Pseudo-neoplastic Lesions of Prostate and the Diagnostic Deception

Abstract

Introduction: Many pseudo-neoplastic lesions of the prostate gland are recognized. Histologically these lesions mimic the adenocarcinoma of prostate. Pseudo-neoplastic lesions comprise of different glandular and non-glandular or solid patterns. Largely emphasized on the epithelial origin but some stromal and solid lesions are also important. In developing countries, the routine Hematoxylin and eosin (H&E) stain is most commonly used to stain the histological tissue sections. The other stains and molecular studies are not frequently used. The pseudoneoplastic lesions are so obscure and deceptive that sometimes it become very difficult to recognize. The diagnostic facilities both in government and private sector should have at least the facility of immunohistochemical staging to avoid misinterpretations.

Methodology: This retrospective study performed at Muhammad Medical College Mirpurkhas Sindh. 192 specimens of radical prostatectomy (RP) and transurethral resection of the prostate (TURP) received between January 2015 to December 2017 were retrieved for review. All retrieved blocks processed as per standard histopathological techniques. Fresh tissue sections taken and stained with H&E.

Results: All tissue sections reviewed to observe the glandular patterns, their architectural morphology, cytological changes and inflammatory process. The lesions were distinguished on epithelial origin and glandular patterns. Cases of benign prostatic hyperplasia were 169 (88 %), adenosis 06 (3.12 %), reactive hyperplasia 06 (3.12 %), Post atrophic hyperplasia 05 (2.6 %), benign stromal proliferation 02 (1 %) and prostate carcinoma 04 (2%).

Conclusion: Many pseudoneoplastic lesions of the prostate are the mimicker of adenocarcinoma. On H&E stains it sometimes become difficult to differentiate the lesions. The histomorphological diagnosis of these lesions should be facilitated at least by immunohistochemical stains at diagnostic tcenters.t

Keywords: Immunohistochemistry, Transurethral resection of prostate (TURP), Radical prostatectomy (RP). Hematoxylin and Eosin (H&E).