Jason's ACP Revision Notes PDF

Prostate : accessory gland + muscle-driven switch...

Prostate : accessory gland + muscle-driven switch and ejaculation between urination my bladder him 1. found below. wtra passing throne 2 prostate Machine Translated by Google 88 88 ACP-L26 Pathology of prostate and testis ACP‑L26 前列腺和睪丸病理學 Prostate disorders 攝護腺疾病 Clinical anatomy 臨床解剖學 - - found corpora amylacea in prostate ↑ - - 5 reductase testosterone > - dihydrotestosterone (more potent) DHT cause prosume enlargement but also risk. Dihydrotestosterone (DHT): from testosterone via 5α -rctase; development of prostate - 二氫睪酮 (DHT)：透過 5α‑rctase 產生睪酮；前列腺的發育 Zone Characteristics 區 特徵 Peripheral % Imm 70 In Palpable during DRE ~ tal rectal exam) [peripheral zone back of gland that surround : 週邊 DRE 期間可觸及 distal urethre and lie neath the Capsule 7 2 Primary site for CA prostate kicritical CA 前列腺的原發部位. area for DRE). ~ 2 Transitional zone 10% Primary site for glandular component of BPH Ismallest zone but tend to - enlargeese) 移行區 BPH 腺體成分的原發部位 , , - - ~ - 3- Periurethral zone - Primary site for stromal (fibromuscular) component - of BPH 尿道周圍區 BPH 基質（纖維肌肉）成分的主要部位 - Canterior fibro-muscular zone)- urethral obstruction (periurethral zone only composed of musle and fim tissues 尿道阻塞 rare, 4. Central zone 20 % Free of Ca prostate or BPH Isurmmndejaculatory duct and sterior to prostate urethral 中心區 不含 Ca 前列腺或 BPH ‧ 組織學： - - -. glandular epithelium promtate contain 3cell types. In Histology: glandular structures, lined by inner columnar and outer fla ened epithelium (basal cells) ge 腺體結構，襯有內部柱狀上皮和外部扁平上皮（基底細胞） ‧ 存在澱粉體：在前列腺中發現意義不明的小透明腫塊 1 luminal cell (secrete prostate fluid component - - - including prostate specific antigen) presence of [ 2 Presence of corpora amylacea: small hyaline masses of unknown significance found in prostate gland , - :. basal cell (locate adjacent maintaining epithelial structure - - 2 to basement membrane and for were - T cell [involved in paracrine signaling but not easily identified on 3 neuwendwine. ukE) Zone of prostate.. - condition). (benign - - (periurethral zone). - Histolgy of prostate gland - Machine Translated by Google 89 89 攝護腺病理學 Prostate pathology Transitional zone. - periurethral tone peripheral zon e. 良性攝護腺增生 攝護腺癌 Benign prostate hyperplasia/prostate enlargement Prostatic carcinoma 流行病學 MC 導致攝護腺肥大 > 50 年 香港成年男性第三例MC癌症 In Epidemiology I MC cause of enlarged prostate > 50y. 1 3rd MC cancer in HK adult male * 風險因素 ＆ 前列腺組織的敏感度增加 年齡、吸煙、高脂飲食 2 Risk. factors & I Increased sensitivity : of - prostate tissue to imAge, smoking, high fat diet exposure testosterone). to chrome 雙氫睪酮 pathogenesis DHT Idih otestosterone 10 times pent than testosterone 2 Hormonal: DHT-dependent : 發病 荷爾蒙：DHT依賴性 ~ fision of TMP gene regulated by androgen and , ~ ~ > promote prostate cell proliferations - 遺傳學：50% 病例中存在 TMPRSS2:ERG 融合基因， 3 Genetics: TMPRSS2:ERG fusion gene in 50% cases, ,ERoncogene - 可能會破壞雄性激素受體訊號傳導 (as man age enzyme 52-reductase activity increases& may disrupt androgen receptor signalling > , -. 去勢抵抗性CA前列腺 castration-resistant CA prostate RPC /A /Prepne 3 Pathology - 病理 腺體和基質細胞增生 多為腺癌. Hyperplasia of glandular & stromal cells In Mostly adenocarcinoma In (develop from sem glad teseminal fluid cell that peripheral zones in module commented of gland stromat - ~ , part of gland. outermost - 過渡帶結節形成 透過 DRE 可明顯看出外圍區域的發展； in transitional zone- nodule formation - - 2 Development in peripheral zone- palpable by DRE;digital rectal exam - Gross: lobular configuration with obstructive uropathy not an early finding Ci prostate slowly) BoThe 毛：小葉構型 阻塞性尿路病變並非早期發現 - - develop cancer 腺體和纖維肌增生 攝護腺上皮內瘤(PIN)：前兆 glandular and stromal pattern, glandular and fibromuscular ---3 proliferation Prostate intraepithelial neoplasia (PIN): precursor - grade prostate intraepithelial neoplasia is 微觀：腺體結構 病變；基底細胞仍完好無損 Microscopic: glandular structures with lesion; basal cells still intact respecially him premor to Prette - - cancer which abnormal growth of , epithelial cells within 基底細胞完整 situation basal. cells intact 4 Gross: glandular differentiation prostaglands. 大體：腺體分化 indicating benign - -. - 顯微鏡下：缺乏基底細胞（即基質細胞） Microscopic: lack of basal cells (i.e. stromal - 入侵） invasion) painful when urine 表現障礙：排尿困難、頻尿、 沉默直到高級階段 4 Manifestation Ic Obstruction: dysuria, urinary frequency, Im. - Silent until advanced - stage (c) obstructive uropathy not early finding) an 夜尿症 nocturia Curine at night) 血尿 , Haematuria 2 mucus for sperm entry into uterus) ↑PSA（30‑50% 的情況） ↑PSA (in 30-50% of case) (prostate specific antigeniliquefying semen and allow sperm to swim freely + dissolve cervical. ~: 5 prostate enlargement compressing. Complications Tr Obstructive uropathy: postrenal BUN obstructing urethra- urinefor a rtist of 1 Obstructive uropathy: extend into bladder men base i've ge prostate 併發症 阻塞性泌尿道疾病：腎後性 阻塞性尿路病變：延伸至膀胱基底底部 - , creatinine - - azotaemia, cystitis Inme Low back/ pelvic pain: bony metastasis 150%: prostate cell exhibit strong preference 氮質血症、膀胱炎 腰痛/骨盆疼痛：骨轉移 for ba - cancer - - socest, +issue 不是前列腺 CA 的危險因子 , NOT a risk factor for CA prostate 2 - - - sety correctly identify which have man 診斷 經直腸超音波 (TRUS) 血清 PSA（前列腺特異性抗原）：敏感但不敏感. 6 Diagnosis (s Transrectal ultrasound (TRUS) Is Serum PSA (prostate-specific Ag): sensitive - - - but not proate a. 4)Inbricated into rectum then emit sound probe insert specific; highly predictive if > 10ng/mL 具體的;如果 > 10ng/mL，則具有高度預測性 , - that bounce off the wave pstate - DRE：10% 的病例呈陰性 2 DRE: negative in 10% cases. (digital rectal examination] transrectal ultrasound. TRUS + 經直腸活檢 3 TRUS + transrectal biopsy. me a Early: surgery, radiation cradrostatectomyremovalofentreprostateslandany nodes e 治療 α‑受體阻斷劑：坦索羅辛 早期：手術、放射治療 7 Treatment I α-blockers: tamsulosin helprelaxSmooth , > i - , I m - urination 5α‑還原酶抑制劑：非那雄胺 高等：荷爾蒙（藥物閹割）、化療、 2 5α-reductase inhibitors: finasteride 2 Advanced: hormonal (medical castration), chemo, mblock conversion of testosterone to DHT) , deprivation m - lando therapy > reduce male that fuel growth) hormone · - cancer 經尿道攝護腺電切術 輻射 3 TURP Itmurethral resection of prostate radiation eg antiandrogen... 預後 TNM 分期：從 T2 開始可觸及 8 Prognosis. Is TNM staging: palpable starting from T2 /Th prostatecancerisstill~ leis : - , Gleason score: predict prognosis 2 格里森評分：預測預後 3 Grading based on the sum of two most predominant 根據兩個最重要的總和進行評分. pa erns in prostate biopsy, with score of 1 (well - - &> add - common - 前列腺切片的模式，得分為 1（很好 ~ glade seen in prostate cancer differentiated) to 5 (poorly differentiated) sample e. 分化） 至 5（低分化） - （修改後的格里森：兩個最高等級） (Modified Gleason: two highest grades) 年級 和 分數 Grade Sum Score 1 3+3 GS 6 gradewellooksvelate cell 1 3+3 GS 6 It Comrade (sc16) Slow growth rate : 2 3+4 GS 7 2 3+4 GS 7 3 4+3 GS 7 3 4+3 GS 7 > intermediate grade (e 7) - may require localized treatment option surgery radiation. = : ,. eg 4 GS 8 5 GS 9, 10 grade 5 cell alene very with : 4 5 GS 8 GS 9, 10 = high grade (score =3) require aggressive treatment eg hormone therapy - : more. abnormal and associated ~ aggressive disease. - 睪丸疾病 Testis disorders 類別 疾病 細節 Categories Disease Details 睪丸下降失敗 Is Congenital Cryptorchidis m ) Failed descent of testes into scrotum before birth (3-4 % male infant) 先天性 隱睪.. - 2) testicle is undescended) · · 米 多為單側（90%），3個月後自發性下降 m , 2 Mostly unilateral (90%), and spontaneously descend by 3 mo - 3 Complications: for both cryptorchid +/- normal testis 併發症：雙側隱睪+/‑正常睪丸 , ‧不孕症：生殖細胞成熟停滯、睪丸萎縮 In Infertility: arrest in germ ~ cell maturation, testicular atrophy imprimed sperm production in undescended teicle) ‧ 精原細胞瘤 * memua emergency risk factor Seminoma AHE Imalignant gene 2 , tumor that involve Mc testicles - ·. 血管 扭轉 2 Vascular Torsion In RF: trauma (MC), cryptorchidism RF：外傷（MC）、隱睪. elevation of ipsilateral testicle if stimulation of inner thigh. - ~ ↳A Fl 2 Sx: acute testicular pain, absent cremasteric reflex, haemorrhagic infarction > testicular infonction and necrosis Sx：急性睪丸疼痛、提睪反射消失、出血性梗塞 > twisting of which , - - ~ - speammatic cord erupt > infertility ,. Tx: spontaneous remission, orchidectomyBitij) 3 - Tx：自發性緩解，睪丸切除術 bloadflow to testicle -. -. rare : testicle untwist on its own.  Machine Translated by Google 90 90 of epididymis) Ba (inflammation. sexually transmited infection (MC) : gonorrhea chlamydia. , I. Inflammation I. Epididymitis I Specific infections: N. gonorrhoeae, C. trachomatis, TB, mumps , - - > - usually located toeticle , 發炎附睾炎 特異性感染：淋病奈瑟菌、沙眼披衣菌、結核病、腮腺炎 非 2. Orchitis 2 Non-specific infections: secondary to UTI leg Ecoli). mem. 睪丸炎 特異性感染：繼發於泌尿道感染 (inflammation of testicle that is no attributed to a infections agent) spetic - Testicular tumours [L50E] 睪丸腫瘤 [L50E] Ic. 2 lage 15-35). gemells which produce sperm > - In Inormallyoccur indeaSi is S - - 4, - *Adi , typically grow slower+ sensitive more to radiation. Si In 2, 2, : 3 3.. 4. -. 5 Tumour Age Morphological/ clinical findings Tumour marker 瘤 年齡 形態學/臨床發現 腫瘤標記 AART I. Seminoma 40s 1Originate from seminiferous tubule. I. Placental alkaline phosphatase 精原細胞瘤 40多歲 起源於生精小管上皮 胎盤鹼性磷酸酶 #El AF female Covary) (Dysgerminoma in F, CNS epithelium (PLAP): ↑in smoking （F 中的無性細胞瘤，CNS 中 (PLAP)：吸煙中的↑ germinoma in CNS) – all. White-yellow "potato" 2 , 2 Oct-4, CD117 的 CNS 生殖細胞瘤） – 全部 白黃色“土豆” 10 月 4 日，CD117 3 Large, clear cells (glycogen), MC in respective categories. 各組別的MC 大而透明的細胞（肝醣）、 lymphocytes, granuloma 淋巴球、肉芽腫 2. NSGCT (non-seminoma germ cell tumor). 神經膠質細胞瘤CT I Embryonal carcinoma. 30s Bulk tumour with haemorrhage and PLAP, Oct-4, CD30 胚胎癌30多歲 腫塊伴隨出血、壞死 PLAP，10 月 4 日，CD30 necrosis , 2 Yolk sac tumour