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Prostate

Microscopic mimics of prostatic carcinoma

Basal cell hyperplasia (BCH)

Reviewers: Komal Arora, M.D., (see Reviewers page)
Revised: 8 June 2012, last major update May 2012
Copyright: (c) 2003-2012, PathologyOutlines.com, Inc.

General
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● Also known as fetalization of prostate
● Patients usually age 60+
● Common in transitional zone in resections, but uncommon in needle biopsies (Hum Pathol 2005;36:480)
● In peripheral zone, 10% incidence in needle core biopsies, 23% incidence in whole prostate glands (Mod Pathol 2003;16:598)

Micro description
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● Small, solid nests of benign appearing epithelial cells with somewhat clear cytoplasm
● Accompanied by nodular hyperplasia
● May be floridwith complex architecture
● May have prominent nucleoli and resemble high grade PIN or adenocarcinoma
● May have adenoid cystic pattern
● In peripheral zone, often associated with lymphocytic inflammation
● Also intracytoplasmic hyaline globules (relatively specific, in 53% of florid cases), psammomatous calcifications (in 40% with florid cases), squamous features, cribriform pattern with multiple layers
● Usually no crystalloids (Am J Surg Pathol 2002;26:237)
● In core biopsies, typically focal and associated with lymphocytic inflammation
● BCH with atrophy (post anti-androgen therapy): diffuse atrophy of prostate glands, also immature squamous metaplasia
● BCH with squamous features: usually mixed with atrophy, normal appearing stroma

Micro images
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Various images

       
Peripheral zone images


34βE12

Positive stains
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● 34betaE12, p63, CK8/18

Negative stains
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● P504S (may be focally positive), CD10

Electron microscopy
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● Luminal calcification and intracytoplasmic electron dense globules focally in florid cases

Differential diagnosis
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● BCH with adenoid cystic pattern resembles adenoid basal cell tumor, but BCH lesions are well circumscribed, no necrosis, no desmoplastic stroma
● Cribriform PIN: BCH with cribriform features has multilayered basal cells and noncribriform BCH
● Adenoid basal tumor: often has desmoplastic stroma, necrosis or perineural invasion, no lobular growth pattern
● Adenocarcinoma or high grade PIN: resembles BCH with prominent nucleoli

Additional references
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● Am J Clin Pathol 1983;80:850, Arch Pathol Lab Med 2010;134:427, Am J Surg Pathol 2002;26:237

Basal cell hyperplasia with prominent nucleoli

General
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● 2% incidence in needle core biopsies
● Preferred term (per Epstein) instead of atypical basal cell hyperplasia
● No definite risk for malignancy
● Part of continuum of basal cell hyperplasia and adenoid basal cell tumor (Am J Surg Pathol 1993;17:645, Am J Surg Pathol 1992;16:1205)

Micro description
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● Nuclear enlargement, hyperchromasia, prominent nucleoli, mitotic figures

Micro images
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Various images

Positive stains
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● High molecular weight keratin

Negative stains
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● Actin

Florid basal cell hyperplasia

Definition
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● Extensive proliferation of basal cells involving >100 small crowded acini (per section) forming a nodule (Hum Pathol 2005;36:480)

Micro description
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● Almost always mild to moderate nuclear atypia (including prominent nucleoli and nuclear enlargement), intraluminal amorphic secretions
● Also intracytoplasmic hyaline globules (53%), microcalcifications (40%), no crystalloids

End of Prostate > Microscopic mimics of prostatic carcinoma > Basal cell hyperplasia (BCH)

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