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Dome
Ureter
Trigone
Bladder Neck
Prostate
Urethra
Prostatic Apex

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Precancerous lesions: Urinary bilharziasis Transitional cell papilloma Aniline dyes Cigarette smoking Chronic cystitis Leukoplakia Ectopia   vesica

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Leukoplakia of the bladder : is a rare condition characterized by squamous metaplasia of the transitional epithelium and keratinization. Diagnosis is made by cystoscopy with biopsies. Ectopia   vesica : Bladder  exstrophy  refers to a herniation of the urinary bladder through an anterior abdominal wall defect.

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Ureter
Ureteric orifices
Detrusor
muscle
Trigone
Bladder neck
Urethra
External urethral
orifice
Internal urethral
sphincter

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Transitional cell carcinoma (grades and stages) Grade I:  well formed papillary structures lined by transitional epithelium  thicker than 7 layers   Mild atypia.   Invasion of the bladder muscle is absent.

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Grade II:  Well formed papillary structures  Moderate cytologic atypia  Muscle invasion may occur.

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Grade III: Poorly formed papillary structure Marked cytologic atypia and a high mitotic figures.  Muscle invasive growth pattern.

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Grade IV: Absent papillary structures So marked cytologic atypia and mitotic figures Cauliflower-like ulcerated mass with muscle invasion.

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Muscle Invasive (T)
lamina Propria
Invasion (TO
Superficial (T A)
CIS

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Squamous cell carcinoma: This is common after  bilharziasis with well differentiated keratinizing squamous cell carcinoma which tends to form a large bulky mass. Adenocarcinoma: May arise from: Urachal  remnants in the dome of the bladder. - Areas of cystitis  glandularis .

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Definition:  Seminoma is a testicular germ cell tumor. It is the commonest malignant tumor of the testis. It almost never develops before puberty and has a peak incidence in the thirties. Gross picture:  well circumscribed, firm, spherical mass, replacing all or part of the testis. The cut surface is solid, grayish white to pink and homogenous.

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Microscopically:  classical seminoma:  large cells with abundant, pale or clear cytoplasm and large central nuclei, separated by a thin stroma which is usually infiltrated by lymphocytes and contains epithelioid cell granulomas which are favorable prognostic finding.  Anaplastic seminoma:  greater cellular pleomorphism and more frequent mitosis than the classical seminoma and carries a worse prognosis. Spermatocytic  seminoma:  the neoplastic cells resemble primary spermatocytes. It occurs at an older age than the classical seminoma and has a better prognosis. Prognosis:  Seminomas are remarkably radiosensitive and it is one of the most curable cancer.

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Definition: Hormonal hyperplasia of the central ( peri -urethral)(transitional zone) prostatic tissue that occurs in old age.

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Testosterone and  dihydrotestosterone   (DHT, 10x more potent than testosterone because it dissociates from receptor more slowly) bind nuclear  androgen receptors  in stromal and epithelial cells, causing  growth factor activation. Stromal cells produce  5 alpha  reductase   (converts testosterone to DHT) Estradiol , increased in aging men, may also increase androgen receptors

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Bladder
Central zone
Transitional zone
Ejaculatory dud
Anterior zone
Prostate
Urethra
Peripheral zone

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The prostate is enlarged The enlargement mainly affects the prostatic tissue in transitional zone and middle lobe  The enlarged middle lobe forms a rounded mass that projects into the base of the urinary bladder just behind the urethral orifice.  The affected prostatic tissue is firm, nodular and may show infarcts or abscesses.

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There is an increase of both glandular and  fibromuscular  stroma elements.  A number of acini are  cystically  dilated and there are papillary projections from the gland lining into the lumen.  Small concentrically laminated eosinophilic, calcified structures known as corpora  amylacea  are commonly found in the gland lumen.  Areas of infarction and abscess formation

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- Frequent or urgent need to urinate. - Increased frequency of urination at night ( nocturia ) - Difficulty starting urination. - Weak urine stream or a stream that stops and starts. - Dribbling at the end of urination. - Inability to completely empty the bladder.

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On the urethra:  Compression of the urethra by the enlarged prostate leads to difficulty of micturition (dysuria). Superadded congestion of the urethral mucosa may lead to acute retention of urine or hematuria.

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On the urinary bladder: - Dilatation and hypertrophy of the bladder leads to obstruction to the outflow of urine. - Residual urine due to accumulation in the pouch formed behind the enlarged middle lobe. - Incontinence of urine due to stretching of the urethral sphincter by the enlarged middle lobe. - Cystitis and stone formation predisposed to by accumulation of urine in the urinary bladder.

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On the ureters and kidneys: - Bilateral  hydroureter  and hydronephrosis due to urinary obstruction. - Ascending infection from the bladder leading to pyelonephritis or  pyonephrosis . - Renal failure due to hydronephrosis.

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Definition :  This is one of the commonest cancers in males. It occurs mainly in old men above the age of 60 years. Benign nodular hyperplasia is not associated with increased risk of cancer. Gross picture:  Peripheral zone: it forms a hard mass with a homogenous, yellow-grey cut surface.

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Microscopic picture:  most prostatic adenocarcinomas are well differentiated and consist of small, closely packed acini. Histologic Grading:  - The Gleason system which is based on the glandular pattern of the tumor. Three grade system: well differentiated (grade 1), moderately differentiated (grade 2) and poorly differentiated (grade 3).

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Spread:  Local, lymphatics,  perineurial  and blood. Bone metastasis of prostatic cancer is usually osteoblastic. Diagnosis: Rectal examination Trans-rectal needle biopsy Cytologic examination High serum levels of PSA by IHC High serum levels of prostatic acid phosphatase are detected when the tumor has spread beyond the prostate. Elevated levels of both acid and alkaline phosphatases occur when the prostatic cancer has metastasized to bone.

Urinary bladder