AAH can be difficult to distinguish from hyperplasia. There is no clear association between the presence of AAH and the development of prostatic adenocarcinoma. Helpap et al, Prostatic intraepithelial neoplasia PIN , which is dysplasia of the epithelium lining prostate glands, is a probable precursor of prostatic carcinoma.
The appearance of PIN may precede carcinoma by 10 or more years. It can be divided into low grade and high grade PIN. Low grade PIN may be found even in men in middle age. PIN usually involves an acinus or a small cluster of acini, but it can be more extensive on occasion. The acini are usually medium-sized to large, with rounded borders. The partial involvement of an acinus is a helpful feature to distinguish PIN from adenocarcinoma. PIN is characterized histologically by progressive basal cell alyer disruption, loss of markers of secretory differentiation, nuclear and nucleolar abnormalities, increasing proliferative potential, increasing microvessel density, variation in DNA content, and allelic loss.
Unlike adenocarcinoma, with which it may coexist, glands with PIN retain an intact or fragmented basal cell layer. Ayala and Ro, Low grade PIN has epithelial cells that are crowded and irregularly spaced, with nuclei that are hyperchromatic and pleomorphic, with small nucleoli. High grade PIN has even more hyperchromatism and pleomorphism, the cells are more crowded and heaped up, and nucleoli can be prominent. Immunohistochemical staining with antibody to low molecular weight keratin can help to identify the fragmented basal cell layer.
Anti-androgenic drug therapy may cause regression of PIN. The appearance of PIN warrants increased surveillance of the prostate for development of an invasive carcinoma because the presence of PIN that is high grade suggests an increased risk for subsequent appearance of adenocarcinoma.
PIN itself is not an indication for aggressive treatment. Lipski et al, Adenocarcinoma of the prostate is common. It is the most common non-skin malignancy in elderly men. Many of these carcinomas are small and clinically insignificant. However, some are not, and prostatic adenocarcinoma is second only to lung carcinoma as a cause for tumor-related deaths among males. Bostwick et al, Men with a higher likelihood of developing a prostate cancer in the U.
Those with an affected first-degree relative have a much greater risk. Prostate cancers may be detected by digital examination, by ultrasonography transrectal ultrasound , or by screening with a blood test for prostate specific antigen PSA. None of these methods can reliably detect all prostate cancers, particularly the small cancers.
Widespread PSA screening is not cost-effective. Men whose life expectancy is less than 10 years not pursue prostate cancer early detection because the likelihood of benefitis outweighed by the risk of harms from treatment. Men at higher risk for prostate cancer at earlier ages, including men of African American ancestry or a family history of prostate cancer in nonelderly relatives, should be provided the opportunity for informed decision making at an earlier age than average-risk men.
Wolf et al, PSA is a glycoprotein produced almost exclusively in the epithelium of the prostate gland. A mildly increased tPSA in a patient with a very large prostate can be due to nodular hyperplasia, or to prostatitis, rather than carcinoma. The cPSA has a greater sensitivity for prostatic adenocarcinomas at the low ranges of elevation. Transrectal needle biopsy, often guided by ultrasound, is useful to confirm the diagnosis, although incidental carcinomas can be found in transurethral resections for nodular hyperplasia.
Jung et al, Demura et al, Prostatic adenocarcinomas are composed of small glands that are back-to-back, with little or no intervening stroma. Cytologic features of adenocarcinoma include enlarged round, hyperchromatic nuclei that have a single prominent nucleolus. Mitotic figures suggest carcinoma. Less differentiated carcinomas have fused glands called cribriform glands, as well as solid nests or sheets of tumor cells, and many tumors have two or more of these patterns. Prostatic adenocarcinomas almost always arise in the posterior outer zone of the prostate and are often multifocal.
Historically, the prostate was described as having five lobes, namely anterior, posterior, median and two lateral lobes. The anterior lobe which joined the two lateral lobes to each other was also known as the isthmus Some radiologists and urologists refer to the central gland CG which consists of both the central and transition zones.
These zones are discernable on MRI. The central zone forms from the Wolffian duct whereas both the transition and peripheral zones arise from the urogenital sinus 3. Anatomy: Abdominopelvic. Please Note: You can also scroll through stacks with your mouse wheel or the keyboard arrow keys.
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Of the patients requiring retreatment, 4. In addition, The MedLift Study, an extension of the L. Enrollment criteria were similar to those in L. The single-arm MedLift study compared outcomes with those recorded in patients with lateral lobe enlargement in L. Seventy-one patients were screened. Patients were confirmed to have a median lobe that would have been a contraindication for inclusion in the L.
Forty-five patients were enrolled in the MedLift study. Compared to the L. On average, IPSS significantly declined
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