Older Male with Glandular Proliferation Within The Bladder

Specimen Type:

Bladder

History:

A 50-year-old man underwent ureteral and bladder biopsies. Cystoscopically, the lesions appeared as discrete small papillary growths. Representative cross-sections were submitted.

Pathologic Features:

Sections revealed small glands within the lamina propria of the bladder wall. The glands displayed a lobular arrangement, most of them had a narrow caliber, and a minority were dilated (Fig.5.1). A high-power view showed columnar cells with eosinoplhilic cytoplasm and bland cytologic features (Fig.5.2). Immunostain for prostatic acid phosphatase (PAP) was positive in those glands (Fig.5.3).

Differential Diagnosis:

  • Cystitis cystica
  • Ectopic prostatic tissue

Cystitis cystica: (Fig.5.4) HE 100X Cystitis cystica consists of Von Brunn’s nests in which the central cells have degenerated to form small cystic cavities. While somewhat less common than Von Brunn’s nests and cystitis glandularis, cystitis cystica is present in up to 60% of bladders. It is most common in adults but also occurs in children. At cystoscopy, its cystic nature is usually apparent. Grossly, the lesions appear as translucent, submucosal cysts that are pearly-white to yellow-brown. Most are less than 5 mm in diameter. But rare examples of a few centimeters in diameter have been reported. The cysts contain clear yellow fluid. Microscopically, the cysts are lined by urothelium or cuboidal epithelium and filled by eosinophilic fluid in which a few inflammatory cells often are present.

Ectopic prostatic tissue:Prostatic acinar epithelium may line the urothelial tract focally. This is seen mostly in adult males but occasionally occurs at younger ages. The most common site for such tissue is the urethra, where it often forms a polyp (prostatic-type polyp). Ectopic prostate may also be found on the wall of the urinary bladder and sometimes in the retrovesicle space, occasionally forming a sizable mass. Hematuria is the most common symptom. Cystoscopically, the lesions appear as discrete small papillary growths, which may be solitary or extensive, producing a velvetlike coating of the mucosa.

Diagnosis:

Ectopic prostatic tissue in both ureters and in the bladder.

Prostatic tissue may form an enigmatic tumor-like lesion when seen beyond the confines of the prostate gland. This process is most common in the prostatic urethra (prostatic urethral polyp) but has also been described at the bladder neck, bulbous, and penile urethra. Reported cases have occurred in men from 20 to 67 years old and hematuria has been the most consistent symptom. In the bladder, about ⅔ of the lesions arise in the trigone and the architecture varies from papillary to polypoid. The stroma contains prostatic glands and the surface is covered by columnar epithelium or urothelium. Rarely, ectopic prostatic tissue involves the seminal vesicle. The epididymis, testis, root of the penis, and even pericolic fat have also been documented to harbor prostatic tissue.

There are more reported cases of benign prostatic tissue in the urterine cervix than in most genitourinary sites in males. The most situation in which benign prostatic tissue is seen beyond the confines of the prostate gland is when it is part of a teratoma or dermoid cyst.

Cystoscopically, the lesions appear as discrete small papillary growths, which may be solitary or extensive. Prostatic acinar epithelium displays abundant clear or faintly eosinophilic apical cytoplasm and a small basally located round or oval nucleus without visible nucleolus. Occasionally, foci of residual urothelium are intermingled with the prostatic epithelium. Immunohistochemical stains for prostate-specific antigen (PSA) and prostatic acid phosphatase ( PAP) are positive.

References:

  1. McCluggage WG, Ganesan R, Hirschowitz L, et al. Ectopic prostatic tissue in the uterine cervix and vagina: report of a series with a detailed immunohistochemical analysis. Am J Surg Pathol. 2006 Feb;30(2):209-15.
  2. Bellezza G, Sidoni A, Cavaliere A. Ectopic prostatic tissue in the bladder. Int J Urol. 2005 Dec;12(12):1066-8.
  3. Dogra PN, Ansari MS, Khaitan A, et al. Ectopic prostate: an unusual bladder tumor. Int Urol Nephrol. 2002-2003;34(4):525-6.