EDUCATION > Educational Programs > E-Learning > Pathology for Urologists

Pathology for Urologists

Prostate


Image A
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Image B
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  • Secretes a thin milky fluid that comprises ~1/3 of seminal fluid.
  • Microanatomy: divided into glandular (the bulk) and non-glandular parts.
    • Glandular prostate divided into peripheral zone (PZ, 70%), central zone (CZ, 25%), transition zone (TZ, 5%)*, and periurethral gland region.
    • Most common cancer are in PZ (~75%), followed by TZ (~15%).
    • Non-glandular part is mainly the anterior fibromuscular stroma and sphincters.

Image C
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Image D
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  • Histology:
    • Ducts and acini: contains secretory, basal and endocrine-paracrine cells (image A) & (image B); ducts and acini on cross section look similar (image C).
      • Secretory cells are cuboidal to low columnar cells that may appear multilayered and express prostatic specific antigen (PSA) and prostate-specific acid phosphatase (PSAP) (image D).
      • Basal cells are between secretory cells and basement membrane and are believed to be the stem cell compartment of acini.

Image E
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Image F
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      • Basal cells express high molecular weight cytokeratin (HMWK, such as keratin 34βE12, keratin 14, keratin 5/6) and p63** (image E).
      • Presence of basal cells distinguishes benign from carcinoma gland, which has NO basal cells. (Carcinoma is HMWK- and p63-)
      • Endocrine-paracrine cells are not readily identifiable on H&E stain, only by ancillary techniques (e.g. synaptophysin or chromogranin).
    • Stroma: Fibrous tissue containing abundant smooth muscles.
    • Lamellated concretions (corpora amylacea) are often present in the lumina of benign acini
      (image F). (Rare in cancer glands)

* Most prostates resected for cancer have larger TZ because of BPH in older men.

* * Immunohistochemistry generally uses brown chromogene and positive reaction will make the cell structure appear brown (aka "brown stain").

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