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Presented by Dr. Jonathan Epstein and prepared by Dr. Sintawat Wangsiricharoen
A 65 year old man underwent an enucleation for urinary obstructive symptoms.
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1. Question
A 65 year old man underwent an enucleation for urinary obstructive symptoms.
Correct
Answer: A
Histological Description: The enucleation consisted of a pure stromal proliferation with focal infarction. The lesion has relatively low cellularity with no pleomorphism or mitotic activity.
Discussion: There are five patterns of STUMP
Most common pattern with slightly hypercellular or normocellular stroma with scattered atypical, but degenerative appearing cells glands. Glands can be crowded with basal cell hyperplasia, adenosis, cribriform hyperplasia, squamous and urothelial metaplasia. Does not mimic BPH.
2nd pattern with hypercellular stroma consisting of bland fusiform stromal cells with eosinophilic cytoplasm admixed with benign glands.
3rd pattern with myxoid stroma containing bland stromal cells and often lacking admixed glands in sheets of stroma without nodularity. Lacks thick walled arterioles.
4th pattern is phyllodes with leaf-like hypocellular fibrous stroma covered by benign appearing prostatic epithelium. Can have associated complex glandular proliferations of basal cell hyperplasia, adenosis, cribriform hyperplasia, squamous and urothelial metaplasia.
5th pattern is round cell with increased stromal cellularity composed of cells with round bland nuclei. In contrast, stromal BPH nuclei are oval and spindled. Can have associated complex glandular proliferations. Abrupt demarcation between normal stroma and STUMP.
The 2nd pattern of STUMP most closely resembles stromal nodular BPH. BPH stroma is not as cellular as 2nd pattern of STUMP and lacks eosinophilic cytoplasm. Also in contrast to STUMP, BPH stroma has nodularity and numerous thick walled small arterioles. These vessels are distinctive, as typically such small vessels would not have thick walls. This feature is particularly helpful on needle biopsy, where the multinodularity cannot be appreciated. This case further mimicked a neoplasm with the presence of necrosis. BPH, stromal or glandular-stromal can undergo infarction which correlates with size of BPH and also systemic atherosclerosis. The
current case lacks the marked hypercellularity, pleomorphism, and mitotic activity seen in stromal sarcomas. Stromal nodular BPH may be extensive without any prostate glands mimicking a stroma neoplasm.Incorrect
Answer: A
Histological Description: The enucleation consisted of a pure stromal proliferation with focal infarction. The lesion has relatively low cellularity with no pleomorphism or mitotic activity.
Discussion: There are five patterns of STUMP
Most common pattern with slightly hypercellular or normocellular stroma with scattered atypical, but degenerative appearing cells glands. Glands can be crowded with basal cell hyperplasia, adenosis, cribriform hyperplasia, squamous and urothelial metaplasia. Does not mimic BPH.
2nd pattern with hypercellular stroma consisting of bland fusiform stromal cells with eosinophilic cytoplasm admixed with benign glands.
3rd pattern with myxoid stroma containing bland stromal cells and often lacking admixed glands in sheets of stroma without nodularity. Lacks thick walled arterioles.
4th pattern is phyllodes with leaf-like hypocellular fibrous stroma covered by benign appearing prostatic epithelium. Can have associated complex glandular proliferations of basal cell hyperplasia, adenosis, cribriform hyperplasia, squamous and urothelial metaplasia.
5th pattern is round cell with increased stromal cellularity composed of cells with round bland nuclei. In contrast, stromal BPH nuclei are oval and spindled. Can have associated complex glandular proliferations. Abrupt demarcation between normal stroma and STUMP.
The 2nd pattern of STUMP most closely resembles stromal nodular BPH. BPH stroma is not as cellular as 2nd pattern of STUMP and lacks eosinophilic cytoplasm. Also in contrast to STUMP, BPH stroma has nodularity and numerous thick walled small arterioles. These vessels are distinctive, as typically such small vessels would not have thick walls. This feature is particularly helpful on needle biopsy, where the multinodularity cannot be appreciated. This case further mimicked a neoplasm with the presence of necrosis. BPH, stromal or glandular-stromal can undergo infarction which correlates with size of BPH and also systemic atherosclerosis. The
current case lacks the marked hypercellularity, pleomorphism, and mitotic activity seen in stromal sarcomas. Stromal nodular BPH may be extensive without any prostate glands mimicking a stroma neoplasm.
