Pathology 2420A Lecture Notes - Lecture 12: Benign Prostatic Hyperplasia, Endometrial Hyperplasia, Rectal Examination
17 Dec 2016
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Granulosa Cell Tumours
This tumour origininates in the stroma of the ovary and it often has hormonal
effects. The tumor cells may produce estrogen which can cause endometrial
hyperplasia or carcinoma. Most occur at age 45-55 years. Rare granulose cell
tumors present before menarche with precocious pseudo-puberty. The prognosis
is good; there are occasional late recurrences which usually respond to
treatment.
Metastatic Carcinoma
Malignant tumors that arise in the gastrointestinal tract, breast, endometrium and
elsewhere frequently metastasize in the ovary. Metastatic carcinoma is typically
bilateral. The prognosis for these women is dismal, and it is important that the
correct diagnosis is made so that patients do not receive inappropriate treatment.
Diseases of the male genital tract- prostate
Anatomy and physiology
The prostate is situated at the base of the bladder, and encircles the urethra. The
organ is roughly the size and shape of a large walnut. Normal weight= 20-30g.
Secretions are produced in the prostatic glands. The prostatic ducts empty these
secretions into the urethra during ejaculation; prostatic fluid makes up about 1/3
of ejaculate volume. Prostate fluid not absolutely necessary for fertilization, but
they optomize the conditions needed for fertilization.
- prostate helps facilitate fertilization
o May help close off bladder neck during sex
o Provides support for the sperm cells
▪ Nutritional role for sperm cells
▪ Buffer the acidic environment of the vagina
▪ Enzyme (PSA) in prostate fluid breaks down proteins to
liquefy the semen, allowing sperm to migrate more freely
o Has contractile properties to assist in ejaculation
Because of the relationship of the proximal urethra to the prostate, the urethra is
susceptible to compression from hyperplastic enlargement of the prostate. The
prostate may be divided into anatomical zones: peri-urethral zones (central and
transitional) are prone to hyperplasia in older men, while the peripheral zone is
much more frequently affected by carcinoma.
Prostatic Hyperplasia
Prostatic enlargement is the most common urologic disease of older men, and a
major case of urinary obstruction. Correct terms include BPH (benign prostatic
hyperplasia), or nodular hyperplasia. Some call is prostatic hypertrophy, but it is
not the correct use of the term hypertrophy.
This condition results in nodular proliferation of glands and stroma, typically in
the periurethral region of the prostate. When sufficiently large (2-5X normal
weight), the nodules compress the urethra, causing partial or complete urinary
obstruction. Growth is hormonally dependent.
Incidence
- Incidence rises rapidly after age 40
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- Pathologic evidence of hyperplasia is present in 50% of men aged 50-60
yrs. This rises to 90% of men by age 85 years. Note that not all of these
patients will present with symptoms of obstruction.
Complications
- Urinary tract obstruction—symptoms:
o Frequency, urgency, nocturia
o Decrease in the caliber and force of the urinary streams
o Hesitancy in initiating urination
o A sensation of incomplete emptying of the bladder
- Late complications—chronic obstruction:
o Bladder hypertrophy
o Dilation/trabeculation of bladder wall
o Urinary stone formation
- Treatment options
o Various medications available:
▪ Selective blocking of smooth muscle receptors to relax the
smooth muscle tension of the bladder neck, prostate, and
urethra.
▪ Anti-androgen meds
o Surgery
▪ Transurethral resection of prostate
▪ Newer minimally invasive procedures being developed
Prostatic Adenocarcinoma
Prostatic adenocarcinoma is the most common form of malignancy in men. While
rare before age 40 yrs, incidence rises rapidly in older men (1/7 chance of being
diagnosed during lifetime; 1 in 27 chance of dying from prostate carcinoma).
Autopsy series have shown occult (clinically silent) prostate cancers in 10-20 %
of men aged 50 yrs, and up to 70% of men aged 80 years.
Risk factors
- Genetic/racial factors
o Different rates in various parts of the world
▪ Most common in men of sub-Saharan African descent
▪ High in North America, Australia, Northern and Central
Europe
▪ Least common in Asian populations
o Familial predisposition
▪ Increased risk and earlier age of presentation if strong family
history
o Various specific gene mutations have been documented
- Dietary factors
o Obesity and diet high in fats may increase risk
o E.g. Asians who migrated to US have increased risk of prostate
cancer compared to native Asian population
- Smoking
o Increased risk of mortality and disease recurrence in smokers
Clinical presentation
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- Asymptomatic in almost 50% of cases
- Urinary tract symptoms occasionally
- Symptoms related to advances disease spread (bone pain, weight loss,
etc.)
- Hence the need for screening
Screening
- Men >50 years; earlier if indicated by race or familial predisposition
- Digital rectal exam (looking for nodules, asymmetry, etc.)
- Serum PSA (prostate specific antigen) level
o PSA produces by prostatic glands, normally secreted into prostatic
fluid
o Elevated blood level of PSA in prostate carcinoma
o However, PSA elevation is not specific for cancer. Beningn
conditions such as hyperplasia or prostatitis can elevate blood PSA
o PSA monitoring also useful post-treatment to screen for disease
recurrence
- Needle core biopsies required for confirmation if concerns raised on
screening
Prognosis factors
- Gleason grading
o Grade = how ugly the tumor looks under microscope
o Based on extent of gland formation. Higher the grade, more solid
growth/less gland formation
o Low grade tumors have a more indolent course; high grade tumors
more likely to metastasize
- Stage
o Extent of disease (tumor volume)
o Local spread beyond prostate
o Metastasis: prostate commonly metastasizes to lymph nodes, bone
- Surgical margin status
Treatment options
- Surgery (prostatectomy)
- Radiation therapy
- Hormone therapy (anti-androgen)
- Conservative (active surveillance)
Outcome
- prostate cancer relatively slow growing, and slow to spread (in general)
- More patients die with prostate cancer than from prostate cancer
- Localized carcinomas: excellent outcome with treatment (App. 99% 5 year
survival)
- Spread beyond the prostate obviously worse (App. 30% 5 year survival)
Testicular Neoplasms
Anatomy and physiology
- Paired organs which normally reside in the scrotum
- Responsible for sperm and hormone production
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Document Summary
This tumour origininates in the stroma of the ovary and it often has hormonal effects. The tumor cells may produce estrogen which can cause endometrial hyperplasia or carcinoma. Rare granulose cell tumors present before menarche with precocious pseudo-puberty. The prognosis is good; there are occasional late recurrences which usually respond to treatment. Malignant tumors that arise in the gastrointestinal tract, breast, endometrium and elsewhere frequently metastasize in the ovary. The prognosis for these women is dismal, and it is important that the correct diagnosis is made so that patients do not receive inappropriate treatment. The prostate is situated at the base of the bladder, and encircles the urethra. The organ is roughly the size and shape of a large walnut. The prostatic ducts empty these secretions into the urethra during ejaculation; prostatic fluid makes up about 1/3 of ejaculate volume. Prostate fluid not absolutely necessary for fertilization, but they optomize the conditions needed for fertilization.
