Case 1

Clinical data

  • The patient was a 68 year old man who was admitted to hospital for cardiac failure.
  • He developed acute urinary retention and had to be catheterised.
  • He died of complications of vascular insufficiency.

Macroscopy pathology

  • The bladder and prostate gland have been opened anteriorly.
vertex of bladder
  • The median lobe of prostate is enlarged and nodular, and intrudes into the bladder floor.
  • It obstructs the internal urethral opening, possibly with a ball-valve effect.
Median lobe and lateral lobes of prostate

This patient’s bladder shows some of the secondary effects of urinary outflow obstruction.

  • Trabeculations (ridging) are due to hypertrophy of the detrusor muscle. The inner surface of a normal bladder is quite smooth.
  • Permanent distension. The normal adult bladder is elastic with a capacity of 300 - 500ml.

 

 

Trabeculations and distension
  • Diverticuli are outpouchings of the bladder wall.
  • At autopsy the patient was also found to have bilateral hydroureter and hydronephrosis (not shown). 

 

Diverticuli

Anatomical note

  • The trigone of the bladder is a triangular region of the inner bladder defined by the ureteral orifices and the internal urethral orifice.
Trigone of bladder diagram

Case 2

Clinical data

  • This is the prostate of a 79 year old man
  • He died of a ruptured aortic aneurysm and the abnormal prostate was an incidental finding at autopsy.

Macroscopic pathology

  • The prostate is enlarged and coarsely nodular. (The normal prostate is the size of a walnut and weighs about 20g.)  
Enlarged prostate

This is a transverse section through the prostate.

  • In this case it is predominantly the two lateral lobes that are hyperplastic
Transverse section through prostate

Terminology

  • The bladder shows hypertrophy
  • The prostate shows hyperplasia
    • What is the difference?
  • What sort of organs tend to hypertrophy?
  • What sort of organs lean to hyperplasia?
  • Can you define hypoplasia or dysplasia or metaplasia, even aplasia?
  • Similarly, dystrophy or atrophy?
  • How would you explain to your patient with benign prostatic hyperplasia (BPH) what is happening in his prostate?

Histology

  • The naked-eye appearance of benign prostatic hyperplasia was confirmed by microscopy.
  • In addition, small foci of adenocarcinoma were seen.

Comment on this case:

  • BPH is very common in men over 50 years.
  • The finding of microscopic or latent prostatic carcinoma is very common in men over 70 years.
  • The two conditions are independent i.e. BPH does not predispose to carcinoma.
  • Benign hyperplasia involves both the glandular tissue and fibromuscular stroma of the prostate. It tends to occur in the central, peri-urethral region of the prostate.
  • Prostate cancer is usually adenocarcinoma, deriving from glandular tissue. Most arise in the peripheral subcapsular region of the prostate, where the main glands are located. 

References and links

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