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Prostate

Histology


Reviewers: Komal Arora, M.D., (see Reviewers page)
Revised: 13 April 2012, last major update March 2012
Copyright: (c) 2003-2012, PathologyOutlines.com, Inc.

Regions
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Transition zone:
● 5% of prostatic volume
● 2 pear shaped lobes surrounding proximal urethra
● Site of nodular prostatic hyperplasia, may expand to bulk of gland
● Site of 10% of prostate cancers (large duct carcinomas)
● Contains moderately compact fascicles of smooth muscle

Central zone:
● 25% of prostatic volume
● Surrounds transition zone to angle of urethra to bladder base
● Site of 5% of prostate cancers
● Unlike peripheral and transition zones, ducts are large and irregular
● Glands are complex with tall columnar, pseudostratified, papillary infoldings
● Striking basal cell layer with eosinophilic cytoplasm
● Stroma is densest in central zone, least dense in peripheral zone, in between for transition zone
Reference: Hum Pathol 2002;33:518

Peripheral zone:
● 70% of prostatic volume, from apex posterior to base, surrounds transition and central zones
● Site of 80% of prostate cancers
● Has loose fibromuscular stroma with widely spaced smooth muscle bundles, moderate gland complexity

Diagrams

               
McNeal zones (1=Peripheral Zone, 2=Central Zone, 3=Transitional Zone, 4=Anterior Fibromuscular Zone. B=Bladder, U=Urethra, SV= Seminal Vesicle)

Glandular versus non-glandular tissue
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Prostatic glandular tissue:
● Prostate glands found normally within skeletal muscle at apex, anteriorly, and in distal posterolateral gland
● Secrete normal mucins, produce pigment (lipofuscin), are androgen sensitive (castration causes atrophy)
● Differentiation and growth is androgen dependent
● Large prostatic ducts have single layer of urothelial-like epithelium without umbrella cells, which is PSA/PAP positive
● May undergo squamous metaplasia with estrogen therapy
● Benign tissue may contain hyaline globules (degenerative, also called thanatosomes (Am J Surg Pathol 2003;27:700); may be adjacent to skeletal muscle or nerves

Prostatic non-glandular tissue:
● “Capsule”: fibromuscular layer most prominent along base and posterior portion of lateral borders
● An inseparable component of prostatic stroma, not a distinct capsule (Am J Surg Pathol 1989;13:21)
● Along lateral borders, fibrous septa traverse periprostatic fat and merge with fibromuscular stroma
● Anteriorly, prostatic stroma merges with fibromuscular tissue of urogenital diaphragm
● Stroma contains abundant smooth muscle, which duplicates function of myoepithelial cells in breast; i.e. squeezes out secretions

Types of cells
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● Secretory cells, basal cells, scattered neuroendocrine cells, urothelium, ejaculatory duct/seminal vesicle type cells

Secretory cells:
● Located along glandular lumen
Positive stains: prostatic acid phosphatase (PAP), prostate-specific antigen (PSA), vimentin, keratin (some), Leu7/CD57, EMA (80%), CEA (25%)
Negative stains: CK903 (34betaE12 / high molecular weight keratin)

Basal cells:
● Separate secretory cells from basement membrane
● Consist of low cuboidal epithelium and columnar mucus secreting cells
● May have prominent nuclear groove, prominent nucleoli
● May be reserve cells (stem cells), can undergo myoepithelial metaplasia but are NOT myoepithelial cells
● Their presence differentiates benign conditions (basal cells are present) from well differentiated adenocarcinoma (not present)
Positive stains: CK903 (34 beta E12 / high molecular weight keratin), p63, androgen receptors
Negative stains: PSA, PAP, S100, actin

Neuroendocrine cells:
● Irregularly distributed
Positive stains: chromogranin A, B, secretogranin II, peptide hormones, PSA
Negative stains: androgen receptors

Urothelium:
● In proximal 2 mm of prostatic ducts

Ejaculatory ducts and seminal vesicles:
● Lined by double cell layer of pseudostratified epithelium
● Contain lipofuscin (golden-brown pigment)
● Have large, hyperchromatic nuclei (also called "monster" nuclei)
● May have intranuclear inclusions

Mucins:
● Normal mucins are neutral
● Most adenocarcinomas secrete acidic and neutral mucins

Glandular secretions:
● Can identify with glutaraldehyde based fixatives
● Fill the normal secretory cell cytoplasm
● Distinct bright red on H&E staining because of high polyamine content
● Also present in penile urethra (Hum Pathol 2002;33:905)

Micro images
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Various images with labels

       
Prostatic glandular tissue with 2 distinct layers

   
Secretory epithelium

           
Corpora amylacea

Spermatazoa


Crystalloids in benign glands


Skeletal muscle

       
Ganglia

           
Paraganglia


Basal cells stained by 34betaE12


Neuroendocrine cells

Videos
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Shotgun histology prostate

End of Prostate > Histology


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