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Presented by Dr. Andres Matoso and prepared by Dr. Monica Butcher
This case talks about an adult male with lower urinary tract symptoms.
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1. Question
Adult male with lower urinary tract symptoms, TURP
Diagnosis:
Correct
Correct: C
Histology: Prostate tissue with nodules of bland spindle cells with small nuclei and variable amount of eosinophilic cytoplasm and arranged in a patternless pattern and areas of intersecting fascicles.
Discussion: One of the most common stromal proliferations identified in prostate needle biopsies and transurethral resections of prostate 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. Histologically, stromal nodule of BPH are characterized by a bland monomorphic proliferation of spindle stroma cells with small nuclei and variable amount of eosinophilic cytoplasm arranged in bundles, but more commonly in whorled of haphazard patterns. Stromal nodules are typically multifocal and have thick-walled vessels. 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
1. Berry SJ, Coffey DS, Walsh PC, Ewing LL. The development of human benign prostatic hyperplasia with age. J Urol. 1984;132(3):474-479.
2. Shapiro E, Becich MJ, Hartanto V, Lepor H. The relative proportion of stromal and epithelial hyperplasia is related to the development of symptomatic benign prostate hyperplasia. J Urol. 1992;147(5):1293-1297.
3. Park H, Park S, Kim KH, Cho MS, Sung SH, Ro JY. Stromal nodules in benign prostatic hyperplasia: morphologic and immunohistochemical characteristics. Prostate. 2014;74(14):1433-1443.Incorrect
Correct: C
Histology: Prostate tissue with nodules of bland spindle cells with small nuclei and variable amount of eosinophilic cytoplasm and arranged in a patternless pattern and areas of intersecting fascicles.
Discussion: One of the most common stromal proliferations identified in prostate needle biopsies and transurethral resections of prostate 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. Histologically, stromal nodule of BPH are characterized by a bland monomorphic proliferation of spindle stroma cells with small nuclei and variable amount of eosinophilic cytoplasm arranged in bundles, but more commonly in whorled of haphazard patterns. Stromal nodules are typically multifocal and have thick-walled vessels. 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
1. Berry SJ, Coffey DS, Walsh PC, Ewing LL. The development of human benign prostatic hyperplasia with age. J Urol. 1984;132(3):474-479.
2. Shapiro E, Becich MJ, Hartanto V, Lepor H. The relative proportion of stromal and epithelial hyperplasia is related to the development of symptomatic benign prostate hyperplasia. J Urol. 1992;147(5):1293-1297.
3. Park H, Park S, Kim KH, Cho MS, Sung SH, Ro JY. Stromal nodules in benign prostatic hyperplasia: morphologic and immunohistochemical characteristics. Prostate. 2014;74(14):1433-1443.
