patchology station/part 1/Benign Prostatic Hyperplasia

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Benign Prostatic Hyperplasia

  • Most common urologic disease of men; incidence increase with age (50% in 50s and 80-90% in 70s and 80s).
  • Pathophysiology remains poorly understood; hormone alteration plays a central role – cellular accumulation of testosterone, particularly the active metabolite dihydrotestosterone (DHT).
  • Almost exclusively involves the area of transition zone (TZ).
  • Presents with lower urinary tract symptoms (LUTS).
  • Most common non-cancerous cause of serum PSA elevation.
  • Gross:
    • Hallmark is nodular prostatic enlargement .
    • Hyperplastic nodules are often multiple, mainly centered on proximal prostatic urethra involving submucosal compartment and TZ

Microscopic (histologic) description
  • Hyperplasia of glandular and stromal tissue with papillary buds, infoldings and cysts
  • Associated with squamous metaplasia and infarction
  • Begins around urethra where ejaculatory ducts enter prostate (transitional or periurethral zone)
  • Basal cell layer is continuous
  • Stromal changes are increased smooth muscle, lymphocytes and ducts (not associated with infectious process of prostatitis in most cases), reduced elastic tissue
  • Variations include sclerosing adenosis, fibroadenoma-like and phyllodes-like hyperplasia, leiomyoma-like nodules, fibromyxoid nodules; associated with infarct
  • Untitled-jpg1.jpg

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