Nodular hyperplasia of the prostate gland

Nodular hyperplasia of the prostate gland, also benign prostatic hyperplasia (abbreviated BPH), is a common benign pathology of the prostate gland.

It is also known as prostatic nodular hyperplasia. Occasionally, it is referred to as benign prostatic hypertrophy; this is a misnomer. This pathology is not a hypertrophy.

General

Very common.
Incidence increases with age.

Clinical - mnemonic I WISH 2p:^[1]

Intermittency.
Weak stream.
Incomplete emptying.
Straining.
Hesitancy.
Post-void dribbling.
Prolonged voiding.

Treatment:

Medications.
Transurethral resection of the prostate (TURP).

Gross

Enlargement of the prostate.
Nodularity of the prostate.

Microscopic

Features:

Stromal and/or glandular hyperplasia.

Note:

Should not be diagnosed on core biopsy!

DDx:

Urothelial carcinoma - significant nuclear atypia.

Images

Prostatic nodular hyperplasia. (WC/Nephron)

Sign out

Urothelium present

PROSTATE TISSUE, TRANSURETHRAL RESECTION OF THE PROSTATE (TURP):
- BENIGN PROSTATIC TISSUE WITH GLANDULAR AND STROMAL PROLIFERATION.
- UROTHELIAL MUCOSA WITH A MILD LYMPHOCYTIC INFILTRATE.
- NEGATIVE FOR MALIGNANCY.

PROSTATE TISSUE, TRANSURETHRAL RESECTION OF THE PROSTATE (TURP) AND URINARY BLADDER NECK:
- BENIGN PROSTATIC TISSUE WITH GLANDULAR AND STROMAL PROLIFERATION.
- UROTHELIUM WITH THE CHANGES OF CYSTITIS CYSTICA ET GLANDULARIS.
- NEGATIVE FOR MALIGNANCY.

PROSTATE TISSUE, TRANSURETHRAL RESECTION OF THE PROSTATE (TURP) AND URINARY BLADDER NECK:
- BENIGN PROSTATIC TISSUE WITH GLANDULAR AND STROMAL PROLIFERATION, AND FOCAL 
  ACUTE AND CHRONIC INFLAMMATION.
- UROTHELIUM WITH THE CHANGES OF CYSTITIS CYSTICA ET GLANDULARIS.
- NEGATIVE FOR MALIGNANCY.

No urothelium present

PROSTATE GLAND, TRANSURETHRAL RESECTION OF THE PROSTATE (TURP):
- BENIGN PROSTATIC TISSUE WITH GLANDULAR AND STROMAL PROLIFERATION.

Post-TURP granuloma present

PROSTATE TISSUE, TRANSURETHRAL RESECTION OF THE PROSTATE (TURP):
- BENIGN PROSTATIC TISSUE WITH GLANDULAR AND STROMAL PROLIFERATION WITH 
PROMINENT BLOOD VESSELS AND SQUAMOUS METAPLASIA.
- PALISADING GRANULOMA WITH NECROTIC CORE, SEE COMMENT.
- UROTHELIAL MUCOSA WITH A MILD INFLAMMATORY INFILTRATE.
- NEGATIVE FOR MALIGNANCY.

COMMENT:
This is morphologically consistent with a post-TURP granuloma.

References

↑ Shiau, Carolyn; Toren, Andrew (2006). Toronto Notes 2006: Comprehensive Medical Reference (Review for MCCQE 1 and USMLE Step 2) (22nd edition (2006) ed.). Toronto Notes for Medical Students, Inc.. pp. U5. ISBN 978-0968592861.

[1] Shiau, Carolyn; Toren, Andrew (2006). Toronto Notes 2006: Comprehensive Medical Reference (Review for MCCQE 1 and USMLE Step 2) (22nd edition (2006) ed.). Toronto Notes for Medical Students, Inc.. pp. U5. ISBN 978-0968592861.

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