Histopathology of Non-neoplastic and

Neoplastic Lesions of the Prostate

Dr. Dyah Marianingrum, Mkes ,Sp.PA

 Introduction
• The prostate weight: 30-40 grams in adult.
• The prostate disorder usually found in older
men (> 50 yrs old).
• Department of Anatomical Pathology Dr.Cipto
Mangunkusumo/ Faculty of Medicine
University of Indonesia : 325-560 prostate
specimens per year.
 Anatomy of the Prostate
• Anatomical lobes:
• Anterior, posterior and 2 lateral lobes.
• Anatomical zone ( Mc Neal ):
• Peripheral zone
• Central zone
• Periurethral zone and transitional zone.
• Anterior fibromuscular stroma.
 Prostatic disorders
• Only 3 pathological processes affect the prostate
gland:
= Non – neoplastic:
• 1. inflammation.
• 2. benign nodular enlargement.
= Neoplastic
• 3. tumors/neoplasm.
Benign enlargements are the most common and
occur so often in advanced age.
 Inflammation

• Prostatitis : maybe divided into:

• Acute and chronic bacterial prostatitis.
• Chronic abacterial prostatitis.
• Granulomatous prostatitis.
 Inflammation
• Acute bacterial prostatitis: caused by E.coli, Gr(-) rod,
enterococci, staphylococci  urinary tracts inf.
• Route of inf: intraprostatic reflux of urine from
posturethra/bladder, lymphohematogen , surgical
manipulation cathether,cytoscopy, urethral dilation,
resection.
• Clinic : fever, chills,dysuria.
• Rectal toucher: prostate tender.
• D/ culture and clinical feature.
• Biopsy : contraindicated.
 Inflammation
• Chronic bacterial prostatitis: difficult to D/ &
treat.
• Clinic: LBP, dysuria,perineal &suprapubic
discomfort asymptomatic.
• Most antibiotics penetrate the prostate
poorly.
• D/ leukocytosis and bacterial culture of
prostate secretion.
 Inflammation
• Chronic a bacterial prostatitis: most common
form of prostatitis.
• No history of recurrent urinary tract inf.
• D/ > 10 leukocytes/LPB, bacterial culture : (-)
of prostate secretion.
 Inflammation
• Granulomatous prostatitis.
• Specific : USA: instillation of BCG in the
bladder.
• Fungal: immunocompromised host.
• Non specific: ruptur of prostatic duct and
acini.
Acute inflammation
Acute inflammation
Chronic inflammation

Squamous metaplasia
Chronic inflammation

Acinuc & corpora amilacea

Chronic inflammation with
dectructed acinus
Granulomatous prostatitis

Tubercle
 Tubercle with Langhans giant cell

Granulomatous prostatitis
Granulomatous prostatiitis

Tubercle
 Prostatic Hyperplasia
• Weight : 60- 100 grams.
• Incidence : 20 % of men 40 – 45 years.
• 70 % by the age 60.
• 90% by the age of 70.
• No correlation between histologik changes with
clinical symptom.
• Morphology : proliferation of acini and
fibromuscular tissue.
• Obstruction -> mechanic and contraction of smooth
muscle alpha 1 adrenoreceptor.
Gross
Prostatic hyperplasia
Prostatic hyperplasia

Dilated acini
 Prostatic hyperplasia with infarction
• Necrosis.
• Hemorrhage,
• Squamous metaplasia near the infarction
area.
 Mimickers of adenocarcinoma of the
prostate
• Basal cell hyperplasia.
• Atypical adenomatous hyperplasia (adenosis).
• Cribriform hyperplasia.
• Cowper’s gland.
• Seminal vesicles.
• Colonic mucosa.
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Prostatic hyperplasia

Basal cell hyperplasia

Prostate hyperplasia

Basal cell hyperplasia

AAH
AAH
AAH
Sclerosing adenosis
Cribriform hyperplasia
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Cribriform hyperplasia
Cowper’s glands
Cowper’s glands
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Seminal vesicles
Seminal vesicles

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Rectal mucosa in prostate
biopsy
 Tumors of the prostate
• Who 2004:
• Epithelial tumor : Adenocarcinoma
• Carcinosarcoma
• Hi grade PIN
• Ductal AdenoCA.
• Urothelial CA
• Squamous cell CA
• Basal cell tumors
 Tumors of the prostate
• Neuroendocrine tumors
• Prostatic stromal tumors: STUMP
• Stromal sarcoma
• Mesenchymal tumors
• Hematolymphatic tumors.
• Miscellaneous tumors.
• Metastatic tumors.
 Tumors of the prostate
• The most common : acinar adenocarcinoma.

• The specimens from: - FNAB

- Core/sextant biopsy
- TUR
- prostatectomy.
 Report
• Histological Type.
• Histological Grading: - nuclear anaplasia.
- Gleason score.
• Histological Staging. TNM.
 Histopathology of prostatic
adenocarcinoma
• Small acini infiltratively among the normal
glands.
• One layer of epithelial cells, without basal
cells.
• Basophilic mucin.
• Eosinophilic cristalloid.
• Perineural invasion  lymphovascular
invasion.
• Collagenous nodule (mucinous fibroplasia)
Adenocarcinoma,
periganglional/neural invasion
 Histological grading
• Nuclear anaplasia : I, II, III.

• Gleason score =
The predominant pattern/primary grade
+
The second most common/ secondary grade.

Tertiary grade
Gleason
pattern
original
Gleason
pattern
modified
 Gleason
score 1+2=3
 Gleason
score 3+3=6
 Gleason
score 4+3=7
 Gleason
score 4+3
=7
Gleason
score
3+3 =6
Gleason score
4+4 = 8
Gleason score
3+3=6
Gleason score
4+4=8
Adenocarcinoma, Gleason
pattern 4
Gleason
pattern 5
 Gleason
score 4+4=8
 Gleason
score 3+3=6
with
mucinous
fibroplasia
 Prostatic intraepithelial neoplasm
• First described by Mc Neal in 1960.
• More precisely characterized by Mc neal and
Bostwick in1986  intraductal dysplasia.
• Architecturally benign acini lined by atypical
cells.
• Grading : PIN 1 – low grade.
PIN 2 – hi grade.
PIN 3 – hj grade.
Hi Grade PIN
Hi Grade PIN
 Staging
• TNM:
+ Tx Primary tumor can’t be assessed
+ T0 no evidence of primary tumor.
+ T1a histological incidental finding in < 5% of tissue
resected.
+ 1b > 5% tsuue resected.
+ 1c. Tumor identified by needle biopsy.
+ T2 Tumor confined within prostate.
+ T3. Tumor extend beyond the prostate.
+ T4 Tumor invades adjacent structures other than
seminal vesicles.
 Immunohistochemistry
• Properties of prostate glands:
+ PSA (prostate specific antigen)
+ PAP ( prostate acid phosphatase ).
+ p63.
+ P504S (AMACR – Alpha Methylacyl Co A
Racemase).
+ 34 B E12 (keratin 903/HMWCK).
+ PSMA (prostate specific membrane antigen).
+ Androgen receptor.
+ Progesteron receptor.
+ Estrogen receptor.
+ etc.
 Ductal Adenocarcinoma
• Prostatic duct adenocarcinoma.
• 0,2-0,8 % from prostatic cancer.
• Gleason pattern : 4.
• Morphologic : - papillary growth.
- cribriform.
- tall columnar cells/
stratified.
Centrally located  periurethral zone.
Aggressive behaviour poor prognosis.
 Mucinous adenocarcinoma
• Mucin producing  acidic mucin ( Alcian Blue
pH 2,5 ).
• Gleason pattern : based on morphology of the
glands/acini.
 Prostatic stromal tumors
• STUMP ( Stromal Tumor of Uncertain
Malignant Potential ).
• Stromal sarcoma.
• Both are (+) for CD34, PR, uncommonly ER.
• STUMP : actin (+), prostatic stromal sarcoma
(-),
Melanoma malignum in TUR
Melanoma malignum in TUR
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