Nodular hyperplasia of the prostate gland

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Nodular hyperplasia of the prostate gland
Diagnosis in short

Nodular hyperplasia of the prostate gland. H&E stain.

Synonyms benign prostatic hyperplasia, benign prostatic hypertrophy (misnomer)

LM stromal and/or glandular hyperplasia
LM DDx smooth muscle tumour of uncertain malignant potential, subtle prostate carcinoma
Gross enlarged prostate gland, nodularity
Grossing notes prostate chips, radical prostatectomy
Site prostate gland

Clinical history 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
Blood work +/-elevation of PSA (mild)
Prognosis benign
Clin. DDx other causes of hematuria (urothelial carcinoma, renal cell carcinoma, cystitis), other causes of obstruction (prostate carcinoma, urothelial carcinoma)
Treatment medical, TURP

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:[1]

  • Intermittency.
  • Weak stream.
  • Incomplete emptying.
  • Straining.
  • Hesitancy.
  • Post-void dribbling.
  • Prolonged voiding.

Others:

  • Hematuria - common.[2]

Treatment:

  • Medications.
  • Transurethral resection of the prostate (TURP).

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.[3]

DDx:

Images

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Urothelium present

Prostate Tissue, Transurethral Resection of Prostate (TURP):
- Benign prostatic tissue with glandular and stromal proliferation.
- Benign urothelial mucosa with inflammation.
- NEGATIVE for malignancy.
Prostate Tissue, Transurethral Resection of Prostate (TURP):
- Benign prostatic tissue.
- Benign urothelial mucosa with mild inflammation and calcification.
- NEGATIVE for malignancy.

Block letters

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.
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.
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.

No urothelium present

PROSTATE GLAND, TRANSURETHRAL RESECTION OF THE PROSTATE (TURP):
- BENIGN PROSTATIC TISSUE WITH GLANDULAR AND STROMAL PROLIFERATION.

Post-TURP granuloma present

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.

See also

References

  1. Shiau, Carolyn; Toren, Andrew (2006). Toronto Notes 2006: Comprehensive Medical Reference (Review for MCCQE 1 and USMLE Step 2) (22nd edition (2006) ed.). Toronto Notes for Medical Students, Inc.. pp. U5. ISBN 978-0968592861.
  2. Sharp, VJ.; Barnes, KT.; Erickson, BA. (Dec 2013). "Assessment of asymptomatic microscopic hematuria in adults.". Am Fam Physician 88 (11): 747-54. PMID 24364522.
  3. Skrzypczyk, MA.; Dobruch, J.; Nyk, L.; Szostek, P.; Szempliński, S.; Borówka, A. (2014). "Should all specimens taken during surgical treatment of patients with benign prostatic hyperplasia be assessed by a pathologist?". Cent European J Urol 67 (3): 227-32. doi:10.5173/ceju.2014.03.art2. PMID 25247076.
  4. Hansel, DE.; Herawi, M.; Montgomery, E.; Epstein, JI. (Jan 2007). "Spindle cell lesions of the adult prostate.". Mod Pathol 20 (1): 148-58. doi:10.1038/modpathol.3800676. PMID 17170745.