- Androgens increase cellular proliferation but also inhibit cell death
*androgens are required for the development of BPH
- Accumulation of epithelial cells due to impaired cell death w/ an accumulation of senescent cells in the prostate
15
Q
Major androgen in the prostate
A
- Dihydrotestosterone (DHT)
16
Q
DHT formation
A
- Major androgen in the prostate
- Formed by the conversion of testosterone by the enzyme type 2, 5 alpha reductase located mainly in the stromal cells of the prostate w/ little in the epithelial cells
17
Q
BPH growth factors
A
- Growth factors include fibroblast growth factor (FGF) especially FGF-7
- Other growth factors include FGFs 1 and 2, TGFbeta which promote fibroblast proliferation
- It is thought that DHT-induced growth factors increase the proliferation of stromal cells and increasing the death of epithelial cells
18
Q
BPH morphology
A
- Arises mostly in the inner aspect of the prostate
- Early nodules composed mostly of stromal cells while later nodules contain mostly epithelial cells
- Nodule may encroach on the urethra resulting in compression and urinary problems
- Median lobe hypertrophy: nodules project into the floor of the urethra
- Nodules vary in size and consistency
- Glandular nodules have a softe consistency w/ presence of a white secretion
- Stromal nodules are firmer white-gray
- Aggregation of small to large cysticlaly dilated glands and an outer cuboidal or flattened epithelium
19
Q
Nodules on both sides of the urethra histo slide
A
20
Q
BPH - inner columnar cells and outer flattened basal cells histo slide
A
34
Q
Prostatic intraepithelial neoplasia histology characteristics
A
- Architecturally benign glands lined by cytologically atypical cells w/ prominent nucleoli
- Divided into low grade and high grade based on nuclear and nucleolar changes
- PIN glands are surrounded by a patchy layer of basal cells and an intact basement membrane
35
Q
PIN low grade histology slide
A
36
Q
PIN high grade histology slide
A
39
Q
Prostate carcinoma malignant vs benign gland histology slide
A
40
Q
Prostatic carcinoma nuclei and cytoplasm histology slide
A
41
Q
Perineural invasion histology slide
A
- Hallmark of a malignant prostatic growth is when the prostate starts growing around a nerve
