Prostate gland & seminal vesicles
Other nonneoplastic lesions
Benign prostatic hyperplasia

Minor changes: 26 January 2021

Copyright: 2003-2021,, Inc.

PubMed search: benign prostatic hyperplasia [title] "loattrfree full text"[sb] pathology

Ali Amin, M.D.
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Cite this page: Amin A. Benign prostatic hyperplasia. website. Accessed March 3rd, 2021.
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)
  • 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)
  • 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 100 g
  • 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

Microscopic (histologic) 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
Microscopic (histologic) images

Contributed by Grzegorz Gurda M.D., Ph.D. and Kenneth Iczkowski, M.D.

Nodular hyperplasia (BPH), 4x, 10x, 20x

Missing Image

Stromal nodule,
a normal component of
benign prostatic

Images hosted on other servers:

Various images

Positive stains
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