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Presented by Dr. Andres Matoso and prepared by Dr. Yembur Ahmad
This case talks about an adult man who has undergone TURP.
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1. Question
An adult male presents with lower urinary tract symptoms and undergoes transurethral resection of the prostate (TURP).
Correct
Correct: C
Histology: Prostate tissue with nodules of cribriform glands with clear cytoplasm, bland nuclei and foci of dark basal cell layer.
Discussion: Clear cell cribriform hyperplasia (CCCH) is a rare form of benign prostatic hyperplasia. When detected, it is most often on TURPs as it is located in the central and transition zone. It comprises of nodules of cribriform glands with clear cytoplasm, bland nuclei, and a prominent dark basal layer. It can be misconstrued as a Gleason score 4+4=8 (Grade Group 4) due to its cribriform morphology. The key to differentiating clear cell cribriform hyperplasia from high-grade PIN/Intraductal carcinoma is the lack of cytologic atypia (no prominent nucleoli). HMWK or p63 stains basal cells, although not every gland will be positive, differentiating it from a high-grade adenocarcinoma.
References
1. Frauenhoffer EE, Ro JY, el-Naggar AK, Ordonez NG, Ayala AG. Clear cell cribriform hyperplasia of the prostate. Immunohistochemical and DNA flow cytometric study. Am J Clin Pathol. 1991;95(4):446-453.
2. Ayala AG, Srigley JR, Ro JY, Abdul-Karim FW, Johnson DE. Clear cell cribriform hyperplasia of prostate. Report of 10 cases. Am J Surg Pathol. 1986;10(10):665-671.Incorrect
Correct: C
Histology: Prostate tissue with nodules of cribriform glands with clear cytoplasm, bland nuclei and foci of dark basal cell layer.
Discussion: Clear cell cribriform hyperplasia (CCCH) is a rare form of benign prostatic hyperplasia. When detected, it is most often on TURPs as it is located in the central and transition zone. It comprises of nodules of cribriform glands with clear cytoplasm, bland nuclei, and a prominent dark basal layer. It can be misconstrued as a Gleason score 4+4=8 (Grade Group 4) due to its cribriform morphology. The key to differentiating clear cell cribriform hyperplasia from high-grade PIN/Intraductal carcinoma is the lack of cytologic atypia (no prominent nucleoli). HMWK or p63 stains basal cells, although not every gland will be positive, differentiating it from a high-grade adenocarcinoma.
References
1. Frauenhoffer EE, Ro JY, el-Naggar AK, Ordonez NG, Ayala AG. Clear cell cribriform hyperplasia of the prostate. Immunohistochemical and DNA flow cytometric study. Am J Clin Pathol. 1991;95(4):446-453.
2. Ayala AG, Srigley JR, Ro JY, Abdul-Karim FW, Johnson DE. Clear cell cribriform hyperplasia of prostate. Report of 10 cases. Am J Surg Pathol. 1986;10(10):665-671.
