What pathology is common with the prostate? When do they occur? What is a possible mechanism for pathogenesis? How can prostatic cancers be detected? How do they spread?
- Prostate = auxiliary gland of male reproductie system
- May undergo nodular hyperplasia (stromoglandular hyperplasia or benign prostatic hyperplasia) or malignancy
- BPH and prostatic cancer are common in men > 50
- Stromoglandular and nodular hyperplasia is common in 8% of men in 40s, 50% of men in 50s, and 75% of men in 80s
- Occurs only in men with intact testes (possibly due to accumulation of dihydroxytestosterone because of decr metabolism or incr intracellular binding)
- Prostatic adenocarcinoma is also common (second most common malignancy in men)
- Prostatic cancers often arise in the periphery of gland and can be detected with digital rectal exam
- Spread can be local, into the bladder/seminal vesicles/prostatic urethra, or to adjacent LN; skeletal system is also common site of metastasis with characteristic osteoblastic changes that are easily distinguishable on radiographs
What is this? What problems can this cause? How can we tx it?
- Stromoglandular or nodular hyperplasia of the prostate: both prostatic stromal and glandular elements are hyperplastic
- Problems: often causes narrowing of prostatic uretrha with asx of hesitation and incomplete emptying of the bladder
- Tx: can be medical or surgical, which involves shaving out chips of the prostate via the urethra (transurethral resection of the prostat eor TURP); chips are then examined microscopically to confirm BPH and look for malignancy
- Note the hyperplastic stroma and glands in the high power image
What is this? What is a possible tx?
- Adenocarcinoma of the prostate
- Tx option: radical porstatectomy that removes the entire prostate aith a thin rim of surrounding tissue and dissection of inguinal nodes
- Note that much of the prostate is replaced by nests of tumor cells that form glandular structures and are invading the stroma
What are the most important conditions affecting the penis? What is a predisposing factor for tumors of the penis?
- Conditions: congenital anomalies (hypospadias and epispadias), inflammatory conditions (balanitis), and tumors
- Predisposing factor: HPV infection
What is this? With what is it associated? Are they limited to the penis? What do we see microscopically? What evidence do we see of the pathogen's influence?
- Condyloma acuminatum of the penis: a benign epithelial tumor
- Associated with: HPV types 6 and 11 infection
- Can be found anywhere on external genitalia and perineal areas in both men and women
- Considered low risk with low probability of progression to high grade dysplasia or carcinoma
- Microscopically: branching of papillary architecture with marked epithelial hyperplasia and hyperkeratosis
- Evidence of viral cytopathic effect: koilocytosis (clear vacuolization or halos in the cytoplasm of squamous cells)
What is this? Where is it typically found? What can you see in the image?
- Squamous cell carcinoma in-situ of the penis: aka Bowen's disease
- Typically found: on the penis shaft and scrotum
- Note: features of disordered maturation of squamous epithelium with nuclear crowding, enlarged nuclei, hyperchromasia, and mitotic figures that extends from base to surface of epithelium
What is this? Is it common? With what is it associated? What is notable about the image? What can we see in the low power image? What is visible in the high power image?
- Penile invasive squamous cell carcinoma
- It is rare (1% of all male malignancies)
- Associated with: high risk HPV types 16 and 18
- Notable: squamous epithelium with marked hyperkeratosis and epidermal thickening; under the epidermal layer is the dermal layer characterized by stromal cells and collagen
- Low power: complete lack of normal maturation in epidermis with no evidence of normal squamous layers; cells are enlarged, hyperchromatic, and have scant cytoplasm
- High power: the lower edge of the lesion is ragged with irregular infiltrating groups of malignant stromal cells invading the underlying dermis