Prostate gland & seminal vesicles

Other nonneoplastic lesions

Benign prostatic hyperplasia



Topic Completed: 12 July 2021

Minor changes: 12 July 2021

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PubMed search: benign prostatic hyperplasia [title] pathology

Zhongbo Jin, M.D.
Sara Moscovita Falzarano, M.D., Ph.D.
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Cite this page: Jin Z, Falzarano SM. Benign prostatic hyperplasia. PathologyOutlines.com website. https://www.pathologyoutlines.com/topic/prostatenodhyper.html. Accessed October 18th, 2021.
Definition / general
  • Benign nodular enlargement of the prostate gland
  • Histopathologically, hyperplasia (nonneoplastic new growth) of stromal and glandular components
Essential features
  • Benign nodular lesion with proliferation of stromal and glandular components
  • Predominantly located in the transition zone of the prostate
  • Diagnosis of benign prostatic hyperplasia (BPH) should not be used on routine prostate biopsies (Hum Pathol 2002;33:796)
Terminology
  • Benign prostatic hypertrophy (misnomer)
  • Nodular hyperplasia
ICD coding
  • ICD-10: N40.1 - benign prostatic hyperplasia with lower urinary tract symptoms
  • ICD-10: N40.0 - benign prostatic hyperplasia without lower urinary tract symptoms
Epidemiology
Sites
Pathophysiology
  • Proliferation of both stromal and epithelial cells, leading to new glandular budding and branching, with formation of nodules
  • Central role of sex steroids (5α­dihydrotestosterone, estrogens) and growth factors (fibroblast growth factor, transforming growth factor beta) (Nat Rev Urol 2011;8:29)
Etiology
  • Exact etiology unknown
  • Multiple theories, including embryonic reawakening, stem cell proliferation and hormonal imbalances (Nat Rev Urol 2011;8:29)
Clinical features
  • Increased bladder outlet resistance
  • Lower urinary tract symptoms (LUTS), including:
    • Obstructive symptoms (hesitancy, intermittent stream and straining)
    • Urinary bladder irritation symptoms (frequency, urgency and urge incontinence)
    • Urinary retention (whether acute or chronic)
  • Severity assessed through self administered questionnaire (Am Fam Physician 2014;90:769)
Diagnosis
  • Clinical history
  • Physical examination (including digital rectal exam, assessment of bladder distention, motor and sensory deficits of the lower extremities and perineum and decreased anal sphincter tone to identify neurogenic bladder)
  • Urinalysis
  • Serum prostate specific antigen (PSA) measurement not recommended routinely (Annu Rev Med 2016;67:137)
  • Other studies, depending on symptoms (Am Fam Physician 2014;90:769)
Laboratory
  • Urinalysis may reveal hematuria, proteinuria or evidence of urinary tract infection
  • Prostate specific antigen (PSA) may be elevated (Curr Opin Urol 2000;10:3)
Radiology description
  • Imaging typically not specific for benign prostatic hyperplasia
  • Often performed to rule out other causes of lower urinary tract symptoms
  • Hypoechogenic nodules or variable echogenicity on ultrasound
  • Nodules ranging from hypointense to hyperintense on MRI T2 weighted images, depending on stroma / gland ratio (Diagn Interv Radiol 2016;22:215)
Radiology images

Images hosted on other servers:

BPH on MRI

Prognostic factors
Case reports
Treatment
Gross description
  • Variably sized nodules with a gray to yellow color and a granular appearance bulge above the cut surface of a prostate section
Gross images

Contributed by Sara Moscovita Falzarano, M.D., Ph.D.

Prominent periurethral nodularity

Microscopic (histologic) description
  • Epithelial hyperplasia is characterized by nodular lesions composed of variably sized glandular structures lined by basal and secretory cells
  • Glandular dilatation with papillary infoldings and cysts, often containing corpora amylacea, sometimes calcifications
  • Epithelial lining ranging from flat to columnar, with pink pale cytoplasm, regular, centrally located nuclei and inconspicuous nucleoli
  • Stromal nodules are composed of bland spindle cells with round to ovoid nuclei with open chromatin
  • Thick walled small capillary vessels can be seen on cross sections
  • Ischemic changes / infarcts can be seen within the nodules
  • Morphologic variants include:
  • Reference: Am J Surg Pathol 1988;12:619
Microscopic (histologic) images

Contributed by Sara Moscovita Falzarano, M.D., Ph.D.

Glandular / epithelial type

Benign prostatic glands

Stromal nodule

p63

p63 / HMWK

Positive stains
Negative stains
Sample pathology report
  • Prostate chips, transurethral resection:
    • Benign prostatic hyperplasia

  • Prostate tissue, transurethral laser enucleation:
    • Benign prostatic tissue with stromal and glandular hyperplasia (58 grams)
Differential diagnosis
Board review style question #1

The above image is from an open suprapubic prostatectomy specimen. Which of the following is true about the disease?

  1. Increasing incidence with increasing age
  2. It is considered a precursor to prostate adenocarcinoma
  3. It is more frequent in the peripheral zone of the prostatic gland
  4. Medical therapy has no role in the management of the disease
  5. Surgical treatment is contraindicated
Board review style answer #1
A. Increasing incidence with increasing age. The image shows benign prostatic hyperplasia.

Comment Here

Reference: Benign prostatic hyperplasia
Board review style question #2

The lesion was seen on transurethral resection of the prostate (TURP) from a patient with a prior clinical diagnosis of benign prostatic hyperplasia. What is the most likely immunohistochemical stain shown in the picture?

  1. CK7
  2. NKX3.1
  3. PSA
  4. P504S (AMACR)
  5. p63
Board review style answer #2
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