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Presented by Jonathan Epstein, M.D. and prepared by Jospeh Kronz, M.D.
Case 2: 75-year-old male with lower urinary tract symptoms
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Question 1 of 1
1. Question
Week 3: Case 2
75-year-old male with lower urinary tract symptoms
Correct
Answer: Remote infarct
Histology: In one of the TUR chips there are widely spaced glands set in a densely fibrotic stroma with some recent hemorrhage. At higher magnification, the glands show squamous differentiation. Some of the glands contain necrotic debris and a neutrophilic infiltrate.
Discussion: Sclerosing adenosis, while having a spindle and glandular component, looks distinctly different than a remote infarct. The glands within sclerosing adenosis either resemble ordinary adenosis or consist of crowded individual single cells resembling high-grade prostate cancer. The spindle cell component is extremely cellular in contrast to the hypocellular fibrotic nature of a remote infarct. Squamous cell carcinoma in addition to showing greater cytologic atypia would have a more infiltrative appearance rather than appearing to show squamous differentiation within a localized nodule. Prostates following the use of hormone therapy may show similar immature squamous metaplasia. However, the squamous metaplasia is present diffusely throughout the gland.
Incorrect
Answer: Remote infarct
Histology: In one of the TUR chips there are widely spaced glands set in a densely fibrotic stroma with some recent hemorrhage. At higher magnification, the glands show squamous differentiation. Some of the glands contain necrotic debris and a neutrophilic infiltrate.
Discussion: Sclerosing adenosis, while having a spindle and glandular component, looks distinctly different than a remote infarct. The glands within sclerosing adenosis either resemble ordinary adenosis or consist of crowded individual single cells resembling high-grade prostate cancer. The spindle cell component is extremely cellular in contrast to the hypocellular fibrotic nature of a remote infarct. Squamous cell carcinoma in addition to showing greater cytologic atypia would have a more infiltrative appearance rather than appearing to show squamous differentiation within a localized nodule. Prostates following the use of hormone therapy may show similar immature squamous metaplasia. However, the squamous metaplasia is present diffusely throughout the gland.
