Benign Prostatic Hyperplasia Nodules Research Articles

Morphological analogies of fetal prostate stroma and stromal nodules in BPH.

A "reawakening" of ontogenetic processes in the development of BPH is still in debate. Therefore, morphological analogies of fetal prostate stroma and nodular stromal proliferates in BPH were investigated. Fetal prostates (n = 30; weeks 12-40 of gestation) and stromal nodules of benign prostatic hyperplasia (n = 375 from autopsies, n = 100 from biopsies) were investigated by histo- and immunohistochemistry with special regard to cytoskeletal (alpha-actin, desmin, myosin, and vimentin), neuronal (S-100 protein), neuroendocrine (neuron-specific enolase), leukocytic (CD3, CD20, and CD68) and vascular (CD34, BMA-120, and factor VIII) antigens. The developing fetal prostate stroma consists of immature mesenchymal cells up to week 17 of gestation, followed by fibroblastic and fibromuscular stromal cells up to week 25 of gestation and predominantly smooth-muscular cells until the end of gestation. Stromal nodules occur as immature mesenchymal, fibroblastic, fibromuscular, and smooth-muscular, suggestive of a maturational process. The fetal prostate stroma and the stromal nodules present, with an increasing degree of maturation, a similar vascular pattern and a similar occurrence of CD3 (T-lymphocytes), CD20 (B-lymphocytes), CD68 (macrophages), S-100, and neuron-specific enolase-positive cells. The data suggest that ontogenetic processes are recapitulated in the development of stromal nodules in benign prostatic hyperplasia, supporting the idea of a "re-awakening" of fetal processes in BPH.

Relationship of neuroendocrine cells of prostate and serotonin to benign prostatic hyperplasia

Neuroendocrine (NE) cells containing neurosecretory granules, rich in various peptide hormones and biogenic amines such as serotonin (5-HT), are components of the human prostate epithelium. The NE cells probably subserve a paracrine or local regulatory role in both prostatic growth and differentiation as well as the exocrine secretory process. Neuroendocrine cells may be involved in the etiology of benign prostatic hyperplasia (BPH). In this study the number of NE cells in areas of BPH was compared with normal tissue using 5-HT immunocytochemistry. In addition, using high-performance liquid chromatography with electrochemical detection (HPLC-ECD), tissue levels of 5-HT and its metabolite 5-hydroxy-indoleacetic acid (5-HIAA) were analyzed in prostatic tissue extracts including 25 cases of BPH and 16 cases of normal tissue verified by adjacent histologic sections. Compared with normal prostate our results demonstrated a marked decrease in 5-HT immunoreactive NE cells in the vast majority of larger hyperplastic nodules of BPH. These findings were corroborated by quantitative analysis where a significant reduction in the tissue 5-HT levels in BPH (0.539 ± 0.09 SE) compared with normal (1.75 ± 0.22 SE) ( p < 0.05) was found. When smaller nodules of BPH were studied, abundant NE cells, equal or increased in number compared with those in adjacent normal prostatic tissue, were seen. The small apparently developing BPH nodules and ductal-like structures contained NE cells which may be growth foci near the periphery of some hyperplastic nodules. These findings particularly in small hyperplastic nodules suggest that NE cells and their products are involved in controlling cell proliferation through a paracrine hormonal mechanism and may be involved in the pathogenesis of BPH. Serotonin (5-HT) and NE peptides may represent that elusive local “missing link” often alluded to in various theories relating to the development of early nodular hyperplasia in BPH.

CT depiction of prostatic zonal anatomy.

The objective of this study was to investigate the frequency of recognition of prostatic zonal anatomy on CT. Computed tomography in 71 patients without known prostate disease was reviewed. Differential attenuation allowed for distinction of the peripheral zone and central gland of the prostate in 24% patients. The peripheral zone was of lower attenuation than the central gland, attributable to relatively increased water content in the peripheral zone. Patients in whom zonal anatomy was evident were significantly older and had prostate glands significantly larger than those in whom the prostate appeared as a homogeneous structure. All patients in whom prostatic zonal anatomy was visualized had received intravenous contrast material injection. Development of benign prostatic hyperplasia nodules within the central gland may contribute to relative increased attenuation or increased contrast enhancement within this region of the prostate gland.

Prostatic carcinoma and benign prostatic hyperplasia: correlation of high-resolution MR and histopathologic findings.

High-resolution magnetic resonance (MR) imaging of 24 fresh radical prostatectomy specimens was performed on an experimental 1.9-T system. Direct correlation between the findings in 7-micron-thick macrosections and their corresponding MR images was possible. Fourteen patients had macroscopic evidence of cancer. In all 14 cases, the carcinoma nodules appeared as areas of low signal intensity on images obtained with a repetition time of 2,500 msec and an echo time of 80 msec. Ten of 14 nodules had well-defined margins and consisted of densely packed glandular elements, which displaced the surrounding normal glandular material of higher signal intensity. Ten specimens displayed benign prostatic hyperplasia (BPH). The MR characteristics of this entity were quite variable but relatively predictable, depending on the distribution and size of the glandular elements, as well as the composition of the surrounding stroma. In BPH, the changes began in the central portion of the gland. The areas of highest signal intensity corresponded to dilated glandular elements (cystic ectasia), while the areas of lowest signal intensity corresponded to collagen (scar) and fibromuscular stroma. Nodules of mixed glandular BPH and fibromuscular BPH were found to have signal intensities similar to those of well-differentiated nodules of prostatic adenocarcinoma.

Stage A Versus Stage B Adenocarcinoma of the Prostate: Morphological Comparison and Biological Significance

Morphological features in radical prostatectomy specimens from 11 stage A and 73 stage B prostatic carcinomas were compared by mapping of tumor locations, and determinations of cancer volumes and histological patterns. Small stage A cancers were located anteromedially, while small stage B carcinomas were concentrated against the posterior capsule at the rectal surface. Small stage A carcinomas commonly invaded the anterior fibromuscular stroma and benign prostatic hyperplasia nodules, features that were uncommon even in large stage B tumors. Stage A cancers often appeared to arise within benign prostatic hyperplasia nodules and had a distinctive histological appearance. Even when large, stage A carcinomas tended not to spread close to the rectal surface of the gland. Stages A and B cancers spanned a roughly comparable volume range, and both showed progressive dedifferentiation with increasing volume. It is proposed that stages A and B cancers are biologically similar malignancies, distinguished only by their site of origin. Prognosis for patients with stage A carcinoma probably is closely related to tumor volume and dedifferentiation, features that are not reliably estimated in tissue samples removed at operation for benign prostatic hyperplasia.

Peptide-hormone- and serotonin-immunoreactive cells in normal and hyperplastic prostate glands

Peptide-hormone- and serotonin-immunoreactive cells of endocrine type are present both in the normal prostatic gland and in the nodules of benign prostatic hyperplasia of man. They are located in the epithelium of the acini and the ducts of all the different parts of the gland, as well as in the urothelium of the prostatic part of the mucosa of the urethra. The endocrine cells are usually argyrophil, sometimes even argentaffin, and immunoreactive with neuron-specific enolase; they can be either of open or of closed type and usually occur widely scattered as single cells. Three kinds of endocrine cells were observed both in the normal gland and in the hyperplastic parenchyma. In the by far most prevalent type serotonin was found to co-exist with a peptide immunohistochemically related to the thyroid stimulating hormone (TSH). In a more rare type serotonin co-existed immunohistochemically with calcitonin. The third kind of endocrine cells was somatostatin-immunoreactive cells; they were also rather rare. The only difference observed between the normal and hyperplastic parenchyma was an increase in the number of all the three kinds of endocrine cells in the hyperplastic nodules. The endocrine cells could easily be visualized by means of silver-staining techniques, even using conventionally formalin-fixed, paraffin-embedded specimens.