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Prostate

Benign lesions/conditions

Nodular hyperplasia


Reviewers: Ali Amin, M.D., (see Reviewers page)
Revised: 7 January 2012, last major update January 2012
Copyright: (c) 2003-2012, PathologyOutlines.com, Inc.

General
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● Also known as benign prostatic hypertrophy (BPH)
● Present in 20% of men at age 40, 50% at age 50, and 70% at age 60
● No correlation between histology and symptoms (50% with histologic findings have clinical enlargement of prostate, only 50% of these have symptoms)
● Incidence higher in African-Americans
● Recommended to not use this diagnosis on biopsies due to lack of correlation with obstructive symptoms; however, presence of stromal nodules does correlate with increased prostatic weight (Hum Pathol 2002;33:796)

Pathophysiology
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● Requires intact testes
● Testosterone and dihydrotestosterone (DHT, 10x more potent than testosterone because it dissociates from receptor more slowly) bind nuclear androgen receptors in stromal and epithelial cells, causing growth factor activation
● Stromal cells produce 5 alpha reductase (converts testosterone to DHT)
● Estradiol, increased in aging men, may also increase androgen receptors

Clinical features
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● Periurethral (transitional zone) nodules may compress urethra and cause obstructive symptoms of urinary tract infection, obstruction, acute urinary retention, bladder hypertrophy, trabeculation
● Diverticula NOT associated with prostatic adenocarcinoma, although it may develop in residual gland after TURP
● One study showed transition from nodular hyperplasia to transition zone adenocarcinoma (Hum Pathol 2003;34:228)

Treatment
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● Transurethral resection of prostate (TURP, #2 most common surgery after cataracts in men > 65, 400,000 per year in US)
● Suprapubic prostatectomy
● Androgen antagonists, smooth muscle relaxers (5 alpha reductase inhibitors decrease DHT and in many cases, prostatic volume and symptoms), minimally invasive treatment (i.e. ethanol ablation in Europe)
● Note: may recur after TURP as peripheral tissue expands to surround the prostatic urethra

Gross description
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● Large, discrete, periurethral nodules
● Mean size of surgical prostatectomy specimens is 100g
● Usually in transitional and periurethral zones (5% in peripheral zone), although enlarged prostate may compress other zones
● Glandular hyperplasia is yellow-pink, soft, oozing prostatic fluids
● Stromal hyperplasia is gray, tough

Gross images
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Various images

Micro description
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● Hyperplasia of glandular and stromal tissue with papillary buds, infoldings and cysts
● Associated with squamous metaplasia and infarction
● Begins around urethra where ejaculatory ducts enter prostate (transitional or periurethral zone)
● Basal cell layer is continuous
● Stromal changes are increased smooth muscle, lymphocytes and ducts (not associated with infectious process of prostatitis in most cases), reduced elastic tissue
● Variations include sclerosing adenosis, fibroadenoma-like and phyllodes-like hyperplasia, leiomyoma-like nodules, fibromyxoid nodules; associated with infarct

Micro images
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Various images

Positive stains
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● CD10 (Hum Pathol 2003;34:450)

End of Prostate > Benign lesions/conditions > Nodular hyperplasia


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