Microscopic mimics of prostatic carcinoma
Postatrophic hyperplasia

Author: Andres Matoso, M.D. (see Authors page)

Revised: 22 October 2015, last major update October 2015

Copyright: (c) 2003-2015,, Inc.

PubMed Search: Postatrophic hyperplasia [title]
Definition / General
  • Postatrophic hyperplasia is a variant of atrophy characterized by a cluster of small glands with atrophic cytoplasm, usually surrounding a dilated atrophic gland with surrounding sclerosis of the stroma
  • Simple atrophy: Large atrophic glands without crowding
  • Postatrophic hyperplasia: Crowded focus of small atrophic areas
  • Associated with older age (Mod Pathol 1998;11:47)
  • Not associated with adenocarcinoma, although may mimic it (Am J Surg Pathol 1999;23:932, Arch Pathol Lab Med 2003;127:840)
  • Although atrophy has been classically associated with age, it is now known to happen in approximately 70% of men younger than 30 year old
  • Most common in the peripheral zone of the prostate
  • Unknown
Prognostic Factors
  • Partial atrophy is not associated with an increased risk of carcinoma
  • Requires no treatment
Gross Description
  • Partial atrophy is not distinguishable grossly
Micro Description
  • Atrophic and hyperplastic glands
  • Maintenance of lobular architecture but scanty cytoplasm
  • Glands stand out at low power due to basophilic appearance
  • Basal layer usually present
  • Associated with elastosis (basophilic tinge of stroma, Arch Pathol Lab Med 2000;124:1306), dilated gland with fibrosis often present in center of atrophic glands
  • Glands show no evidence of active involution (Am J Surg Pathol 1998;22:1073)
  • Chronic inflammation (32%), acute inflammation (21%), prominent nucleoli (14%), atrophy in adjacent areas; mitoses rare (1%), MIB staining in 3%
Micro Images
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Sclerotic atrophy

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Simple atrophy

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Various images

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Elastic stains

WebPathology Images:

Positive Stains
Differential Diagnosis
  • The only relevant differential diagnosis is with prostate adenocarcinoma
  • The glands in postatrophic hyperplasia, while crowded, have basophilic appearance and scant cytoplasm
  • In contrast, prostate cancer glands usually show moderate amount of amphophilic cytoplasm
  • The most difficult differential diagnosis is with atrophic carcinoma, which may have very scant amount of cytoplasm, similar to benign atrophy
    • Atrophic carcinoma should only be diagnosed if: atrophic glands infiltrate between non-atrophic glands, the atrophic area merges with non-atrophic (usual type) adenocarcinoma, or if the degree of atypia is overtly malignant
Additional References