1. Diseases of the prostate Osvaldo Rubinstein, MD

2. Normal urinary bladder with right and left ureters.

3. NORMAL PROSTATE, CUT SURFACE

4. Same lesion at higher magnification A double layer of epithelial cells can be seen lining several glands.

5. Diagram showing the prostatic zones: Peripheral zone ( brown), central zone (red) and intermediate zone (blue).

6. Normal prostatic tissue The glands are lined by two layers of epithelial cells. The inner layer produce the prostatic secretions and the outer layer is composed of myoepithelial cells.

7. Prostatic tissue at higher magnification The myoepithelial cells have a spindle shape nucleous and are seen in t he outer layer of the gl;and.

8. Prostatic hemorrhagic infarct Some of the adjacent glands show squamous metaplasia.

9. Similar section at higher magnification

10. Multiple calculi in the prostatic gland They are composed of inspissated prostatic secretions and calcific deposits.They have no clinical significance.

11. Acute bacterial prostatitis 1)It takes place when microorganisms (E. coli is the most frequent cause) are implanted in the prostate by intraprostatic reflux of urine from the posterior urethra. 2)It may occur by lymphohematagenous spread from an infectious process. 3)By surgical manipulation of the urethra, such as catheterization, cystoscopy, and dilatation of the urethra. 4)Resection procedures of the prostate. The final diagnosis of these conditions is made on cultures of prostatic secretion.

12. Granulomatous Prostatitis The most common cause is when patients are vaccinated with the BCG bacillus. The histopathologic lesion is similar to the one in tuberculous prostatitis. Nonspecific granulomatous prostatitis is the result of a reaction to prostatic secretions as a result of ruptured prostatic ducts or prostatic acini.

13. Tuberculous granulomas in the prostatic gland The four granulomas are easily seen immediately below the urinary bladder.

14. Histology of the previous lesion showing a classical tuberculous granuloma with epithelioid cells and Langhans type of giant cells.

15. Diagram showing the clinical presentation of benign nodular hyperplasia of prostate.

16. Gross features of benign nodular hyperplasia of prostate

17. Histology of the previous specimen Nodular lesion composed by dense aggregates of prostatic glands lined by a double layer of epithelial cells. Notice the smooth muscle stroma on the left of the slide.

18. Diagram showing the complications of benign prostatic hyperplasia.

19. Urinary bladder and adjacent prostate showing the classical picture of acute hemorrhagic cystitis The trabeculations of the bladder mucosa indicates hypertrophy.The prostate is enlarged.

20. Urinary bladder showing prominent trabeculations indicating marked hypertrophy and a left mild hydroureter.

21. Urinary bladder and prostate showing nodular hyperplasia and bilateral hydroureters.

22. Kidneys showing bilateral hydronephrosis and hydroureters.

23. Kidney showing severe hydronephrosis and hydroureter..

24. Pathogenesis of nodular glandular hyperplasia of prostate

25. Clinical presentation of benign nodular prostatic hyperplasia.

26. Transurethral resection of benign prostatic hyperplasia

27. Anatomical relations among the prostate, urinary bladder and seminal vesicles.

28. Anatomical locations of primary carcinoma of the prostate

29. Cross section of the prostate showing a primary adenocarcinoma The white areas represent the primary tumor.

30. Cross section of a prostate gland showing a primary adenocarcinoma on the left and nodular hyperplasia on the right side of the slide.

31. Gross anatomy of primary carcinoma of the prostate.

32. Normal prostatic gland at high magnification showing the inner layer of secretory cells and the outer layer of myoepithelial cells.

33. Progression of a normal to a malignant prostatic cell Notice the prominent nucleoli of malignant prostatic cells.

34. Primary intraepithelial neoplasia (PIN) Notice the papillary projections and the clusters of prostatic cells at the tip.This lesion does not represent malignancy.

35. Another case of PIN. Increased number of cells lining papillary projections.

36. Primary, well differentiated adenocarcinoma of prostate All the glands are malignant except for the cystic glands on the left side of the slide.

37. Well differentiated adenocarcinoma of prostate at high magnification Notice the prominent nucleoli of the tumor cells.

38. Similar case at even higher magnification Notice the prominent nucleoli of the tumot cells and the lack of myoepithelial cells in the tumor glands.

39. Prostatic tissue stained with immunoperoxydase against myoepithelial cells The stain is positive on the left indicating that the glands are benign and negative on the right indicating that the glands are malignant.

40. Prostatic tissue showing dense clusters of malignant cells in lymphatic channels

41. Nerve bundle in prostatic tissue infiltrated by malignant prostatic glands (perineural invasion)

42. Diagram showing the most common sites and frequency of metastatic carcinoma of the prostate.

43. Metastatic adenocarcinoma of prostate to the lung Notice the multiple, white, miliary nodules of metastatic tumor lining the pleural surface.

44. Histology of the previous case Segment of lung tissue showing dense clusters of tumor cells within lymphatic channels.

45. Portion of lumbar spine showing osteolytic lesions and bone fractures secondary to metastatic carcinoma of prostate.

46. Metastatic well differentiated adenocarcinoma to bone The tumor is seen in the bone marrow.

47. Histology of the previous lesion. Metastatic adenocarcinoma of prostate Metastatic adenocarcinoma of prostate. Notice some glandular spaces and prominent nucleoli in some of the tumor cells.

48. Clinical staging of carcinoma of the prostate

49. Tissue section of a seminal vesicle seen at the right of the slide and adjacent prostatic tissue at the left infiltrated by adenocarcinoma of prostate.

50. Gleason grading system of adenocarcinoma of prostate.