Bladder - Ectopic prostate

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Bladder

Congenital anomalies

Ectopic prostate

Reviewer: Alcides Chaux, M.D., Johns Hopkins University School of Medicine (see Reviewers page)
Revised: 19 April 2011, last major update April 2011
Copyright: (c) 2003-2011, PathologyOutlines.com, Inc.

Definition
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● Prostatic-type glands within bladder mucosa

Epidemiology
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● Rare; < 50 cases reported
● Usually in young males

Sites
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● Mainly at bladder neck but also trigone and interureteral ridge
● Very rarely at retrotrigone and ureteral orifices

Etiology
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● Due to vestigial remains of embryonic prostate remnants, metaplasia in response to chronic inflammation or abnormal migration of undifferentiated embryonic prostatic tissue with hormonal stimulation during adult life (Int J Urol 2005;12:1066)

Clinical features
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● May cause hematuria (most common symptom), dysuria, bladder outlet obstruction or persistent urinary tract infection
● May simulate a neoplastic process
● Benign behavior; no reported cases of malignant transformation

Case reports
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● 24 year old man with trigone mass (Indian J Urol 2008;24:564)
● 55 year old man with glands appearing to infiltrate bladder skeletal muscle (Cesk Patol 2001;37:65)
● 58 year old man with incidental finding (Actas Urol Esp 2002;26:369)

Treatment
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● Excision; may persist / recur if incomplete excision

Gross description
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● Firm, smooth, dome-shaped, broad-based polypoid mass
● Flat lesions also reported but very rare

Micro description
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● Prostatic-like glands with luminal secretions beneath partially/totally denudated urothelium
● May be associated with cystitis cystica and cystitis glandularis
● Prostate-specific immunohistochemical markers are confirmatory but not mandatory

Micro images
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Prostatic glands with luminal secretion underlying urothelium (right: PSA+)

Positive stains
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● Glands: PSA, PAP
● Basal layer: keratin 34betaE12

Differential diagnosis
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● Post-surgical ingrowth of prostatic tissue
● Retrovesical prostatic tissue (Urol Int 2001;66:171)

End of Bladder > Congenital anomalies > Ectopic prostate

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