Abstract
A 62-year-old male presented with symptoms of urinary obstruction and elevated serum prostate-specific antigen level of 3.61 ng/mL. Prostate needle biopsies showed benign prostatic tissue with a focus of crowded glands with minimal cytological atypia, fairly well-circumscribed with infiltrative appearance of glands at the edges. This focus had both small and larger glands with similar histological features. This focus was strongly positive for alpha-methylacyl-coenzyme A-racemase (AMACR), but showed scattered patchy staining with basal cell markers (p63 and CK903/34βE12). Hence, the final histologic diagnosis was benign prostatic tissue with a focus of florid adenosis. Two subsequent follow-up prostate needle biopsies performed six and 12 months later both showed benign prostatic tissue with atrophic changes. This case highlights the utility of these three immunostains (AMACR, p63 and CK903/34βE12) in the accurate diagnosis of adenosis of the prostate on needle biopsy, and avoiding its misinterpretation as prostate adenocarcinoma.
Highlights
Atypical adenomatous hyperplasia (AAH) or adenosis of the prostate is a pseudoneoplastic lesion that can mimic prostate adenocarcinoma because of its cytologic and architectural features [1,2,3]
As the sampling of the transition zone of the prostate has become more frequent recently with ultrasound-guided multiple segmental prostate biopsies [4] the practicing surgical pathologists must be aware of the histologic features of AAH of the prostate in needle biopsy specimens, in order to avoid misinterpretation of AAH of the prostate, a benign lesion, as prostate adenocarcinoma
Original magnification × 400. (C) Predominantly large glands lined by epithelial secretory cells with clear eosinophilic cytoplasm and minimal cytological atypia
Summary
Atypical adenomatous hyperplasia (AAH) or adenosis of the prostate is a pseudoneoplastic lesion that can mimic prostate adenocarcinoma because of its cytologic and architectural features [1,2,3]. Since AAH occurs predominantly in the transition zone, which is only rarely sampled in needle biopsy, it is uncommon to see examples of this lesion in biopsy specimens. As the sampling of the transition zone of the prostate has become more frequent recently with ultrasound-guided multiple segmental prostate biopsies [4] the practicing surgical pathologists must be aware of the histologic features of AAH of the prostate in needle biopsy specimens, in order to avoid misinterpretation of AAH of the prostate, a benign lesion, as prostate adenocarcinoma. The histologic section of one needle biopsy was characterized at low-power examination by the replacement of normal prostatic tissue by a proliferation of haphazardly arranged glands, partially arranged in an ill-defined nodule. Two subsequent follow-up prostate needle biopsies performed six and 12 months later both showed benign prostatic tissue with atrophic changes
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