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Presented by George Netto, M.D. and prepared by Alex Chang, M.D.
Case 4: 70 year old man presented with symptoms of BPH.
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1. Question
Week 422: Case 4
70 year old man presented with symptoms of BPH. A TURP was performed
Correct
Answer: Prostatic sclerosing adenosis
Histology: none provided
Discussion: Sclerosing adenosis is a rare lesion that is mainly encountered in TURP specimens performed for urinary obstruction. Sampled on needle biopsy it may lead to potential overdiagnosis as PCa. Sclerosing adenosis is composed of a relatively well circumscribed proliferation of well-formed glands admixed with single epithelial cells set in a background of dense spindle cell proliferation. The glandular structures are similar to those seen in adenosis. Some glands are surrounded by a distinct eosinophilic hyaline sheath- like collarette. The lining epithelial cells usually lack atypia. Basal cell layer can be appreciated on H&E. Establishing the diagnosis of sclerosing adenosis in examples demonstrating atypical features such as presence of crystalloids, mitotic figures and prominent nucleoli, require the aid of immunostains. Basal cells and spindle cells are unique in their true myoepethelial differentiation as indicated by co-expression of keratin and muscle-specific actin.
Incorrect
Answer: Prostatic sclerosing adenosis
Histology: none provided
Discussion: Sclerosing adenosis is a rare lesion that is mainly encountered in TURP specimens performed for urinary obstruction. Sampled on needle biopsy it may lead to potential overdiagnosis as PCa. Sclerosing adenosis is composed of a relatively well circumscribed proliferation of well-formed glands admixed with single epithelial cells set in a background of dense spindle cell proliferation. The glandular structures are similar to those seen in adenosis. Some glands are surrounded by a distinct eosinophilic hyaline sheath- like collarette. The lining epithelial cells usually lack atypia. Basal cell layer can be appreciated on H&E. Establishing the diagnosis of sclerosing adenosis in examples demonstrating atypical features such as presence of crystalloids, mitotic figures and prominent nucleoli, require the aid of immunostains. Basal cells and spindle cells are unique in their true myoepethelial differentiation as indicated by co-expression of keratin and muscle-specific actin.
