Prostate
Benign lesions / conditions
Nodular hyperplasia

Authors: Ali Amin, M.D. (see Authors page)

Revised: 28 July 2016, last major update January 2012

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

PubMed search: prostatic nodular hyperplasia
Cite this page: Nodular hyperplasia. PathologyOutlines.com website. http://www.pathologyoutlines.com/topic/prostatenodhyper.html. Accessed December 10th, 2016.
Definition / General
  • 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
  • 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
  • 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
  • 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
  • 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

Images hosted on other servers:

Various images

Micro Description
  • 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

Images hosted on other servers:

Various images

Positive Stains