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1

Histology of granulomatous prostatitis: Idiopathic type.

Giant cells, histiocytes, plasma cells, lymphocytes, and granulocytes form sheets around ruptured ducts and acini.

2

Histology of granulomatous prostatitis: After therapy with BCG.

Mostly histiocytes and giant cells around ducts or acini.

3

Histology of granulomatous prostatitis: Post-procedural type (2).

Palisade of histiocytes and giant cells around fibrinoid necrosis.

Eosinophils may be seen.

4

Malakoplakia:

A. Presentation.
B. Frequent cause.

A. Fever, frequency, dysuria, hematuria.

B. E. coli.

5

Malakoplakia: Histology.

Sheet of von Hansemann's histiocytes, containing Michaelis-Gutmann bodies, are surrounded by chronic inflammation.

6

Prostatic infarct: Risk factors (3).

Nodular hyperplasia.

Hypotension.

Urinary catheter.

7

Histology of prostatic infarct: Acute (3).

Hemorrhage surrounding coagulative necrosis.

Reactive glands and squamous metaplasia.

8

Histology of prostatic infarct: Remote.

Scar containing hemosiderin and small glands that often show squamous metaplasia.

9

Basal-cell hyperplasia: Pitfall.

Mistaking basal-cell hyperplasia with nucleolomegaly for high-grade PIN.

10

Sclerosing adenosis vs. prostatic adenocarcinoma (3).

Sclerosing adenosis:

− Preserved basal-cell layer.
− Thickened basement membrane.
− Inconspicuous nucleoli.

11

Atypical adenomatous hyperplasia: Architecture (2).

Circumscribed but may have focally infiltrative border.

Tightly packed small glands with admixed large glands.

12

Atypical adenomatous hyperplasia: Cytology (2).

Basal-cell layer may be incomplete in some glands.

Some nucleoli may be large.

13

Urothelial metaplasia vs. normal urothelium.

The former lacks umbrella cells.

14

Atypical adenomatous hyperplasia vs. prostatic adenocarcinoma (2).

Atypical adenomatous hyperplasia:

− No macronucleoli (more than 3 μm).
− Often contains corpora amylacea.

15

Types of metaplasia of prostatic epithelium (3).

Urothelial.

Squamous.

Mucinous.

16

Chronic abacterial prostatitis:

A. Definition.
B. Possible causes.

A. Prostatitis with negative bacterial culture.

B. Chlamydia, Ureaplasma, Mycoplasma.

17

Bacterial prostatitis:

A. Organisms.
B. Complication.

A. Same as those that cause UTI.

B. Antibiotic therapy may fail because the prostate is a "safe haven" for bacteria.

18

Granulomatous prostatitis: Antecedents (3).

A. Therapy with BCG.

B. TURP or biopsy.

C. Infection.

19

Granulomatous prostatitis: Physical examination.

Prostate may be firm, raising suspicion for carcinoma.

20

Granulomatous prostatitis: Presentation.

Obstructive symptoms, dysuria, fever, chills.

21

Granulomatous prostatitis:

A. Bacterial causes (3).
B. Fungal causes (3).
C. Parasitic causes (2).
D. Viral cause.

A. M. tuberculosis, T. pallidum, Brucella.

B. Cryptococcus, Blastomyces, Coccidioides.

C. Schistosomes, Echinococcus.

D. Herpes viruses.

21

High-grade PIN: Duration of progression to adenocarcinoma.

About 10 years.

22

High-grade PIN: Likelihood of adenocarcinoma on rebiopsy.

25%.

23

High-grade PIN: Patterns (4).

Tufted.

Cribriform.

Micropapillary.

Flat.

24

High-grade PIN: Nuclear features.

Large nuclei.

Large nucleoli.

25

High-grade PIN: Immunohistochemistry (3).

HMWCK and p63 highlight the basal cells.

AMACR: If positive, staining is less intense than that of carcinoma.

26

Adenocarcinoma: Typical location.

Posterior peripheral zone.

27

Adenocarcinoma: Activity of metastases to bone.

May be either osteoblastic or osteolytic.

28

Acinar adenocarcinoma: Histologic features that are pathognomonic for malignancy (4).

Glomeruloid structures.

Mucinous fibroplasia.

Circumferential perineural invasion.

Extension beyond the prostate.

29

Acinar adenocarcinoma: Intraluminal structures.

Blue or pink blobs and crystalloids are relatively common.

Corpora amylacea are rare.