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Nodular hyperplasia of the prostate gland (view source)
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{{ Infobox diagnosis | |||
| Name = {{PAGENAME}} | |||
| Image = Nodular_hyperplasia_of_the_prostate.jpg | |||
| Width = | |||
| Caption = Nodular hyperplasia of the prostate gland. [[H&E stain]]. | |||
| Synonyms = benign prostatic hyperplasia, benign prostatic hypertrophy (misnomer) | |||
| Micro = stromal and/or glandular hyperplasia | |||
| Subtypes = | |||
| LMDDx = [[smooth muscle tumour of uncertain malignant potential]], subtle [[prostate carcinoma]] | |||
| Stains = | |||
| IHC = | |||
| EM = | |||
| Molecular = | |||
| IF = | |||
| Gross = enlarged prostate gland, nodularity | |||
| Grossing = [[prostate chips]], [[radical prostatectomy]] | |||
| Site = [[prostate gland]] | |||
| Assdx = | |||
| Syndromes = | |||
| Clinicalhx = old man | |||
| Signs = hematuria, weak urine stream, incomplete urinary emptying, post-void dribbling, prolonged voiding, intermittency, hesitancy | |||
| Symptoms = increased frequency of urination, straining | |||
| Prevalence = very common, esp. elderly | |||
| Bloodwork = +/-elevation of PSA (mild) | |||
| Rads = | |||
| Endoscopy = | |||
| Prognosis = benign | |||
| Other = | |||
| ClinDDx = other causes of hematuria ([[urothelial carcinoma]], [[renal cell carcinoma]], cystitis), other causes of obstruction ([[prostate carcinoma]], [[urothelial carcinoma]]) | |||
| Tx = medical, [[TURP]], others | |||
}} | |||
'''Nodular hyperplasia of the prostate gland''', also '''benign prostatic hyperplasia''' (abbreviated '''BPH'''), is a common benign pathology of the [[prostate gland]]. | |||
It is also known as '''prostatic nodular hyperplasia'''. Occasionally, it is referred to as | |||
'''benign prostatic hypertrophy'''; this is a [[misnomer]]. This pathology is ''not'' a hypertrophy. | |||
==General== | |||
*Very common. | |||
*Incidence increases with age. | |||
Clinical - mnemonic ''I WISH 2p'':<ref>{{Ref TN2006| U5}}</ref> | |||
*Intermittency. | |||
*Weak stream. | |||
*Incomplete emptying. | |||
*Straining. | |||
*Hesitancy. | |||
*Post-void dribbling. | |||
*Prolonged voiding. | |||
Others: | |||
*Hematuria - common.<ref name=pmid24364522>{{Cite journal | last1 = Sharp | first1 = VJ. | last2 = Barnes | first2 = KT. | last3 = Erickson | first3 = BA. | title = Assessment of asymptomatic microscopic hematuria in adults. | journal = Am Fam Physician | volume = 88 | issue = 11 | pages = 747-54 | month = Dec | year = 2013 | doi = | PMID = 24364522 }}</ref> | |||
Treatment: | |||
*Medications. | |||
*Transurethral resection of the prostate (TURP). | |||
*[[Rezum]].<ref>{{cite journal |authors=Westwood J, Geraghty R, Jones P, Rai BP, Somani BK |title=Rezum: a new transurethral water vapour therapy for benign prostatic hyperplasia |journal=Ther Adv Urol |volume=10 |issue=11 |pages=327–333 |date=November 2018 |pmid=30344644 |pmc=6180381 |doi=10.1177/1756287218793084 |url=}}</ref> | |||
*Laser treatment ([[GreenLight]]).<ref name=pmid31617419>{{cite journal |authors=Campobasso D, Marchioni M, Altieri V, Greco F, De Nunzio C, Destefanis P, Ricciardulli S, Bergamaschi F, Fasolis G, Varvello F, Voce S, Palmieri F, Divan C, Malossini G, Oriti R, Tuccio A, Ruggera L, Tubaro A, Delicato G, Laganà A, Dadone C, De Rienzo G, Frattini A, Pucci L, Carrino M, Montefiore F, Germani S, Miano R, Schips L, Rabito S, Ferrari G, Cindolo L |title=GreenLight Photoselective Vaporization of the Prostate: One Laser for Different Prostate Sizes |journal=J Endourol |volume=34 |issue=1 |pages=54–62 |date=January 2020 |pmid=31617419 |doi=10.1089/end.2019.0478 |url=}}</ref> | |||
==Gross== | |||
*Enlargement of the prostate. | |||
*Nodularity of the prostate. | |||
==Microscopic== | |||
Features: | |||
*Stromal and/or glandular hyperplasia. | |||
**Stromal component has small blood vessels. | |||
Notes: | |||
*Should '''not''' be diagnosed on core biopsy! | |||
*One series suggests clinically relevant prostate cancer is seen in ~1.5% of resections for BPH.<ref>{{Cite journal | last1 = Skrzypczyk | first1 = MA. | last2 = Dobruch | first2 = J. | last3 = Nyk | first3 = L. | last4 = Szostek | first4 = P. | last5 = Szempliński | first5 = S. | last6 = Borówka | first6 = A. | title = Should all specimens taken during surgical treatment of patients with benign prostatic hyperplasia be assessed by a pathologist? | journal = Cent European J Urol | volume = 67 | issue = 3 | pages = 227-32 | month = | year = 2014 | doi = 10.5173/ceju.2014.03.art2 | PMID = 25247076 }}</ref> | |||
DDx: | |||
*[[Urothelial carcinoma]] - significant nuclear atypia. | |||
*[[Prostate carcinoma]] - especially low-grade. | |||
*[[Prostatic stromal tumour of uncertain malignant potential]] - lacks small vessels.<ref name=pmid17170745>{{Cite journal | last1 = Hansel | first1 = DE. | last2 = Herawi | first2 = M. | last3 = Montgomery | first3 = E. | last4 = Epstein | first4 = JI. | title = Spindle cell lesions of the adult prostate. | journal = Mod Pathol | volume = 20 | issue = 1 | pages = 148-58 | month = Jan | year = 2007 | doi = 10.1038/modpathol.3800676 | PMID = 17170745 }}</ref> | |||
===Images=== | |||
<gallery> | |||
Image:Nodular_hyperplasia_of_the_prostate.jpg | Prostatic nodular hyperplasia. (WC/Nephron) | |||
</gallery> | |||
==Sign out== | |||
===Urothelium present=== | |||
<pre> | |||
Prostate Tissue, Transurethral Resection of Prostate (TURP): | |||
- Benign prostatic tissue with glandular and stromal proliferation. | |||
- Benign urothelial mucosa with inflammation. | |||
- NEGATIVE for malignancy. | |||
</pre> | |||
<pre> | |||
Prostate Tissue, Transurethral Resection of Prostate (TURP): | |||
- Benign prostatic tissue. | |||
- Benign urothelial mucosa with mild inflammation and calcification. | |||
- NEGATIVE for malignancy. | |||
</pre> | |||
====Block letters==== | |||
<pre> | |||
PROSTATE TISSUE, TRANSURETHRAL RESECTION OF THE PROSTATE (TURP): | |||
- BENIGN PROSTATIC TISSUE WITH GLANDULAR AND STROMAL PROLIFERATION. | |||
- UROTHELIAL MUCOSA WITH A MILD LYMPHOCYTIC INFILTRATE. | |||
- NEGATIVE FOR MALIGNANCY. | |||
</pre> | |||
<pre> | |||
PROSTATE TISSUE, TRANSURETHRAL RESECTION OF THE PROSTATE (TURP) AND URINARY BLADDER NECK: | |||
- BENIGN PROSTATIC TISSUE WITH GLANDULAR AND STROMAL PROLIFERATION. | |||
- UROTHELIUM WITH THE CHANGES OF CYSTITIS CYSTICA ET GLANDULARIS. | |||
- NEGATIVE FOR MALIGNANCY. | |||
</pre> | |||
<pre> | |||
PROSTATE TISSUE, TRANSURETHRAL RESECTION OF THE PROSTATE (TURP) AND URINARY BLADDER NECK: | |||
- BENIGN PROSTATIC TISSUE WITH GLANDULAR AND STROMAL PROLIFERATION, AND FOCAL | |||
ACUTE AND CHRONIC INFLAMMATION. | |||
- UROTHELIUM WITH THE CHANGES OF CYSTITIS CYSTICA ET GLANDULARIS. | |||
- NEGATIVE FOR MALIGNANCY. | |||
</pre> | |||
===No urothelium present=== | |||
<pre> | |||
PROSTATE GLAND, TRANSURETHRAL RESECTION OF THE PROSTATE (TURP): | |||
- BENIGN PROSTATIC TISSUE WITH GLANDULAR AND STROMAL PROLIFERATION. | |||
</pre> | |||
===Post-TURP granuloma present=== | |||
<pre> | |||
PROSTATE TISSUE, TRANSURETHRAL RESECTION OF THE PROSTATE (TURP): | |||
- BENIGN PROSTATIC TISSUE WITH GLANDULAR AND STROMAL PROLIFERATION WITH | |||
PROMINENT BLOOD VESSELS AND SQUAMOUS METAPLASIA. | |||
- PALISADING GRANULOMA WITH NECROTIC CORE, SEE COMMENT. | |||
- UROTHELIAL MUCOSA WITH A MILD INFLAMMATORY INFILTRATE. | |||
- NEGATIVE FOR MALIGNANCY. | |||
COMMENT: | |||
This is morphologically consistent with a post-TURP granuloma. | |||
</pre> | |||
==See also== | |||
*[[Prostate gland]]. | |||
==References== | |||
{{Reflist|2}} | |||
[[Category:Prostate gland]] | |||
[[Category:Diagnosis]] | |||