Home > Flashcards > Women's & Gender Studies > Prostate: Benign/mal tumors

Details Title: Prostate: Benign/mal tumors Description: 4.27.07 Total Flash Cards: 64 Created: 04/28/2007 10:25:23	To study from this set of flash cards, or to create your own your own study flash cards, register HERE. If you are already a registered user, CLICK HERE.
Cards Term what is prostate made of? Definition glandular tissue and stroma Term what is promary gross anatomical marks in the prostate? Definition the urethra Term what 3 Zones are found in the sagittal plane? Definition TZ (surrounds urethra), CZ, and PZ (what we examine in the rectum) Term what do you see in the coronal plane? Definition CZ and PZ Term what do you see in oblique coronal? Definition PZ and TZ Term What path do you get in TZ? Definition TRANSITION ZONE : BENIGN PROSTATIC HYPERPLASAIA Term What path do you get in PZ? Definition PERIPHERAL ZONE: PROSTATIC ADENOCARCINOMA ( CAP ) Term what path do you get in the CZ? Definition CENTRAL ZONE: RESISTENT to CAP and INFLAMMATION Term what is the normal microscopic anatomy? Definition BRANCHING TUBULOALVEOLAR SYSTEM GLANDS ORIGINATE from URETHRA in CURIVILINEAR PATTERN APICAL and BASAL LAYER in GLANDS APICAL = SECRETORY LAYER FEW ENDOCRINE CELLS GLANDS SIT in FIBROMUSCULAR STROMA Term What is the apical layer? Definition APICAL and BASAL LAYER in GLANDS APICAL = SECRETORY LAYER Term where do the glands sit? Definition FEW ENDOCRINE CELLS GLANDS SIT in FIBROMUSCULAR STROMA...so muscle: Muscle Cells of Stroma Positive for Smooth Muscle Actin Term what 2 layers of the prostate gland? Definition apical cell layer and basal cell layer Term what are glands supported by? Definition Glands Supported By Fibromuscular Stroma Term When do you get Benign Prostatic Hyperplasia? Definition BEGINS as EARLY as 45 yrs; PROGRESSIVELY INCREASES with AGE; INCREASED with STRONG FAMILY HISTORY; BY AGE 80 AFFECTS 80% of MEN; ONLY 5-10% SYMPTOMATIC Term what are BPH symptoms? Definition URETHRAL COMPRESSION; DIFFICULTY STARTING URINE STEAM; DIFFICULTY STOPPING URINE STREAM; BLADDER DILATATION; MUSCULAR THICKENING of BLADDER WALL; URINE STASIS; CYSTITIS Term what creates bladder outlet obstruction? Definition BPH--this creates trabeculated hypertrophy of bladder muscle, with a hyperplastic median lobe--the TZ area blocks the blocks the bladder, creating urinary stasis Term what androgen is trophic for prostatic growth? Definition DHT Term What is 1 therapy for BPH? Definition Inhibit 5 alpha reductace, since this turns T insto DHT Term How does horomonal dysregulation affect BPH? Definition Increased 17-b-estradiol ( relative), Increased Androgen Receptors , Decreased Catabolism of DHT which leads to increased intracellular DHT, which leads to hyperplastic growth Term What are other factors contributing to BPH etiology? Definition POSITIVE: EPIDERMAL GROWTH FACTOR (EGF): POSITIVE GROWTH FACTOR BASIC FIBROBLAST GROWTH FACTOR (BFGF): POSITIVE GROWTH FACTOR NERVE GROWTH FACTOR (NGF): POSITIVE GROWTH FACTOR PLATLET DERIVED GROWTH FACTOR (PDGF): POSITIVE GROWTH FACTOR INBITORY: TRANSFORMING GROWTH FACTOR B (TGFB)- INHIBITS GROWTH Term What is the morphology of BPH? Definition NODULAR ENLARGEMENT of TRANSITION ZONE; HYPERPLASIA of STROMA OCCURS FIRST; PERIURETHRAL MESENCHYMAL NODULES; BOTH GLANDS AND STROMA BECOME HYPERPLASTIC 30-50% HAVE CHRONIC PROSTATITIS Term With regards to morphhology, what happens first? Definition HYPERPLASIA of STROMA OCCURS FIRST Term DO BOTH GLANDS AND STROMA BECOME HYPERPLASTIC? Definition yes Term What allows us to define this growth as benign? Definition that the glands grow together (they are contigousous), so the ability of glands to hang together and not infiltrate the rest of the prostate. Term what are different types of prostatitis? Definition ACUTE BACTERIAL; CHRONIC BACTERIAL; PROSTATITIS WITH INFECTED CALCULI; NONBACTERIAL PROSTATITIS; RARE: GONOCOCCAL, TUBERCULOUS, NONSPECIFIC GRANULOMATOUS Term Is prostatitis often associated with BPH? Definition yes Term what is prostatitis? Definition any type of inflammation of the prostate/ Term what do you see in acute prostatitis? Definition neutrophils in glands Term what do you see in chronic prostatitis? Definition lymphatic inflammation in the prostate Term what do you see in granulomatous prostatitis? Definition giant cells and histiocytes Term How do you diagnose prostate cancer? Definition structural analysis (biopsy). no lab tests are available Term What are the relevant stats of Carcinoma of prostate? Definition 189, 000 NEW CASES and 32,200 DEATHS in 2002; MOST COMMON MALIGNANCY and SECOND LEADING CAUSE of CANCER DEATH in MEN; CAP RATE DOUBLED BERWEEN 1976-1994 INCREASED LIFE EXPECTANCY ENVIROMENTAL CARCINOGENS AND INCREASED PREVALENCE MORE SENSITIVE DIAGNOSTIC METHODS RECENT LEVELING OF INCIDENCE Term What diagnostic tool can you use? Definition Test for PSA (prostate specific antigen) Term What is PSA? Definition From Wikipedia, the free encyclopedia kallikrein-related peptidase 3 Identifiers Symbol KLK3 APS HUGO 6364 Entrez 354 OMIM 176820 RefSeq NM_145864 UniProt P07288 Other data Locus Chr. 19 q13.41 Prostate specific antigen (PSA) is a protein produced by the cells of the prostate gland. PSA is present in small quantities in the serum of normal men, and is often elevated in the presence of prostate cancer and in other prostate disorders. A blood test to measure PSA is the most effective test currently available for the early detection of prostate cancer. Higher than normal levels of PSA are associated with both localized and metastatic prostate cancer (CaP Term What are risk factors for CAP? Definition AGE *** FAMILY HISTORY: RR 1.5 to 2.4 for CAP in FIRST DEGREE RELATIVES *** RACE: INCREASED IN AFRICAN-AMERICANS *** CADMIUM EXPOSURE: ? SEXULLAY TRANSMITTED DISEASE: ? VASECTOMY: ? BPH : ? SERUM TESTOSTERONE: ? DIET: ? INCREASED FAT MORPHOLOGIC PRECUROR LESIONS- PIN *** Term When should you begin screening for CAP? Definition age 50. For African Americans and first degree relatives: screening at age 45 Term What is pristatic intraepithelial neoplasia? Definition Prostatic intraepithelial neoplasia (PIN) is a non-invasive lesion in the prostate gland which is though to be a precursor to prostate cancer. Microscopically, PIN is a collection of irregular cells which are fully contained within the gland structure and have not spread to the surrounding tissue. This may be proven by the identification of basal cells forming the supporting layer of the gland. PIN does not require specific therapy, but close follow-up with additional biopsies is warranted. PIN may disappear, remain unchanged, or progress to prostate cancer, often over as many as ten years. Term How do you describe the gross morphology of CAP? Definition PERIPHERAL ZONE; FIRM POSTERIOR NODULE ON DRE; YELLOW -TAN AND COMPACT Term How do you describe the microscopic morphology of CAP? Definition (generally: increase in # of gland. but the glands are DYSFUNCTIONAL. DON"T KONW HOW TO RELATE TO EACH OTHER. instead of having normal, streaky tissue, it is hard). INCREASED NUMBERS OF ACINI; ACINI GROW IN HAPHAZZARD PATTERN; ACINAR GROWTH VIOLATES THE NORMAL ARCHITECTURE; NUCLEAR ENLARGEMENT AND NUCLEOLATION LOSS OF BASAL LAYER; ABNORMAL PROTEIN SECRETIONS; PERINEURAL INVASION IN SOME CASES Term What are acini? Definition A acinus (adjective: acinar, plural acini) refers to the berry-shaped termination of an exocrine gland, where the secretion is produced. Term What do you see in prostatic adenocarinoma? Definition increased # of acini, glands are haphazard growth pattern, the acinar growth violates the normal architecture (no normal curval linear architecture); there is nuclear enlargement and nucleolation; there is a loss of basal cell layer; abnormal protein secretion, perineural invasion Term what is gleason grade1 CAP? Definition tightly cohesive nodule, well formed glands Term Gleason grade 2 cap? Definition loosely cohesive nodule of well formed glands Term What is gleason grade #3 cap? Definition haphazard infiltration of irregular gland? Term What is gleason grade 4 cap? Definition large cribiform plates and small sheets of cells without glandular lumens Term what is gleason grade 5 CAP? Definition sheets of cells without any gland formation Term What is latent CAP? Definition 30% of AUTOPSIES WITH SMALL MICROSCOPIC FOCI of CAP 30% of PROSTATES in CYSTOPROSTATECTOMIES for BLADDER DISEASE with INCIDENTAL CAP NON PROGRESSIVE IN LIFE HOW TO DISTINGUISH from PROGRESSIVE CAP ? Term How do you screen for CAP? (start at age 50) Definition DIGITAL RECTAL EXAM; SERUM PSA; BIOPSY Term what is PSA (continued)? Definition 33 KD GLYCOPROTEIN; SERINE PROTEASE; LIQUIFIES SEMEN WHICH ENHANCES SPERM MOTILITY Term Is PSA a perfect diagnosis? Definition No--there is a huge overlap in PSA values btw benign and CAP--it's probably more useful to chart the rate of increase of PSA Term What are the prognostic factors in CAP? Definition GLEASON SCORE GREATER THAN 7 LYMPH NODE METASTASES SEMINAL VESICLE INVASION EXTENSIVE CAPSULAR PENETRATION POSITIVE MARGINS VOLUME: < 0.5 CC WITH MINIMAL RISK of PROGRESSION Term What is the ultimate mediator of prostatic growth? Definition DHT Term With aging, what steroid increases in male? Definition estriol levels Term What does increased estrogens do? Definition They increase receptors for DHT. (remember, DBT = ultimate mediator) Term what is the characteristic gross change in BPH? Definition nodular enlargement of the TZ Term what are most of the clinical symptoms of BPH related to ? Definition obstruction of the urethra Term what is a common component of BPH? Definition chronic inflammation (prostatisis) Term Can proostatitis occur independelty of BPH? Definition yes Term What should you feel for on rectal exams? Definition hard, posterior noduals in the PZ Term Where does CAP metastisize to? Definition bone and lymph nodes Term What are most bone metastases? Definition they are often osteoblastic Term What is the characteristic microscopic morphology of CAP? Definition an abnormal proliferation of glands/ Term Are all histopathologic carnimosa progressive? Definition no Term How do you best screen for CAP? Definition PE + chem exams for CAP