Renal Pathology 1

Question 1

Prostate STRUCTURE and FUNCTION?

Answer 1

S: walnut size, multi-lobed, surrounds urethra, nerves that control penile erection surround the prostate
F: produce fluid that protects sperm

Question 2

What are 3 histological characteristics of a normal prostate?

Answer 2

1. Glandular epithelial (not endothelial!!!) cells in columnar arrangement
2. Muscular stroma (contractile) surrounding this
3. Glandular secretions which supplements seminal fluid and supports sperm survival

Question 3

What are the 4 common prostate disorders:

Answer 3

1. Prostatitis
2. Benign Prostatic Hyperplasia (BPH)
3. Prostatodynia
4. Prostate cancer

Question 4

BPH

1. What is its characteristic feature?
2. Also known as?
3. Where do the nodules grow?

Answer 4

1. Large nodules (made of glands, muscular stroma cells or both)
2. Lower Urinary Tract Syndrome (LUTS)
3. In the transitional zones, towards the urethra, compresses lumen

Question 5

In regards to BPH:

1. What causes the thickened bladder wall?
2. Mucosal trabeculation?

Answer 5

1. Working hard to try and pass urine

2. Inflammation (from the UTI)

Question 6

What are 3 histological changes seen in BPH?

Answer 6

1. Fibromuscular proliferation (and subsequent loss of elongated shape)
2. Papillary infolding
3. Cystic dilation

Question 7

What are the 2 therapeutic treatment options for BPH?

Answer 7

1. No treatment - if can still urinate/function normally
2. Oral medication: alpha-blockers, phosphodiesterase-5 inhibitors, 5-alpha reductase inhibitors - they work to relax muscle
3. Surgery: TURP (most common), TUIP, laser

Question 8

Prostate cancer is known as a well-differentiated _______.

Answer 8

Carcinoma

Question 9

70-80% of prostate cancer is found in the _____ lobe.

Answer 9

Posterior

Question 10

What does the prostate feel like when someone has prostate cancer.

Answer 10

Multi-nodular, hard.

If there is inflammation then boggy, enlarged.

Question 11

One complication of prostate cancer is URINARY OBSTRUCTION. What are 2 secondary complications that result from it?

Answer 11

1. HYDRONEPHROSIS: A condition tin which the kidney swells due to urine failing to properly drain from the kidney to the bladder.
2. ATROPHY in the parenchyma of the renal medulla (looks pinched, normally looks quite smooth).

Question 12

What is prostatitis?

Answer 12

Inflammation of the prostate. Antibiotics used if it is caused by an infection. If not treated can turn into BPH.

Question 13

What is prostatodynia?

Answer 13

Chronic prostate disease - often no sign of inflammation or infection. Painful. NSAIDs, antibiotics & muscle relaxants used as treatment.

Question 14

Often prostate cancer develops with no/lots of symptoms?

Answer 14

No

Question 15

What is Transitional Cell Carcinoma and where does it occur?

Answer 15

In the bladder! But can also less commonly be found in the renal ureters, pelvis and calyxes
Occurs in TRANSITIONAL EPITHELIUM, a tissue that lines the inner surface of all hollow organs (including bladder).

Question 16

Does TCC affect more men or women? Why?

Answer 16

Men 2:1 women. More men work in occupations in which they are exposed to pesticides, chemicals etc.

Question 17

What are 2 presenting symptoms of TCC?

Answer 17

1. Painless haematuria
2. Growths attached to bladder wall
   * ** often linked to increases in UTIs

Question 18

What are 4 risk factors of TCC?

Answer 18

1. Chemical solvents/pesticides
2. Heavy smoking
3. Cyclophosphamide - a med used as chemotherapy
4. Schistosomiasis

Question 19

TCC can be benign or malignant.
What is the size of the growth (in cm) of each?
What is the 5 year prognosis if it is malignant?

Answer 19

Benign: < 1cm (well differentiated, papillary pattern)
Malignant: > 3cm (flat, anaplastic, invasive, sessile)
20% 5 year survival

Question 20

What are 2 invasive methods used to treat TCC?

Answer 20

1. Ultrasound guided intra-bladder cutting tools

2. Laproscopic nephrectomy