Prostate Pathology Flashcards

1
Q

What are the 4 glandular compartments of the prostate?

A
Peripheral Zone (PZ)
Central Zone (CZ)
Transitional Zone (TZ)
Periurethral Gland Region
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2
Q

From what part of the prostate do most cancers come from?

A

Peripheral Zone (PZ) - the part you can feel in a DRE.

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3
Q

What does a zoomed-out view of normal prostate glands look like?

A

Glands follow a curvilinear pattern and originate from the urethra.

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4
Q

How many endocrine cells does the normal prostate have? What should normally surround the glands?

A

“Few endocrine cells”

Glands sit in fibromuscular stroma.

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5
Q

3 types of cells in a normal duct-acinar unit?

A
Secretory cells (cuboidal - columnar)
Basal cells (probs stem cells for secretory cells)
Endocrine/paracrine cells (hard to see normally)
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6
Q

What 3 stains should you see on a normal prostate gland?

A

Keratin in the basal call layer.
Prostate-specific Actin in the epithelial cells.
Smooth muscle actin - illustrating that fibromuscular stroma surrounds the duct.

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7
Q

Definition of benign prostatic hyperplasia (BPH): What proliferates? What symptoms?

A

Nodular prostate enlargement due to proliferation of:
Prostatic glands and stroma
Causes lower urinary tract symptoms (hard to pee).

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8
Q

What do we know about BPH etiology?

A

Not much. Aging and family Hx are risk factors.

T and estrogen may be involved…

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9
Q

Tx for BPH? (3 things)

A

Alpha adrenergic blocker.
5-alpha reducatse inhibitor (blocks T -> DHT).
Surgical.

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10
Q

What does BPH look like macroscopically? (quality and location)

A

Nodules in TZ, submucosal compartment, mostly near proximal prostatic urethra.

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11
Q

2 microscopic features of BPH?

A
Suburethral stromal nodules (i.e. hyperplasia of stromal cells)
Duct proliferation (but the ducts look normal)
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12
Q

Where does prostate carcinoma (PCa) rank in terms of prevalence and lethality? (in the US)

A

Most common cancer in men.

2nd most lethal cancer (after lung cancer)

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13
Q

3 risk factors for PCa?

A

Family Hx.
Increased age.
Diets rich in animal products / red meat?

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14
Q

What’s the gold standard for PCa Dx?

A

Needle biopsy.

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15
Q

What makes you want to get a needle biopsy to test for PCa? (2 things)

A

Increased serum PSA.

Abnormal DRE.

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16
Q

What are 3 ways PCa can give you symptoms?

A
Obstructive bladder symptoms (if in TZ).
Pelvic pain (local extension).
Bone pain (metastases).
17
Q

What’s the traditional PSA serum level that merits needle biopsy?

A

4 ng / ml

it really has poor diagnostic value, though

18
Q

What is PSA actually? What does it do?

A

A serine protease that liquifies semen and enhances sperm motility.

19
Q

What was the “number needed to treat” at best for PSA screening? Conclusion?

A

need to screen 1000 to prevent 1 PCa death.

Risk from dealing with false positives outweighs benefit.

20
Q

PCa macroscopic features?

A

Hard, dense, yellow to yellow-tan, lacks necrosis / hemorrhage, infiltrative.

21
Q

What is PCa grading based on?

A

Architectural features of ducts seen in histology.

22
Q

What do nuclei look like in PCa?

A

Enlarged, open chromatin, nucleoli.

23
Q

What do malignant lumenal secretions look like?

A
Amorphous or crystalline eosinophilic.
Blue mucin (on H&E) also bad.
24
Q

What’s a luminal secretion that is more suggestive of a benign process?

A

Corpora amylacea (lamellar eosinophilic depositions)

25
Q

Collagenous micronodules: good or bad?

A

Bad.

26
Q

What are the 5 steps in Gleason grading?

A

1: Tightly packed, well-formed glands.
2: More space between well-formed glands.
3: Haphazard, irregular glands.
4. Cribiform plates, sheets with glandular lumens
5. Sheets of cells without any gland formation

27
Q

What are the numbers in the Gleason grade?

A

Primary (majority) grade + secondary (minority) grade.

5-6 has pretty good prognosis. Stuff over 7 is getting pretty bad.

28
Q

What are the American Joint Committe on Cancer PCa staging guidelines? (What do T1 - T4 mean?)

A

T1: Incidental (it exists…. but not a big deal)
T2: Confined to prostate
T3: Extending out of capsule / to seminal vesicle
T4: Invading adjacent structures

29
Q

What are the 3 subdivisions of T2?

A

T2A: 1/2 of one lobe or less
T2B: more than 1/2 of one lobe, not still in just one lobe
T2C: in more than one lobe.

30
Q

Most common cytogenic alteration in PCa?

A

Loss of chromosome 8p.

31
Q

Most common amplifications seen in PCa? (name 3)

A

MYC
NCOA2
AR (androgen receptor)

32
Q

Most common deletions seen in PCa? (name 2-3)

A

PTEN
P53
RB1
(and more….)