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YEAR 2 PATHOLOGY > WEEK 10 FINISHED > Flashcards

WEEK 10 FINISHED Flashcards

1
Q

How many lobes does the prostate have and what divides it into these lobes

A

5

Divided by the urethra and ejaculatory ducts

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2
Q

What are the dimensions of a normal prostate?

A

2.5cm (AP) by 3cm (W) by 4cm (H)

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3
Q

How many capsules does the prostate have, what are they called and what are they made of?

A

2

True capsule - thin fibrous sheath the surrounds the prostate
False capsule - lies outside the true capsule and is formed by extra peritoneal fascia

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4
Q

Where does venous drainage take place in the prostate? Where does it lie?

A

Prostatic plexus, lies between the true capsule and the surrounding false capsule

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5
Q

What are the 3 anatomical zone os the prostate? What % of the prostate is each and what do they comprise of?

A

Peripheral zone - 65% of total gland volume. Extends around the postero-lateral aspects and comprises small acinar spaces lined by secretory epithelial cells

Central zone - 25% of gland volume. Surround ejaculatory ducts and makes up the base of the prostate

Transition zone - 5-10% of the gland volume. Comprised of 2 symmetrical lobules on either side of the prostatic urethra

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6
Q

What are acini?

A

Small spaces embedded in the prostate smooth muscle stroma. During ejaculation, SNS stimulation causes prostatic secretions to be expelled into the urethra

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7
Q

Where does benign prostatic hyperplasia usually begin?

A

In the transition zone

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8
Q

Where do prostatic carcinomas usually develop?

A

In the peripheral zone

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9
Q

What do prostatic secretions do?

A

Secrete a milky alkaline fluid that assists sperm to survive the acidic environment of the female reproductive tract. It also contains seminal clotting enzymes which cause seminal fluid to become sticky and gel-like.

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10
Q

What is PSA? Where is it produced and what is the measurement of it used in conjunction with?

A

Prostate specific enzyme
Produced by prostatic epithelial cells
The measurement of serum PSA is used in conjunction with a DRE to screen for prostatic pathology

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11
Q

Define acute prostatitis

A

Acute inflammation of the prostate gland

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12
Q

What is the most common form of prostatitis.. bacterial or non-bacterial?

A

Non bacterial (usually non infectious inflammatory or auto immune

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13
Q

What are the most common organisms responsible for bacterial prostatitis?

A

E. coli, chlamydia, gonorrhoea

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14
Q

What are the clinical features of acute prostatitis?

A
  • Perineal, lumbosacral or suprapubic pain, often dull and poorly localised
  • Dysuria
  • Obstructive voiding symptoms (mechanical obstructions to urinary flow) e.g hesitancy, weak or intermittent urinary flow, straining, terminal dribbling
  • Irritative voiding symptoms; urinary frequency, urgency, noturia
    Infective prostatitis - positive urine culture +/- fever and chills
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15
Q

What is BPH? Define it?

A

Benign prostatic hyperplasia

Hyperplasia (NOT hypertrophy) of the prostatic stromal and epithelial cells, resulting in the formation of large discrete nodules.

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16
Q

What is a possible complication of benign prostatic hyperplastia?

A

Can gradually increase in bladder obstruction and can progress to complete obstruction (urinary retention) - anuria and a painful distended bladder).

Increased risk of bacterial infections.

Reflux of urine into the prostatic ducts and ureters can lead to prostatitis, pyelonephritis.

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17
Q

Pathophysiology of BPH.

A

Dihydrotestosterone is the androgen implicated in prostatic growth.
Affects the transitional zone oc the prostate, producing noodles that compress the prostatic urethra.

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18
Q

What is the difference between early and late BPH?

A

Early BPH: the nodules are composed almost entirely of stromal cells - pale grey and tough

Late stage BPH: the nodules produces are predominately epithelial cells - yellowy pink and soft

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19
Q

Clinical features of BPH

A

Symptoms can be divided into obstructive and irritative

  • Obstructive: mechanical obstruction to urinary flow, including hesitancy, decreased force and calibre of stream, straining to urinate and post void dribbling.
  • Irritative: retention of urine secondary to obstruction, including urgency, frequency and nocturia

A DRE may reveal an enlarged prostate that is smooth, non tender and elastic.

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20
Q

What is the most common form of prostate cancer? What kind of tissue does it arise from?

A

Adenocarcinoma (arises from glandular epithelium)

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21
Q

Epidemiological data for PC in Australia: Incidence, rank in terms of death, rank in terms of cancer

A

Most common cancer diagnosed in Australia
1 in 5 Aussie men
3rd most common cause of death in Australia

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22
Q

Risk factors for PC?

A 
Age
Race
Family History
Hormonal levels
Environment influences
Chronic inflammation and metabolic disruptions (eg diabetes, obesity)
Charred meats
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23
Q

Is BPH a precursor to PC?

A

No

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24
Q

What does PC usually initially develop?

A

In the peripheral zone of the prostate

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25
Q

Pathophysiology of PC

A

The cancer spreads in the gland and often invades the urethra causing obstruction. As the cancer starts in the peripheral zone of the prostate the metastasis could could spread to the surrounding tissues before any urinary symptoms present.
The spread usually occurs via the lymphatics to the pre sacral, ilia, and para-aortic nodes and then more widely.
The spread can also occur via the blood stream with particular predilection for the spine.
The primary tumour grows fast, its secondaries grow slowly

It is important to know that prostatic tumours cause osteoplastic secondaries which stimulate bone formation, therefore bones appear more dense on an X-ray.

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26
Q

What are the clinical features of PC?

A

Obstructive and irritative symptoms
Asymptomatic (only diagnosed when routine PSA screen prompts further testing)
Painless haematuria
Blood in semen
Generalised tiredness and weight loss
Bone pain in the back or pelvic might indicate metastatic spread (can lead to pathological fractures and anaemia may appear due to bone marrow replacement by tumour)
Sacral sciatic or perineal pain (inflammation of sacral nerve roots)
DRA may reveal craggy, irregular hardness of prostate
Bilateral oedema due to obstruction of pelvic lymphatics
Enlarged inguinal nodes

27
Q

What is obstructive symptoms? What are irritative symptoms?

A
  • Obstructive: mechanical obstruction to urinary flow, including hesitancy, decreased force and calibre of stream, straining to urinate and post void dribbling.
  • Irritative: retention of urine secondary to obstruction, including urgency, frequency and nocturia
28
Q

How is PC diagnosed?

A

Serum PSA levels - limitations in sensitivity and specificity
Transrectal ultrasound guided biopsy

29
Q

Using which system is PC graded?

A

Gleason system

30
Q

What are the 5 stages of prostate cancer?

A

Stage I - carcinoma only in 1 lobe
Stage II A - more advanced than stage I but still in one lobe (greater PSA and Gleason score)
Stage IIB - Cancer found in opposite side of the prostate
Stage III - Cancer has spread beyond prostatic capsule
Stage IV - Cancer has spread beyond seminal vesicles

31
Q

Define cryptochidism

A

Failure of one or both testes to descend from the abdomen into the scrotum

32
Q

What % of full term and premie babies have cryptochidism?

A

%5 full term

20% premie

33
Q

Where is the most common site of cryptochidism?

A

In the inguinal canal

34
Q

What are the possible complications of cryptochidism?

A 
Risk of infertility
Increased rick (3-5x) for testicular cancer
35
Q

What is varicocele?

A

A varicosity of the testicular vein and pampiniform plexus

36
Q

Where does the right testicular vein drain into?

A

IVC

37
Q

Where does the left testicular vein drain into?

A

The left renal vein

38
Q

What is the pampiniform plexus?

A

A convoluted venous network that ascends with the spermatic cord (there is a left and a right). Unites to form 3/4 veins at the level of the superficial inguinal ring and pass through the inguinal canal. As they reach the deep inguinal ring they have united to form the testicular vein.

39
Q

What are the 2 types of varicoceles?

A

Primary and secondary

40
Q

What are primary varicoceles caused by? Where are they more common?

A

Deficient or absent valves in the testicular veins

More common on the left.

41
Q

What ar secondary varicoceles?

A

Affect either side at any age and can be as a result of invasion of compression of the intra-abdominal portion of the testicular vein. Possible causes include renal or retroperitoneal tumour, or it may follow trauma, infection or inflammation.

42
Q

What are the clinical features of a varicoceles?

A

Can be asymptomatic
May be a dragging sensation or aching pain attributed to extra weight on the spermatic cord
Swelling is more prominent on standing
There may be a palpable enlargement during a valsalva manoeuvre
May feel like a bag of worms
May result in a low sperm count and sub fertility

43
Q

What is hydrocele of the tunica vaginalis?

A

An accumulation of fluid between the parietal and visceral layers of the tunica vaginalis

44
Q

What is the tunica vaginalis derived from?

A

The peritoneum

45
Q

What can cause of primary hydrocele?

A

Defective absorption of the hydrocele fluid e.g interference with the lymphatic drainage of the cord.

46
Q

What are the 3 types of hydrocele? Which is the most common?

A

Primary - most common
Secondary
Congenital

47
Q

What is the cause of secondary hydrocele?

A

Due to excessive production of fluid as a result of infection of the testis or the epididymus and may follow injury or malignancy.

Fluid may accumulate rapidly in infections such a gorrohoea and mumps, but slowly accumulate with TB, syphillis and neoplasia

48
Q

What is congenital hydrocele caused by?

A

Due to the persistence of the connection between the tunica and the peritoneum.

49
Q

What are the clinical features of hydrocele?

A

Swelling may not be a complaint until it becomes very large
A smooth swelling confined to the scrotum
It can be tense or lax but fluctuates on pressure and is translucent unless very thick walled
The testis cannot be felt as it is surrounded by fluid

50
Q

What is testicular torsion?

A

Twisting of the spermatic cords which cuts off the venous drainage. Typically the arteries remain patent, which produces intense vascular engorgement followed by haemorrhagic infarction.

51
Q

What is a ‘bell-clapper’ abnormality?

A

A bilateral anatomical defect where the testes are suspended more horizontally and are more mobile.

52
Q

What are the clinical features of testicular torsion?

A

Severe abdominal pain before the testicular localisation in apparent, this is due to the innervation of the testes.
Nausea, vomiting, sweating
Testes are usually drawn up into the scrotum which becomes oedematous with marked tenderness.

53
Q

What is acute epididymo-orchitis?

A

The inflammation of the epididymus (epididymitis) or can possibly spread to the involve the testes as well (epididymo-orchitis)

54
Q

What is the most common cause of acute epididymo-orchitis? What else can cause it?

A

Infection, can be secondary to prostatitis or via blood stream spread.
Common infection causing organisms are E.coli, gonorrhoea and chlamydia

Can also be caused by instrumentation of the urethra, prostatectomy urethritis or cystitis

55
Q

What are the clinical features of acute epididymo-orchitis?

A

Increasing pain around the testes
A red, hot scrotal swelling with increasing pain alongside
Generalised signs: malaise, anorexia, pyrexia

56
Q

What complications might arise from acute epididymo-orchitis?

A

Hydrocele formation, abscess formation, infertility, necrosis

57
Q

What is chronic epididymo-orchitis? Who gets it?

A

Infection of the epididymus usually associated with recurrent urinary infections in elderly men. It can become irregular, craggy and enlarged. Can be caused by TB

58
Q

What are the 2 types of testicular cancer that arise from germ cells? Which is the most common?

A

Seminomas - most common

Non-seminomas

59
Q

What are the risk factors for testicular cancer?

A

Unknown, there is a hereditary link

One main risk factor of cryptochidism

60
Q

What is seminoma?

A

A carcinoma of the seminiferous tubules
Direct spread to the epididymus or spermatic cord is common
Lymphatic dissemination can occur: upper lumbar nodes are the first group to be affected with the supraclavicular nodes involved later on. Blood stream metastasis can also occur.

61
Q

What is a mixed germ cell tumour?

A

A common type of non-seminoma testicular cancer.
They are more aggressive that seminomas, the tumour is comprised of more than one pure tumour pattern. The most common pattern is teratoma mixed with embryonal carcinoma.

62
Q

What are the clinical features of testicular cancer?

A

Painless, testicular swelling which can be either very rapidly growing or may enlarge more slowly depending on the subtype.
Sensation of heaviness
May be asymptomatic
Some patients present with symptoms of metastatic disease (back pain, cough, haemoptysis)
Examinaton reveals a smooth uniform swelling in the testes with a firm consistency.

Advanced disease may present with abdo mass, hepatomegaly, supraclavicular lymphadenopathy, lower limb oedema due to vena cava/lymphatic obstruction

63
Q

What are the stages of testicular cancer?

A

Stage I - tumour in the testes
Stage II - Distant spread confined to retroperitoneal nodes below the diaphragm
Stage III - Metastases outside retroperitoneal nodes or adobe diaphragm

YEAR 2 PATHOLOGY (13 decks)

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