Atypical basal cell hyperplasia of the prostate.

Basal cell hyperplasia classically has been described as having bland cytologic features. During the past 2 years, we have seen 12 cases (11 in consultation) with atypical features that were confused with adenocarcinoma of the prostate. Eleven of these 12 cases contained prominent nucleoli mimicking carcinoma; in the 12th case, nuclei were enlarged, hyperchromatic, and moderately pleomorphic. Immunohistochemistry with antibodies against high-molecular-weight cytokeratin (34 beta E12) was performed in nine of the cases, verifying their basal cell nature. Additional findings in these cases were necrotic intraluminal secretions (two cases), immature squamous metaplasia (two cases), peculiar hyaline cytoplasmic globules (two cases), adenosis (one case), markedly atypical nuclei of uncertain nature occurring elsewhere in the specimen (one case), and intraluminal blue mucin (two cases). We analyzed nine cases of typical basal cell hyperplasia, all of which showed classic features of basal cell hyperplasia with benign cytology. Both atypical and classical basal cell hyperplasia were frequently infiltrated by lymphocytes such that the cytologic changes could not be attributable to inflammation. Atypical basal cell hyperplasia must be differentiated from ordinary adenocarcinoma of the prostate, prostatic intraepithelial neoplasia, and basaloid carcinoma (adenoid cystic carcinoma) of the prostate.     

Sclerosing adenosis of the prostate gland. A lesion showing myoepithelial differentiation.

Sclerosing adenosis of the prostate is a rare lesion characterized by the proliferation of variably sized glands in a cellular stroma. We report light microscopic, immunohistochemical, and ultrastructural studies in 22 examples from 15 patients. Two cases were identified in 100 consecutive prostates embedded by a whole organ method, giving a prevalence of 2%. Antibodies directed against the following antigens were used: high-molecular-weight cytokeratin (CKH; 34 beta E12); cytokeratin (CK; AE1/AE3), prostatic acid phosphatase (PAP), prostate-specific antigen (PSA), S-100 protein, muscle-specific actin (HHF35), and vimentin (Vim). Cells within the glandular component demonstrated positive reactivity for CK, CHH, PSA, and PAP, indicating a prostatic epithelial origin. In addition, a distinct population of cells reacting for muscle-specific actin and S-100 protein was identified within this glandular element. Adequate material for ultrastructural study was available in five cases; all showed the presence of flattened cells located between the basement membrane and secretory epithelial cells, which had features typical for myoepithelial differentiation. Although the prostate gland does not normally contain myoepithelial cells, we have documented their consistent presence in this unusual lesion; we believe these cells arise by a metaplastic process from the prostatic basal cells.     

Unusual morphologic patterns of basal cell hyperplasia of the prostate.

The distinction of basal cell hyperplasia (BCH) from carcinoma or high-grade prostatic intraepithelial neoplasia may be difficult. We reviewed 25 cases of BCH with unusual features and identified four distinct groups: BCH with intracytoplasmic globules (five cases); BCH with calcifications (eight cases), including one with globules; BCH with squamous features (three cases); and cribriform BCH (nine cases), including two cases with globules. A total of five cases contained prominent nucleoli and/or cytologic atypia. Hyaline cytoplasmic globules have not been described in any other prostatic entity and appear diagnostic of BCH. Calcifications observed in BCH were psammomatous, differing from the fine stippled calcifications occasionally seen in areas of comedonecrosis within high-grade prostatic carcinoma. Basal cell hyperplasia with squamous features differed from squamous differentiation in carcinomas (adenosquamous carcinoma) and from benign foci of squamous differentiation seen associated with either prostatic infarcts or with hormonal therapy. Whereas cribriform prostatic intraepithelial neoplasia and cribriform cancer glands represent a single glandular unit with punched out lumina, many of the glands within a focus of cribriform BCH appeared as fused individual BCH glands. The use of cytokeratin 34betaE12 can help in difficult cases. In cribriform BCH high-molecular-weight cytokeratin shows multilayered staining of the basal cells in some of the glands and a continuous layer of immunoreactivity. Cribriform prostatic intraepithelial neoplasia demonstrates an interrupted immunoreactive single cell layer of basal cells. Recognition of the architectural and cytologic features of unusual morphologies of BCH can be used to facilitate its diagnosis and differentiation from prostatic carcinoma and high-grade prostatic intraepithelial neoplasia.     

A case of "verrucous hyperplasia"; a vesical leukoplakia showing unusual macroscopic and histological findings

A patient who had vesical leukoplakia with unusual macroscopic and histological findings was studied. The mucous membrane of the urinary bladder in this patient showed a tumor-like proliferation similar to verrucous hyperplasia which is often found in the oral mucosa. We propose a new classification of vesical leukoplakia, dividing it into three groups, atrophic, hypertrophic and verrucous types. The atrophic type has a heavily keratinized, flat and thin type of epithelium with features resembling lichen sclerosis et atrophius. Histologically, it shows a variable degree of hyperkeratosis but no parakeratosis. The hypertrophic type has histological characteristics resembling features of leukoplakia in sites elsewhere in the body, which is marked by hyperkeratosis and irregular hyperplasia of the prickle cell layer with lengthening and abnormality in shape of rete pegs. The verrucous type has very rare features of coral shape, white color and verrucous proliferation. Histologically, this type shows severe hyperkeratosis, parakeratosis and elongation of the rete pegs, but no irregular invasion can be observed.     

A case report of intrahepatic biliary atresia showing an unusual liver histology

The extrahepatic biliary tract of a male infant, including both the left and right hepatic ducts, was proven to be patent up until his time of death, however, histologic examination of the liver revealed severe fibrosis of the portal areas with ductular proliferation, scattered bile thrombi, and subsequent biliary cirrhosis. In this case, since the obstructive lesion occurred at the secondary branching of the bilateral hepatic duct and because fewer changes were present in the interlobular bile ducts, it seemed possible to consider that the liver histology revealed findings similar to those of extrahepatic biliary atresia.     

A case report of intrahepatic biliary atresia showing an unusual liver histology

The extrahepatic biliary tract of a male infant, including both the left and right hepatic ducts, was proven to be patent up until his time of death, however, histologic examination of the liver revealed severe fibrosis of the portal areas with ductular proliferation,scattered bile thrombi, and subsequent biliary cirrhosis. In this case, since the obstructive lesion occurred at the secondary branching of the bilateral hepatic duct and because fewer changes were present in the interlobular bile ducts, it seemed possible to consider that the liver histology revealed findings similar to those of extrahepatic biliary atresia.     

Large abdominal mass: an unusual clinical form of prostate cancer

Contribution of one case of prostate cancer presenting with a large abdominal mass associated to anaemia and weight loss. Serum PSA level was greater than 10,000 ng/mL. Imaging studies showed large retroperitoneal mass that led to other differential diagnoses. Biopsy revealed findings suggestive of adenocarcinoma with a distinct immunohistochemical pattern. No metastasis was evidenced in bone scan. Complete hormonal blockade resulted in significant decreased PSA levels and almost complete involution of adenopathies, as well as overall improvement.     

A case report: Leukaemic infiltration and hyperplasia of the prostate

Leukaemic infiltration of prostate with hyperplasia is a rare manifestation and is usually found in known cases of leukaemia, but it may be the first sign of an undiagnosed leukaemia. In this report, a rare case of leukaemic infiltration of the prostate in a 64-year-old man is represented.     

A case report: Leukaemic infiltration and hyperplasia of the prostate

Leukaemic infiltration of prostate with hyperplasia is a rare manifestation and is usually found in known cases of leukaemia, but it may be the first sign of an undiagnosed leukaemia. In this report, a rare case of leukaemic infiltration of the prostate in a 64-year-old man is represented. This revised version was published online in August 2006 with corrections to the Cover Date.     

Basal cell hyperplasia of prostate: an elusive lesion?

We report a case of basal cell hyperplasia of the prostate accompanying benign prostatic hypertrophy. The histogenesis of the basal cells as well as the histologic features and differential diagnosis of basal cell hyperplasia are reviewed.     

Potassium-titanyl-phosphate laser vaporization of the prostate: a case series of an unusual complication

Abstract Despite its increasing use in the management of symptomatic benign prostatic hyperplasia, the long-term complications after potassium-titanyl-phosphate photoselective vaporization of the prostate are poorly reported. We describe a rare complication of this technology-calculi formation in the prostatic urethra. All patients presented with visible hematuria and variable lower urinary tract symptoms up to 5 years after the original surgery. In all cases, the calculi were successfully removed endoscopically. Possible causes for this unusual complication are discussed, and the importance of warning patients about this potential long-term complication are highlighted.     

Subcutaneous basal cell carcinoma: A case report

An unusual case of a patient who presented with a subcutaneous soft tissue lesion of the back is described. The patient had no preceding history of cutaneous malignancy or local trauma. Excision of the lesion revealed a diagnosis consistent with basal cell carcinoma with deep infiltration. The site was re-excised with a generous margin to ensure complete removal. There has been no recurrence for 18 months. This case is presented to underscore the rarity and importance of its existence.     

Pheochromocytoma of the prostate: an unusual location

We report a case of pheochromocytoma of the prostate. The clinical presentation, diagnostic evaluation, therapy and pathological findings are discussed.     

A case of sclerosing lipogranuloma

Although sclerosing lipogranuloma is relatively rare, it is of special interest to urologists because the majority of the cases occur in the genital and urinary tracts. A 49-year-old man complained of urinary frequency and lower abdominal pain. IVP examination revealed compression and irregularity of dome of bladder. CT scan showed giant abnormal mass upper dome of bladder. The tumor and part of the bladder which was adhered to it were excised. Histological findings were necrosis of the fat cells with liberation of fat droplets into the intercellular spaces. There were giant cells clinging to fatty masses and small fat vacuoles in them. Essentially sclerosing lipogranuloma is a disease affecting the fat cells which for some unknown reason undergo a degenerative type of change which results in rupture of the cells with liberation of free fat droplets into the surrounding intercellular spaces and then reaction around. Complete surgical excision is the treatment of choice. Otherwise the lesion recurs.