Page 732 - Textbook of Pathology, 6th Edition

716 HPV types 16 and 18 are strongly implicated and their DNA The prostate has numerous blood vessels and nerves. In
has been documented in the nuclei of malignant cells. addition to nervous control, the prostate is an endocrine-
Carcinoma of the penis is quite rare in Jews and Muslims dependent organ. Based on hormonal responsiveness, the
who undergo a ritual of circumcision early in life. In India, prostate is divided into 2 separate parts:
cancer of the penis is rare in Muslims who practice circum- the inner periurethral female part which is sensitive to
cision as a religious rite in infancy, whereas Hindus who do oestrogen and androgen; and
not normally circumcise have higher incidence. Circumcision outer subcapsular true male part which is sensitive to
provides protection against penile cancer due to prevention androgen.
of accumulation of smegma which is believed to be Prostate is involved in 3 important pathologic processes:
carcinogenic. The greatest incidence of penile cancer is prostatitis, nodular hyperplasia and carcinoma. While benign
between 45 and 60 years. nodular hyperplasia occurs in the periurethral part distorting
and compressing the centrally located urethral lumen, the
MORPHOLOGIC FEATURES. Grossly, the tumour is
located, in decreasing frequency, on frenum, prepuce, prostatic carcinoma usually arises from the outer subcapsular
glans and coronal sulcus. The tumour may be cauliflower- part in which case it does not compress the urethra
like and papillary, or flat and ulcerating (Fig. 23.10). (Figs. 23.12, B, C).
Histologically, squamous cell carcinoma of both
fungating and ulcerating type is generally well differen- PROSTATITIS
tiated to moderately-differentiated type which resembles Inflammation of the prostate i.e. prostatitis, may be acute,
in morphology to similar cancer elsewhere in the body chronic and granulomatous types.
(Fig. 23.11).
Acute Prostatitis
The tumour metastasises via lymphatics to regional
lymph nodes. Visceral metastases by haematogenous route Acute focal or diffuse suppurative inflammation of the
are uncommon and occur in advanced cases only. prostate is not uncommon. It occurs most commonly due to
ascent of bacteria from the urethra, less often by descent from
PROSTATE the upper urinary tract or bladder, and occasionally by
lymphogenous or haematogenous spread from a distant
NORMAL STRUCTURE focus of infection. The infection may occur spontaneously
or may be a complication of urethral manipulation such as
SECTION III
The prostate gland in the normal adult weighs approximately by catheterisation, cystoscopy, urethral dilatation and
20 gm. It surrounds the commencement of the male urethra surgical procedures on the prostate. The common pathogens
and is composed of 5 lobes during embryonic development— are those which cause UTI, most frequently E. coli, and others
anterior, middle, posterior and two lateral lobes. But at birth, such as Klebsiella, Proteus, Pseudomonas, Enterobacter, gono-
the five lobes fuse to form 3 distinct lobes—two major lateral cocci, staphylococci and streptococci. The diagnosis is made
lobes and a small median lobe (Fig. 23.12,A). by culture of urine specimen.
Histologically, the prostate is composed of tubular alveoli
(acini) embedded in fibromuscular tissue mass. The MORPHOLOGIC FEATURES. Grossly, the prostate is
glandular epithelium forms infoldings and consists of 2 enlarged, swollen and tense. Cut section shows multiple
layers—a basal layer of low cuboidal cells and an inner layer abscesses and foci of necrosis.
of mucus-secreting tall columnar cells. The alveoli are Histologically, the prostatic acini are dilated and filled
Systemic Pathology
separated by thick fibromuscular septa containing abundant with neutrophilic exudate. There may be diffuse acute
smooth muscle fibres.

Figure 23.12 Normal prostate, benign nodular hyperplasia and prostatic carcinoma. The nodule in case of benign nodular hyperplasia (B) is
located in the inner periurethral part and compresses the prostatic urethra while prostatic carcinoma (C) generally arises in the peripheral glands
and, thus, does not compress the urethra.