Transcript Embryology and anatomy of the female genital tract

男性生殖系统疾病
•
前列腺疾病 Prostate diseases
Zhu keqing 竺可青
Pathology Department
Zhejiang University School of Medicine
2015-6-21
Male Genital Tract
(short version)
• Penis: Congenital, Inflammation,
Tumors
• Testis/Epididymis: Congenital,
Regressive, Inflammation, Vascular
diseases, Tumors
• Prostate: Inflammation, Benign
Enlargement, Malignancy
PROSTATE
• INFLAMMATIONS
• BENIGN ENLARGEMENT
• MALIGNANT TUMORS
PROSTATITIS
• ACUTE, usually same as
urinary tract pathogens
• CHRONIC, usually A-bacterial,
but also often recurrent or
persistent from acute
• GRANULOMATOUS, non-TB or
TB
“BENIGN” Enlargement
• BPH
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(H= Hypertrophy)
BPH (H= Hyperplasia)
Glandular and Stromal Hyperplasia
“Nodular” Hyperplasia
Associated with old age
Causes urinary obstruction, frequency,
bladder hypertrophy and bladder
trabeculations
• By itself, it is NOT premalignant, however….
Hyperplasia of the prostate
Introduction
age: over age 50
Etiology:
hormonal influence
Hyperplasia of the prostate
Pathological changes
Microscopically:
(1) glandular proliferation and dilation
(2) fibrous or muscular proliferation
(3) squamous metaplasia
(4) infarction
Grossly:
Enlargement multiple nodules,
glandular proliferation: yellow-pink with soft ,
fibromuscuclar involvement: pale gray, tough
Hyperplasia of the prostate
Clinical presentations
• Compression of the urethra
frequency, nocturia overflow, dribbling
dysuria
• Retention of urine
Hypertrophy of the blaader, infection,
cystitis, renal infection
Prostatic cancer
The most common form of cancer in men
(followed closely by lung cancer) .
Age: increase from 20% to 70% between
50yr to 70&80 yr
Incidence: 69 per 100, 000 in US
1 per 100, 000 in China
Prostatic cancer
Etiology
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Age
Race
Family history
Environmental influences
Hormone level (androgen)
Prostatic cancer
Pathological changes
Microscopically:
adenocarcinoma
•
well differentiated
a single uniform layer of epithelium, absence of
outer basal layer of cells, one or more nucleoli
• poorly differentiated
Grossly: gritty, firm, less clearly demarcated
Prostatic cancer
Metastasis
• direct spread: seminal vesicles, the baser of
bladder
• lymphoatic
• bloodstream: chiefly to the bones
• prostate-specific antigen PSA
BIOLOGIC BEHAVIOR
• NORMAL PROSTATE 
• HYPERPLASIA
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• P.I.N. (Prostatic Intraepithelial Neoplasia), is
like “dysplasia leading to adenocarcinomain situ
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• INFILTRATION of “stroma” 
• CAPSULE
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• LYMPH NODES
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• DISTANT, especially BONE 
STAGING
TNM
• Prostate is #1 most common malignancy in
men but NOT #1 killer. WHY?
• 80% over 80
• Every elderly male presenting with
widespread bone metastases is carcinoma
of the prostate until proven otherwise
• PSA (Prostate Specific Antigen) has been
controversial as a screening test but is
GREAT for follow up of a known prostate
cancer
Penis: Neoplasia
•Benign : Condyloma Acuminata
(caused by HPV), aka venereal or
genital “warts”
•Malignant: Squamous cell
carcinoma
Carcinoma of penis
Pathological changes
–Two types:
• Squamous cell carcinoma
• Verrucous carcinoma:
– well differentiated variant of squamous cell
carcinoma
– low malignant potential
– locally invasive, rarely metastasize,
– HPV 6, 11 related
– Groosly :Two patterns:
– papillary: cauliflower –like fungating mass
– flat: Slowly growing, locally metastasizing lesion