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Presented by Dr. Andres Matoso and prepared by Dr. Yembur Ahmad
A 64 year old male with a prostate mass.
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1. Question
A 64 year old male presents with a prostate mass. What is the diagnosis?
Correct
Correct Answer: C
Histology: This prostate tumor shows a proliferation of spindle stroma cells with small nuclei and variable amount of eosinophilic cytoplasm arranged in a whorled of haphazard pattern. The tumor is characterized by having thick walled vessels.
Discussion: One of the most common stromal proliferations identified in prostate needle biopsies are stromal nodules of benign prostatic hyperplasia (BPH). BPH is common among middle age and elder men and it affects up to 80% of men. BPH refers to the proliferation and enlargement of both the stromal and the glandular components but there is evidence that suggests that it is the stroma the one that leads to more pronounced enlargement and obstructive symptoms. By immunohistochemistry, the spindle cells are most commonly positive for vimentin and some cases with more prominent fibromuscular differentiation show positive staining for smooth muscle actin and desmin. The immunohistochemistry profile is not specific and of limited utility in the differential diagnosis. The main differential diagnoses include stromal tumor of uncertain malignant potential (STUMP) which, in contrast to stromal nodule of BPH, has more pronounced nuclear pleomorphism, often infiltrates around glands, and lacks the characteristic thick-walled blood vessels.
References:
J Urol. 1984;132(3):474-479.
J Urol. 1992;147(5):1293-1297.
Prostate. 2014;74(14):1433-1443.Incorrect
Correct Answer: C
Histology: This prostate tumor shows a proliferation of spindle stroma cells with small nuclei and variable amount of eosinophilic cytoplasm arranged in a whorled of haphazard pattern. The tumor is characterized by having thick walled vessels.
Discussion: One of the most common stromal proliferations identified in prostate needle biopsies are stromal nodules of benign prostatic hyperplasia (BPH). BPH is common among middle age and elder men and it affects up to 80% of men. BPH refers to the proliferation and enlargement of both the stromal and the glandular components but there is evidence that suggests that it is the stroma the one that leads to more pronounced enlargement and obstructive symptoms. By immunohistochemistry, the spindle cells are most commonly positive for vimentin and some cases with more prominent fibromuscular differentiation show positive staining for smooth muscle actin and desmin. The immunohistochemistry profile is not specific and of limited utility in the differential diagnosis. The main differential diagnoses include stromal tumor of uncertain malignant potential (STUMP) which, in contrast to stromal nodule of BPH, has more pronounced nuclear pleomorphism, often infiltrates around glands, and lacks the characteristic thick-walled blood vessels.
References:
J Urol. 1984;132(3):474-479.
J Urol. 1992;147(5):1293-1297.
Prostate. 2014;74(14):1433-1443.
