Renal 1 Flashcards
Describe the normal structure and function of the prostate at both macro- and microscopic levels.
✅ Model Answer:
* Macrostructure:
o Multi-lobed organ located below the bladder and in front of the bowel.
o Surrounds the beginning of the urethra.
o Size: about that of a walnut in young adults.
* Function:
o Produces secretory fluid that protects and enhances sperm viability.
* Microscopic Structure:
o Glandular epithelial cells arranged in a columnar fashion.
Immature basal cells mature into secretory cells.
o Fibromuscular stroma:
Smooth muscle helps expel secretions during ejaculation.
o Secretions stored in glandular lumens.
List and briefly describe the four main types of prostatic disorders.
✅ Model Answer:
1. Prostatitis:
o Inflammation (often bacterial).
o Causes painful urination; treated with antibiotics.
2. Benign Prostatic Hyperplasia (BPH):
o Non-cancerous enlargement of prostate (age-related).
o Compresses the urethra, leading to urinary obstruction.
3. Prostatodynia:
o Chronic pelvic pain without infection.
o Treated with NSAIDs, muscle relaxants.
4. Prostate Cancer:
o Adenocarcinoma arising typically in the posterior lobe.
o Often asymptomatic until late; PSA levels and digital rectal exam used for detection.
Explain the pathogenesis, clinical features, and microscopic changes seen in benign prostatic hyperplasia.
✅ Model Answer:
* Pathogenesis:
o Driven by hormonal changes (increased androgen receptor expression despite reduced testosterone).
o Nodular hyperplasia mainly in the transitional (periurethral) zone.
* Clinical Features:
o Urinary hesitancy.
o Weak stream, incomplete emptying.
o Frequent infections.
* Microscopy:
o Enlarged glands with papillary infolding.
o Cystic dilation due to lumen obstruction.
o Proliferation of both epithelial and fibromuscular stroma.
Discuss the characteristics of prostate cancer
✅ Model Answer:
* Origin:
o Adenocarcinoma arising in the posterior lobe.
* Risk Factors:
o Age, family history, androgen receptor upregulation.
* Clinical Detection:
o Raised PSA levels (non-specific).
o Digital rectal examination (feels hard, nodular).
* Histology:
o Increased glandular proliferation.
o Loss of normal glandular architecture.
prostate cancer difference to BPH (Zone/ Growth/ Nature)
BPH
Transitional
Symmetric, non-invasive
Benign
Prostate Cancer
Posterior
Asymmetric, invasive
Malignant
Describe the complications of untreated prostate cancer.
✅ Model Answer:
* Local Invasion:
o Penetration into the bladder and rectum (recto-vesical space).
o Obstruction of ureters.
* Urinary Obstruction:
o Causes hydronephrosis (back-pressure atrophy of the kidneys).
* Metastasis:
o Bone metastases common (e.g., pelvis, spine).
* Histological Features:
o Necrosis due to hypoxia.
o Hemorrhage from fragile neo-vessels.
Summarize the pathogenesis, risk factors, morphology, and prognosis of transitional cell carcinoma of the bladder.
✅ Model Answer:
* Pathogenesis:
o Transformation of bladder transitional epithelium (urothelium) into malignant phenotype.
o Often preceded by chronic irritation/infection.
* Risk Factors:
o Heavy smoking.
o Exposure to industrial chemicals (e.g., pesticides, solvents).
o Chronic urinary tract infections.
o Schistosomiasis (in endemic areas).
* Morphology:
o Papillary pattern: Large frond-like tumors protruding into bladder lumen.
o Flat invasive pattern: Disc-shaped tumors infiltrating the bladder wall (worse prognosis).
* Prognosis:
o 5-year survival ~20% if there is deep wall invasion.
o Better if detected early without muscle invasion.
BPH Feature
Nature
Zone
Symptoms
Histology
Risk Factors
BPH
Benign hyperplasia
Transitional zone
Urinary obstruction
Glandular & stromal proliferation
Age
Prostate Cancer
Feature
Nature
Zone
Symptoms
Histology
Risk Factors
Prostate Cancer
Malignant adenocarcinoma
Posterior lobe
Late urinary symptoms
Infiltrative, disorganized glands
Age, genetics
TCC Feature
Nature
Zone
Symptoms
Histology
Risk Factors
TCC
Malignant epithelial cancer
Bladder wall
Painless haematuria
Papillary or flat invasive patterns
Smoking, chemicals
BPH Condition Cause Key Feature Main Concern
Hormonal changes Enlarged prostate Urinary obstruction
Prostate cancer Condition Cause Key Feature Main Concern
Prostate Cancer Malignant growth Hard nodular prostate Metastasis
TCC Condition Cause Key Feature Main Concern
TCC Carcinogen exposure Papillary tumors Bladder wall invasion
Describe the structure and function of the normal prostate gland at both macro and microscopic levels.
✅ Model Answer:
* Macroscopic Level:
o Multi-lobed, walnut-sized organ located beneath the bladder.
o Surrounds the upper part of the urethra.
o Functions primarily to produce prostatic fluid, a component of semen aiding sperm viability.
* Microscopic Level:
o Composed of glandular epithelium (columnar cells).
Basal immature cells mature upwards into secretory epithelial cells.
o Surrounded by fibromuscular stroma:
Smooth muscle aids in propelling prostatic secretions during ejaculation.
o Glandular lumens store the secretions temporarily.
✏️ Question 2:
What symptoms might a patient with a prostatic disorder present with? Provide examples for different conditions.
✅ Model Answer:
* Prostatitis (Inflammation):
o Painful urination (dysuria).
o Pelvic or perineal pain.
o Fever (if infectious).
* Benign Prostatic Hyperplasia (BPH):
o Hesitancy in urination.
o Weak stream.
o Urinary frequency and urgency.
o Nocturia (frequent urination at night).
* Prostate Cancer:
o Often asymptomatic in early stages.
o Late symptoms include urinary obstruction, bone pain (from metastasis), and hematuria.
Describe the histopathological and gross anatomical changes seen in benign prostatic hyperplasia (BPH).
✅ Model Answer:
* Gross Changes:
o Enlarged prostate (50–200g).
o Nodules centered around the periurethral transitional zone.
o Obstruction of the urethra.
* Microscopic Changes:
o Glandular proliferation: Hyperplastic glands with papillary infolding.
o Stromal proliferation: Increased fibromuscular tissue.
o Cystic dilation: Glands can become cystically enlarged.
o Trabeculation and thickening of bladder wall due to outflow obstruction.
BPH
Feature:
Location
Nature
Growth Pattern
Symptoms
Palpation
PSA Elevation
BPH
Transitional/periurethral zone
Benign hyperplasia
Symmetrical, compressive growth
Early urinary obstruction
Smooth, enlarged prostate
Mild
Prostate Adenocarcinoma
Feature:
Location
Nature
Growth Pattern
Symptoms
Palpation
PSA Elevation
Prostate Adenocarcinoma
Peripheral (posterior) zone
Malignant epithelial cancer
Asymmetrical, infiltrative
Late urinary symptoms
Hard, nodular prostate
Often significant but nonspecific
Discuss the pathology, phenotypes, and risk factors of transitional cell carcinoma (TCC) of the bladder.
✅ Model Answer:
* Pathology:
o Malignant neoplasm of urothelial (transitional) epithelial cells.
o Most common bladder cancer.
* Phenotypes:
o Papillary TCC: Frond-like exophytic tumors protruding into bladder lumen.
o Flat invasive TCC: Grows along and invades bladder wall, worse prognosis.
* Risk Factors:
o Smoking.
o Industrial chemical exposure (pesticides, aromatic amines).
o Chronic urinary tract infections.
o Schistosomiasis infection (in endemic areas).
* Clinical Features:
o Painless hematuria (most common presenting sign).
o Potential urinary obstruction if tumors are large.
* Prognosis:
o Good if superficial and resected early.
o Poor (~20% 5-year survival) with deep invasion into muscle layer.
