男性生殖系统疾病 前列腺疾病 Prostate diseases Zhu keqing 竺可青 Pathology Department Zhejiang University School of Medicine

Male Genital Tract (short version) Penis: Congenital, Inflammation, Tumors Testis/Epididymis: Congenital, Regressive, Inflammation, Vascular diseases, Tumors Prostate: Inflammation, Benign Enlargement, Malignancy

PROSTATE INFLAMMATIONS BENIGN ENLARGEMENT MALIGNANT TUMORS

PROSTATITIS ACUTE, usually same as urinary tract pathogens CHRONIC, usually A-bacterial, but also often recurrent or persistent from acute GRANULOMATOUS, non-TB or TB

“BENIGN” Enlargement BP H (H= H ypertrophy ) BP H (H= H yperplasia ) Glandular and Stromal Hyperplasia “Nodular” Hyperplasia Associated with old age Causes urinary obstruction, frequency, bladder hypertrophy and bladder trabeculations By itself, it is NOT premalignant, however….

Hyperplasia of the prostate Introduction age: over age 50 Etiology: hormonal influence

Pathological changes Microscopically: (1) glandular proliferation and dilation (2) fibrous or muscular proliferation (3) squamous metaplasia (4) infarction Grossly: Enlargement multiple nodules, glandular proliferation: yellow-pink with soft, fibromuscuclar involvement: pale gray, tough Hyperplasia of the prostate

Clinical presentations Compression of the urethra frequency, nocturia overflow, dribbling dysuria Retention of urine Hypertrophy of the blaader, infection, cystitis, renal infection Hyperplasia of the prostate

Prostatic cancer The most common form of cancer in men (followed closely by lung cancer). Age: increase from 20% to 70% between 50yr to 70&80 yr Incidence: 69 per 100, 000 in US 1 per 100, 000 in China

Etiology Age Race Family history Environmental influences Hormone level (androgen) Prostatic cancer

Pathological changes Microscopically: adenocarcinoma well differentiated a single uniform layer of epithelium, absence of outer basal layer of cells, one or more nucleoli poorly differentiated Grossly: gritty, firm, less clearly demarcated Prostatic cancer

Metastasis direct spread: seminal vesicles, the baser of bladder lymphoatic bloodstream: chiefly to the bones prostate-specific antigen PSA Prostatic cancer

BIOLOGIC BEHAVIOR NORMAL PROSTATE  HYPERPLASIA  P.I.N. ( P rostatic I ntraepithelial N eoplasia), is like “dysplasia leading to adenocarcinoma-in situ  INFILTRATION of “stroma”  CAPSULE  LYMPH NODES  DISTANT, especially BONE 

STAGING TNM

Prostate is #1 most common malignancy in men but NOT #1 killer. WHY? 80% over 80 Every elderly male presenting with widespread bone metastases is carcinoma of the prostate until proven otherwise PSA ( P rostate S pecific A ntigen) has been controversial as a screening test but is GREAT for follow up of a known prostate cancer

Penis: Neoplasia Benign : Condyloma Acuminata (caused by HPV), aka venereal or genital “warts” Malignant: Squamous cell carcinoma

Pathological changes –Two types: Squamous cell carcinoma Verrucous carcinoma: – well differentiated variant of squamous cell carcinoma – low malignant potential – locally invasive, rarely metastasize, – HPV 6, 11 related – Groosly :Two patterns: –papillary: cauliflower – like fungating mass –flat: Slowly growing, locally metastasizing lesion Carcinoma of penis