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Pathology for Urologists

Benign Prostatic Hyperplasia


Image A
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Image B
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  • 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 (image A).
    • Hyperplastic nodules are often multiple, mainly centered on proximal prostatic urethra involving submucosal compartment and TZ.

Image C
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Image D
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  • Histology:
    • Both glands and stroma can become hyperplastic (image B) & (image C).
    • Stromal or epithelial predominant hyperplasia may occur.
    • Medium or large glands with 2 benign cell layers (secretory and basal) showing some architectural complexity including papillary infoldings.
    • Stroma shows proliferation of bland spindle cells typically condensed around and follows the contour of small capillaries (image D).
    • Pure stromal hyperplasia with time may acquire more smooth muscles and may look like leiomyoma (leiomyomatous hyperplasia).
    • Large nodule may undergo infarction, and causes squamous metaplasia.

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