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Urinary Path Review. Normal Prostate. Two components of the prostate: Glands Stroma Glands have 2 type of cells: Basal luminal. Normal prostate. Note the two cell layers and continuous layer of basal cells. The presence of basal cells indicates benignity.
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Normal Prostate Two components of the prostate: • Glands • Stroma Glands have 2 type of cells: • Basal • luminal
Normal prostate • Note the two cell layers and continuous layer of basal cells. • The presence of basal cells indicates benignity
Basal cells stain with high molecular weight cytokeratin, PSA - and PAP - What about the luminal cells?
Transitional Zone, periurethral • In which zone do most carcinomas arise?
Peripheral Zone • Makes up the bulk of the gland • Easiest area to biopsy and feel with DRE • What’s the third zone called?
Transitional Zone Peripheral Zone
5 alpha reductase. In the prostate this enzyme converts the testosterone secreted by the leydig cells of the testes into DTH. Receptor are located in the stroma. Testosterone receptors are in the epithelium.
What’s the hallmark of acute prostatitis? Neutrophils
Granulomatous Prostatitis Key here is the presence of giant cells and macrophages. Response to rupture of intraluminal contents or TB/fungi.
Benign Prostatic Hyperplasia Note the nodular appearance and the slit-like shape of the urethra due to compression
Prostatic intraepithelial neoplasia • Precursor to invasive carcinoma of the prostate • Intraductal lesion
Normal prostate Stained with high molecular weight cytokeratin. Note the continuous layer of staining around the glands
Benign prostatic hyperplasia More stroma, more glands, more cellular, more dilated
Prostatic intraepithelial neoplasia HMWC stain: interruptions in the basal cell layer. Precursor lesion to adenocarcinoma of the prostate.
Prostate Carcinoma • Most often in peripheral zone • Most often adenocarcinoma • Firm yellow white nodule on gross
T/F: the prostate is necessary for reproduction/fertility False. The prostate secretes bacterialcidal liquid that activates the sperm, but is not necessary for sperm viability.
Cystitis • This is acute inflammation
Prostate adenocarcinoma • Lots of small glands
Prostate adenocarcinoma Grade 5: undifferentiated. Can’t even tell it’s adeno. Fused masses of malignant cells
Common sites of prostate CA metastases: • Bone (blastic lesions, not lytic lesions) • Lymph nodes • Invasion is often by perineural invasion
Prostate CA Perineural invasion
Adenocarcinoma of the prostate • Note that the malignant glands lack the HMWK stain…absence of basal cell layer is bad.
Prostatic Abscess • Look for this when you are diagnosing acute bacterial prostatitis. • Important to find because antibiotics won’t penetrate the abscess. • Treatment for acute bacterial prostatitis is usually with Quinolones.
Bladder Wall • Image shows the various layers • Urothelium • Lamina propria • Muscularis propria
Urothelium • Note the superficial umbrella cells…big and broad…