Transcript Urinary Path Review

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
What markers and staining do
the basal cells have?
Basal cells stain with high
molecular weight cytokeratin,
PSA - and PAP What about the luminal cells?
Luminal cells are PSA + and
PAP+
Which zone of the prostate is
the area of hyperplasia?
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?
Central zone; resistant to
pathology. Like me.
Point to the zones
Transitional Zone
Peripheral Zone
What is the enzyme that converts
testosterone into DTH?
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…
Horseshoe Kidney
• Congenital anomaly
• Does not cause any functional problems
• Important for radiation and surgical
treatments…
Renal Dysplasia
• Most common cause of abdominal mass in
newborns
• Undifferentiated tubules and ducts in
bunch of undifferentiated mesenchyme
• Can sometimes contain cartilage and
muscle
• Note the cysts
T/F: Adult polycystic disease
is autosomal dominant
True. Infantile polycystic disease
is autosomal recessive.
Infant polycystic kidney disease
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Autosomal recessive
Cysts = Dilations of the collecting system
¾ infants die in perinatal period
Gross: enlarged but smooth kidneys, in
contrast to the adult form of the disease,
where the kidneys are enlarged but
distorted…
Hydronephrosis and hydroureter
• Due to some obstruction distal to the
kidney
• Obstruction can be intrinsic (stones, UT
neoplasm) or extrinsic (BPH, pregnancy)
Clear Cell renal cell carcinoma
• Cells are filled with glycogen
• Classic presenting triad:
– Flank pain
– Hematuria
– Abdominal mass
• Rare to have patients present with these
symptoms…
Adult polycystic renal disease
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Bilateral
Autosomal dominant
Midlife renal failure
Cysts interspersed with normal kidney
Big distorted kidneys
Infant polycystic kidney disease
• Note how smooth the enlarged kidney is
This is associated with which type
of bladder cancer?
Squamous cell CA
• Schistosomiasis
• Rare in US, common worldwide
Seminoma
• Testicular germ cell neoplasm
• Note the lymphocytes and malignant germ
cells?
• What kind of tumor markers will
seminomas have?
AFP – and BHCG –
Embryonal CA
• Big ugly cells
• Some necrosis
• What kind of tumor markers?
AFP + and BHCG –
Yolk sac tumor
• This is an image of the chacteristic lesion called
a schiller-duval body..tuft of malignant cells
around a vessel
• what age group does this hit?
• Boys younger than 10
• What tumor markers?
• AFP + and BHCG –
Choriocarcinoma
• I guess some of these are
synciciotrophoblasts and some are
cytotrophoblasts
• What markers?
• AFP – and BHCG +++
Teratoma
• Tissues from all three germ cell layers
• Note the cartilage and glands (GI tract
cells)