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?

What about the luminal cells? 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 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 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)