70 year old man with urinary obstruction Discrete, large nodules Avg wt of TURP – 100 grams Periurethral transitional 5% peripheral zone involved Bulging nodules soft, pink, and oozing prostatic fluids Stromal hypertrophy with increased gray/tan, firm tissue Thickened urinary bladder wall with trabeculation Hydronephrosis or acute retention with secondary urinary tract infection and even azotemia or uremia Nodular Hyperplasia

70 year old man with an elevated PSA (10x greater than normal) with a firm nodule palpated on rectal exam prostate carcinoma Rock hard on digital rectal exam Gritty and firm White-yellow area, nonbulging Poorly delineated, asymmetric Most often in peripheral location More easily felt than seen, often undetectable if tumor small Loss of basal layer – 34 betaE12/CK903 negative Pattern depends on Gleason score, small or medium sized glands Cribriform (gland in gland formation) (Gleason 3) Diffuse single cell infiltration with or without necrosis (Gleason 5) Significantly enlarged nuclei Prominent nucleoli:>3 microns specific for CA,>1 micron suggestive Glands too many, too small, too crowded

One year old boy with a testicular mass testicular torsion First year of life, also in puberty due to trauma or violent movement; affected testis painful swollen lying higher than normal Torsion without infarct infertility in proportion to duration Treat: untwist and fix testis to dartos muscle, or orchiectomy Up to 6 hr – venous congestion and interstitial hemorrhage 2-3 d neutrophils in capillaries 4 days – hemorrhagic infarct, coagulative necrosis

40 year old man with testicular mass seminoma