Prostate gland & seminal vesicles

Nonneoplastic

Clear cell cribriform hyperplasia



Last author update: 19 December 2023
Last staff update: 19 December 2023

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PubMed Search: Clear cell cribriform hyperplasia

Arpan Samaddar, M.B.B.S.
Rafael E. Jimenez, M.D., M.H.A.
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Cite this page: Samaddar A, Jimenez RE. Clear cell cribriform hyperplasia. PathologyOutlines.com website. https://www.pathologyoutlines.com/topic/prostateclearcellcribhyper.html. Accessed April 14th, 2024.
Definition / general
  • Epithelial cribriform proliferation that is considered to be a histological variant of benign prostatic hyperplasia (BPH)
Essential features
  • Nodular clusters of cribriform acini lined by clear cells with small monotonous nuclei and inconspicuous nucleoli
  • Basal cell layer is intact
  • Predominantly occurs in the transitional zone of the prostate
Terminology
ICD coding
  • ICD-11: GA90 - hyperplasia of prostate
Epidemiology
  • As a morphologic variant of benign prostatic hyperplasia, clear cell cribriform hyperplasia shares the same epidemiology
Sites
  • Transitional zone of the prostate
Pathophysiology
  • Considered a variant of benign prostatic hyperplasia whose pathophysiology is incompletely understood
  • Dominant role of androgens and androgen receptors is recognized and recently the role of prostatic inflammation and metabolic factors has been described (Gerontology 2019;65:458)
Diagnosis
  • Mostly in transurethral resection of the prostate (TURP) specimens of men with lower urinary tract obstruction secondary to benign prostatic hyperplasia (Am J Surg Pathol 1986;10:665)
Prognostic factors
  • Not a risk factor for prostate cancer
Case reports
Treatment
  • Mostly found incidentally in TURP specimens treated for benign prostatic hyperplasia; no additional therapy is required
Gross description
  • No specific gross features
Microscopic (histologic) description
  • Focal or diffuse nodular clusters of acini with cribriform morphology
  • Involved ducts follow the architectural distribution of adjacent benign prostatic hyperplasia
  • Cuboidal to columnar cells with clear to pale eosinophilic granular cytoplasm and small, monotonous nuclei with inconspicuous nucleoli
  • Basal cell layer is prominent and frequently discernible on light microscopic examination
  • Stroma surrounding glands is cellular (benign prostatic hyperplasia-like)
  • References: Am J Clin Pathol 1991;95:446, Surg Pathol Clin 2022;15:591
Microscopic (histologic) images

Contributed by Rafael E. Jimenez, M.D. and Arpan Samaddar, M.B.B.S.
Clusters of cribriform acini

Clusters of cribriform acini

Clear cells

Clear cells

Intact basal cell layer

Intact basal cell layer

Small nuclei without atypia Small nuclei without atypia

Small nuclei without atypia

Positive stains
Negative stains
Molecular / cytogenetics description
Sample pathology report
  • Prostate, transurethral resection:
    • Benign prostatic hyperplasia

  • Note: it is not necessary to specify clear cell cribriform hyperplasia in the diagnosis as it has no clinical impact and the term may cause confusion
Differential diagnosis
Additional references
Board review style question #1

Which of the following is true about the prostatic lesion shown above?

  1. Carries a risk of progressing to high grade prostatic intraepithelial neoplasia
  2. Commonly encountered in the peripheral zone
  3. Considered to be an architectural variant of nodular prostatic hyperplasia
  4. Cytologically atypical with prominent nucleoli
Board review style answer #1
C. Considered to be an architectural variant of nodular prostatic hyperplasia. The image shows clear cell cribriform hyperplasia, which is considered to be a histological variant of benign prostatic hyperplasia. Answer B is incorrect because clear cell cribriform hyperplasia is commonly encountered in the transitional zone of the prostate. Answer D is incorrect because clear cell cribriform hyperplasia is cytologically bland with monotonous nuclei and inconspicuous nucleoli. Answer A is incorrect because clear cell cribriform hyperplasia is not a premalignant condition.

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Reference: Clear cell cribriform hyperplasia
Board review style question #2
Which of the following matches the immunohistochemical profile for clear cell cribriform hyperplasia of the prostate?

  1. HMWCK-, p63-, AMACR-
  2. HMWCK-, p63-, AMACR diffuse +
  3. HMWCK-, p63+, AMACR-
  4. HMWCK+, p63+, AMACR-
  5. HMWCK+, p63+, AMACR diffuse +
Board review style answer #2
D. HMWCK+, p63+, AMACR-. Acini are lined by an intact basal cell layer positive for HMWCK and p63. AMACR is usually negative but may be focally positive in some cases of this entity, a histological variant of benign prostatic hyperplasia. This immunohistochemical profile would also be seen in central zone histology and basal cell hyperplasia with a cribriform / pseudocribriform pattern. Answer E is incorrect because atypical intraductal cribriform proliferation and intraductal carcinoma will show an intact basal cell layer positive for HMWCK and p63 (may show discontinuous staining) with AMACR positivity. Answer B is incorrect because invasive acinar adenocarcinoma with cribriform Gleason pattern 4 and ductal type adenocarcinoma do not have an intact basal cell layer and will be negative for HMWCK and p63, while being positive for AMACR. Answers A and C are incorrect because these immunohistochemical profiles do not align with any other entities in the differential.

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Reference: Clear cell cribriform hyperplasia
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