Recurrent intraurethral proliferation of ectopic prostatic tissue associated with hematuria

Ectopic prostatic tissue: histogenesis and histopathological characteristics

AIMS

To evaluate the histological and immunohistochemical characteristics of ectopic prostatic tissue.

METHODS AND RESULTS

We studied 20 cases of ectopic prostate. In 85% (17/20) of the cases, the ectopic prostatic tissue was located in the bladder; in the remaining cases, it was located in the urethra. In 60% of the cases (12/20), no significant inflammatory or reactive/reparative changes were identified in the adjacent tissue. Immunohistochemical stains for prostate-specific antigen, prostate-specific acid phosphatase, and prostein were positive in the glandular epithelial cells of all cases. Stains for 34βE12 and p63 confirmed the presence of basal cells in all cases. There was no overexpression of α-methylacyl-CoA racemase in any of the cases. There was cytoplasmic luminal staining for CD10 and cytoplasmic staining for cytokeratin 18 in acinar cells in all cases. In cases in which followup data were available, no patient was found to have residual or recurrent ectopic prostatic tissue and none developed prostatic adenocarcinoma.

CONCLUSIONS

Ectopic prostatic tissue is occasionally encountered in the lower urinary tract, most commonly in the bladder and urethra of males. Ectopic prostatic tissue has histological and immunohistochemical characteristics that are indistinguishable from those of normal prostatic tissue, and most likely represents the persistence of embryonic structures.

Benign Diseases of the Bladder

Benign diseases of the bladder often present diagnostic challenges to practicing pathologists due to their diverse nature and ability to mimic a variety of epithelial or mesenchymal neoplasms. Categories of benign bladder disease include infectious cystitis, noninfectious cystitis, reactive proliferative processes, and benign processes that secondarily involve the bladder. An understanding of the key clinical and morphologic features of these lesions and the useful ancillary techniques specific for these entities is critical to the correct diagnosis of these lesions. This article reviews the key features of these benign bladder diseases and highlights methods to distinguish these lesions from other benign and malignant processes involving the bladder.

Capillary haemangioma of verumontanum: case report and review of the literature

A case of 24-year-old male patient with persisting microscopic haematuria is described. The endoscopic diagnosis revealed polyp lesion protruding from the origin of verumontanum. The histopathologic examination showed capillary haemangioma with fibroepitel component containing no prostatic glandular structure. The literature was reviewed, the histogenesis and nomenclature was discussed.

Ectopic prostatic tissue in the bladder

Ectopic prostatic tissue in the bladder has rarely been reported and usually involves the midline in the form of vestigial remains of embryonic prostatic elements. To our knowledge there are only 32 reports on this lesion in the literature in English. Prostatic heterotopia may be endoscopically confused with malignancy in the urinary system. We report three cases of ectopic prostatic tissue at the retrotrigonal area and left ureteral orifice. The patients presented with gross or microscopic hematuria and all the lesions had a polypoid appearance. The histopathologic and immunohistochemical examination revealed the prostatic nature of the tissue. No recurrences were evidenced. The authors review the literature concerning this lesion which should be recognized by urologists and pathologists, who must be aware of its benign nature.

[Ectopic prostatic tissue in the bladder]

We report the case of a 58-year-old man with ectopic prostatic tissue at the bladder trigone. The diagnosis was by chance during study and treatment of benign prostatic hyperplasia. The appearance was pseudocystic. It occupied completely the bladder trigone. On histology, the lesion was formed by prostatic type-glands, which were positive for the presence of prostatic specific antigen by using inmunoperoxidase technique. It was partially covered by normal urothelium. Ten months later, no trace of recurrence has been evidenced.

Ectopic prostatic tissue in the uterine cervix: a report of four cases and review of ectopic prostatic tissue

We report four examples of prostatic tissue occurring in the uterine cervix of patients aged 22, 25, 31, and 77 years. Three were incidental findings in loop excisions (two patients) and cone biopsy (one patient) of the cervix for high-grade squamous dysplasia. One presented as a cervical mass, clinically suspected to represent a fibroid. The prostatic tissue consisted of ducts and acini, some of which had papillary or cribriform patterns. Squamous metaplasia was prominent in all cases. No Wolffian duct tissue was present. The glandular epithelium in all cases was positive for prostatic acid phosphatase and prostate-specific antigen. High molecular weight keratin, performed in two cases, highlighted basal cells in a manner similar to the normal prostate. These unusual cases, only one of which is documented previously, further complicate the often-challenging area of interpretation of benign glandular lesions of the cervix. The unusual phenomenon of ectopic prostate tissue in general is reviewed.

Fibroepithelial polyp of the verumontanum. A case report and literature review

A case of fibroepithelial polyp of the verumontanum in a 20-year-old male is presented. The endoscopic examination revealed polypoid lesion protruding from the verumontanum, and transurethral resection of the tumour was performed. The histopathological diagnosis was fibroepithelial polyp, containing no prostatic glandular structures. As the nomenclature of the lesions is widely varying, we tried to classify polypoid or papillary lesions of the prostatic urethra by a literature review.

Painless hematuria and urethral discharge secondary to ectopic prostate

We report a case of ectopic prostatic tissue found in the penile urethra of a 16-year-old boy. A literature review and discussion of this rare entity are presented.

Ectopic prostate tissue at the bladder dome

A 71-year-old white man with asymptomatic microscopic hematuria had a sessile tumor at the dome of the bladder containing benign prostatic glandular tissue. Benign prostatic polyps occur commonly in the prostatic urethra and bladder neck as vestigial remains of embryonic prostatic elements. Ectopic prostatic tissue elsewhere is rare and has not been described previously arising at the bladder dome. The origin of prostate glands in this unlikely location is unclear. The clinical course of ectopic prostatic polyps at any location is benign, although local recurrence has been reported.

Benign villous polyp with prostatic type epithelium of the penile urethra

We report a case of a benign polyp of the penile urethra composed of prostatic type epithelial tissue. The etiology, pathology, diagnosis and treatment of these uncommon lesions are discussed.

Extra-urethral ectopic prostate

Extra-urethral ectopic prostatic tissue is a distinct entity which has been identified in the bladder of seven patients and may be more common than previously thought. Such tissue probably derives from the subtrigonal glands of Lowsley.

Prostatic-type polyps of the lower urinary tract: three histogenetic types?

Seventeen prostatic-type polyps of the lower urinary tract are reported. All occurred in males, and the mean ages of the patients with ureteric orifice, bladder and urethral polyps were 20.5, 60.2 and 36.6 years, respectively. The commonest presentation for the bladder and ureteric orifice polyps was haematuria, whereas that for the urethral polyps was either dysuria or haematuria. The polyps consisted of acini and papillae lined by prostatic-type epithelium, as confirmed by immunostaining for prostatic-specific antigen. Most had interspersed islands or complete covering of transitional epithelium on the surface. We believe that the histogenesis of prostatic-type polyps may differ in the different sites. For the ureteric orifice polyp, the early age of presentation and the simple occurrence of prostatic acini beneath an intact urothelium suggest a developmental abnormality. For the bladder polyp, the late onset of disease and the commonly observed transition with cystitis cystica-glandularis suggest that it may be a metaplastic variant of cystitis cystica-glandularis. On the other hand, the urethral polyp probably represents a hyperplastic lesion, since the prostatic urethra is normally lined partly by prostatic-type epithelium.

Papillary adenoma of the prostatic urethra

Six patients with papillary adenoma of the prostatic urethra are described. Their ages ranged from 39 to 70 years old. Two of them showed evidence of clinical recurrence 1 year after treatment. The pathological features as well as the immunohistochemical demonstration of prostate specific antigen (PSA) and prostatic acid phosphatase (PAP) are illustrated. A brief review of the literature is discussed with special emphasis on the histogenesis and nature of this lesion.

Benign prostatic epithelial polyp of the urethra

Acquired polyps of the male urethra often present with hematuria and sometimes hemospermia. The histogenesis of these tumors has been debated. We report a case of a prostatic urethral polyp that proved to be of prostatic epithelial differentiation, as demonstrated by immunohistochemical identification of prostatic acid phosphatase and prostatic specific antigen within the tumor cells.

Polyps and papillary lesions of the prostatic urethra

There is confusion over the type and nature of polypoid and papillary lesions of the prostatic urethra. These are uncommon growths which may present clinically with hematuria, frequency, obstruction or hematospermia. Pathologically, they usually occur in the region of the verumontanum and show papillary epithelial overgrowth. There is much variation in the terminology applied to such lesions, and many different theories of histogenesis have been advanced. Both benign and malignant lesions may occur. Two cases, one benign and one malignant, are described. The literature is reviewed and a rational nomenclature and histogenesis are proposed.

Polyps of the urethra in children

The authors present two cases of polyps of the urethra occurring exclusively in boys: one in a 12-month-old infant, the other in a 15-year-old boy. In both patients the polyp caused dysuria or urinary retention. Diagnosis was based on mictional cystography. This examination usually gives a picture of a filling defect spotted in the area of the bladder neck. During miction the defect may move deeper into the urethra. An endoscopic examination may be also helpful. The authors believe that treatment should consist in total excision of the polyp together with its base through the open urinary bladder. Polyps of the urethra have to be differentiated from a valve of the posterior urethra or a shadowless calculus. After total excision of the polyp prognosis is good.