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Urinary Path Review.

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Presentation on theme: "Urinary Path Review."— Presentation transcript:

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?


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)

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