Prostate
General
Histology

Author: Kenneth Iczkowski, M.D. (see Authors page)

Revised: 6 February 2016, last major update February 2016

Copyright: (c) 2003-2016, PathologyOutlines.com, Inc.

PubMed Search: Histology [title] prostate
Cite this page: Histology. PathologyOutlines.com website. http://www.pathologyoutlines.com/topic/prostatehistology.html. Accessed December 11th, 2016.
Terminology
Regions

  • Transition zone:
    • 5% of prostatic volume
    • 2 pear shaped lobes surrounding proximal urethra
    • Site of nodular prostatic hyperplasia; may expand to 95% of gland
    • Site of 10% of prostate cancer (often ductal carcinoma)
    • 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 cancer
    • Unlike peripheral and transition zones, ducts are large and irregular
    • Glands are complex with tall columnar, pseudostratified, papillary infoldings (can mimic high grade prostatic intraepithelial neoplasia)
    • Striking basal cell layer with eosinophilic cytoplasm
    • Stroma is densest in central zone, least dense in peripheral zone, in between for transition zone (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 cancer
    • Has loose fibromuscular stroma with widely spaced smooth muscle bundles, moderate gland complexity
Diagrams / Tables

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Sagittal view

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Axial views

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Prostate zones

Micro Description
Types of cells

  • Secretory cells:
    • Located along glandular lumen
    • Positive stains: prostatic acid phosphatase (PAP), prostate specific antigen (PSA), vimentin, keratin (some), Leu7/CD57, EMA (80%)
    • Negative stains: cytokeratin 903 (34βE12 / 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 grooves, prominent nucleoli
    • Are reserve cells (stem cells) and can undergo myoepithelial metaplasia but are NOT myoepithelial cells
    • Undergo hyperplasia causing multilayering in reactive / inflamed prostates
    • Their presence differentiates benign conditions (basal cells present) from well differentiated adenocarcinoma (not present), although cancer can retain rare basal cells (Am J Surg Pathol 1999;23:147, Am J Surg Pathol 1999;23:147)
    • Positive stains: CK903 (34βE12 / high molecular weight keratin), p63, androgen receptors
    • Negative stains: PSA, PAP, S100 protein, actin

  • Neuroendocrine cells:
    • Irregularly distributed, not perceptible without stains
    • Positive stains: chromogranin A, B, secretogranin II, peptide hormones, PSA
    • Negative stains: androgen receptors

  • Urothelium:
    • Lines proximal 2 mm of prostatic ducts

  • Ejaculatory ducts and seminal vesicles:
    • Lined by double cell layer of pseudostratified epithelium
    • Forms more elongated tubules compared to prostatic glands
    • 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
Micro Images

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Various images

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Prostatic glandular tissue

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Secretory epithelium



WebPathology Images:

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Basal cells

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Corpora amylacea

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Seminal vesicle: complex papillary folders, usually pigment granules

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Paneth cell-like change

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Intraluminal eosinophilic crystalloids

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Spermatozoa

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Skeletal muscle fibers

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Neurovascular bundles

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Ganglion cells

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Paraganglion

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Benign prostatic glands

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Eosinophilic material

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Lipofuscin

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Incidental rectal mucosa

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34βE12

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Synaptophysin+

Videos



Differential Diagnosis
  • Stratified epithelium: urothelial lined ducts, basal cell hyperplasia, normal central zone glands, high grade PIN