Flashcards in Prostate Pathology Deck (32)
What are the 4 glandular compartments of the prostate?
Peripheral Zone (PZ)
Central Zone (CZ)
Transitional Zone (TZ)
Periurethral Gland Region
From what part of the prostate do most cancers come from?
Peripheral Zone (PZ) - the part you can feel in a DRE.
What does a zoomed-out view of normal prostate glands look like?
Glands follow a curvilinear pattern and originate from the urethra.
How many endocrine cells does the normal prostate have? What should normally surround the glands?
"Few endocrine cells"
Glands sit in fibromuscular stroma.
3 types of cells in a normal duct-acinar unit?
Secretory cells (cuboidal - columnar)
Basal cells (probs stem cells for secretory cells)
Endocrine/paracrine cells (hard to see normally)
What 3 stains should you see on a normal prostate gland?
Keratin in the basal call layer.
Prostate-specific Actin in the epithelial cells.
Smooth muscle actin - illustrating that fibromuscular stroma surrounds the duct.
Definition of benign prostatic hyperplasia (BPH): What proliferates? What symptoms?
Nodular prostate enlargement due to proliferation of:
Prostatic glands *and stroma*
Causes lower urinary tract symptoms (hard to pee).
What do we know about BPH etiology?
Not much. Aging and family Hx are risk factors.
T and estrogen may be involved...
Tx for BPH? (3 things)
Alpha adrenergic blocker.
5-alpha reducatse inhibitor (blocks T -> DHT).
What does BPH look like macroscopically? (quality and location)
Nodules in TZ, submucosal compartment, mostly near proximal prostatic urethra.
2 microscopic features of BPH?
Suburethral stromal nodules (i.e. hyperplasia of stromal cells)
Duct proliferation (but the ducts look normal)
Where does prostate carcinoma (PCa) rank in terms of prevalence and lethality? (in the US)
Most common cancer in men.
2nd most lethal cancer (after lung cancer)
3 risk factors for PCa?
Diets rich in animal products / red meat?
What's the gold standard for PCa Dx?
What makes you want to get a needle biopsy to test for PCa? (2 things)
Increased serum PSA.
What are 3 ways PCa can give you symptoms?
Obstructive bladder symptoms (if in TZ).
Pelvic pain (local extension).
Bone pain (metastases).
What's the traditional PSA serum level that merits needle biopsy?
4 ng / ml
(it really has poor diagnostic value, though)
What is PSA actually? What does it do?
A serine protease that liquifies semen and enhances sperm motility.
What was the "number needed to treat" at best for PSA screening? Conclusion?
need to screen 1000 to prevent 1 PCa death.
Risk from dealing with false positives outweighs benefit.
PCa macroscopic features?
Hard, dense, yellow to yellow-tan, lacks necrosis / hemorrhage, infiltrative.
What is PCa grading based on?
Architectural features of ducts seen in histology.
What do nuclei look like in PCa?
Enlarged, open chromatin, nucleoli.
What do malignant lumenal secretions look like?
Amorphous or crystalline eosinophilic.
Blue mucin (on H&E) also bad.
What's a luminal secretion that is more suggestive of a benign process?
Corpora amylacea (lamellar eosinophilic depositions)
Collagenous micronodules: good or bad?
What are the 5 steps in Gleason grading?
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
What are the numbers in the Gleason grade?
Primary (majority) grade + secondary (minority) grade.
5-6 has pretty good prognosis. Stuff over 7 is getting pretty bad.
What are the American Joint Committe on Cancer PCa staging guidelines? (What do T1 - T4 mean?)
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
What are the 3 subdivisions of T2?
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.