1. Urinary Path Review

3. Normal Prostate Two components of the prostate: Glands Stroma
Glands have 2 type of cells:
Basal
luminal

5. Normal prostate
Note the two cell layers and continuous layer of basal cells.
The presence of basal cells indicates benignity

6. What markers and staining do the basal cells have?

7. What about the luminal cells?
Basal cells stain with high molecular weight cytokeratin, PSA - and PAP -
What about the luminal cells?

8. Luminal cells are PSA + and PAP+

9. Which zone of the prostate is the area of hyperplasia?

10. Transitional Zone, periurethral
In which zone do most carcinomas arise?

11. Peripheral Zone Makes up the bulk of the gland
Easiest area to biopsy and feel with DRE
What’s the third zone called?

12. Central zone; resistant to pathology. Like me.

13. Point to the zones

14. Transitional Zone
Peripheral Zone

15. What is the enzyme that converts testosterone into DTH?

16. 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.

17. What’s the hallmark of acute prostatitis?
Neutrophils

19. Granulomatous Prostatitis
Key here is the presence of giant cells and macrophages. Response to rupture of intraluminal contents or TB/fungi.

21. Benign Prostatic Hyperplasia
Note the nodular appearance and the slit-like shape of the urethra due to compression

23. Prostatic intraepithelial neoplasia
Precursor to invasive carcinoma of the prostate
Intraductal lesion

25. Normal prostate
Stained with high molecular weight cytokeratin. Note the continuous layer of staining around the glands

27. Benign prostatic hyperplasia
More stroma, more glands, more cellular, more dilated

29. Prostatic intraepithelial neoplasia
HMWC stain: interruptions in the basal cell layer. Precursor lesion to adenocarcinoma of the prostate.

31. Prostate Carcinoma Most often in peripheral zone
Most often adenocarcinoma
Firm yellow white nodule on gross

32. 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.

34. Cystitis
This is acute inflammation

36. Prostate adenocarcinoma
Lots of small glands

38. Prostate adenocarcinoma
Grade 5: undifferentiated. Can’t even tell it’s adeno. Fused masses of malignant cells

39. Common sites of prostate CA metastases:
Bone (blastic lesions, not lytic lesions)
Lymph nodes
Invasion is often by perineural invasion

41. Prostate CA
Perineural invasion

43. Adenocarcinoma of the prostate
Note that the malignant glands lack the HMWK stain…absence of basal cell layer is bad.

45. 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.

47. Bladder Wall Image shows the various layers Urothelium Lamina propria
Muscularis propria

49. Urothelium
Note the superficial umbrella cells…big and broad…

51. Horseshoe Kidney Congenital anomaly
Does not cause any functional problems
Important for radiation and surgical treatments…

53. 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

54. T/F: Adult polycystic disease is autosomal dominant
True. Infantile polycystic disease is autosomal recessive.

56. 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…

58. Hydronephrosis and hydroureter
Due to some obstruction distal to the kidney
Obstruction can be intrinsic (stones, UT neoplasm) or extrinsic (BPH, pregnancy)

60. 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…

62. Adult polycystic renal disease
Bilateral
Autosomal dominant
Midlife renal failure
Cysts interspersed with normal kidney
Big distorted kidneys

64. Infant polycystic kidney disease
Note how smooth the enlarged kidney is

65. This is associated with which type of bladder cancer?

66. Squamous cell CA
Schistosomiasis
Rare in US, common worldwide

68. Seminoma Testicular germ cell neoplasm
Note the lymphocytes and malignant germ cells?
What kind of tumor markers will seminomas have?

69. AFP – and BHCG –

71. Embryonal CA
Big ugly cells
Some necrosis
What kind of tumor markers?

72. AFP + and BHCG –

74. 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 –

76. Choriocarcinoma
I guess some of these are synciciotrophoblasts and some are cytotrophoblasts
What markers?
AFP – and BHCG +++

78. Teratoma Tissues from all three germ cell layers
Note the cartilage and glands (GI tract cells)