53 Year Old Man with Elevated PSA Underwent Needle Biopsy of the Prostate

Junqi Qian, M.D.

Specimen Type:

Needle Biopsy of the Prostate

History:

53 year old man with serum PSA of 5.6 and lower urinary track obstruction underwent 12 core TRUS needle biopsy of the prostate. This patient also has HIV infection and is on antiretroviral medication.

Pathologic Features:

The specimen consists of open, slit-like, often anastomosing channels devoid of erythrocytes (Fig. 1, 2) and lined by discontinuous, often attenuated cells without atypia or mitotic activity set (Fig. 3, 4) in a hyalinized collagenous stroma (Fig. 5, 6); these are classic findings, and the appearance is identical at all sites. Immunohistochemically, the cells lining the sinusoidal spaces are positive for pan-cytokeratin (Fig. 7), CD34 (Fig. 8), PR (Fig. 9), SMA (Fig. 10), desmin (Fig. 11) and vimentin (Fig.12), but negative for PSA, Factor 8, CD31, HHV-8, D240, synaptophysin, and chromogranin.

Differential Diagnosis:

  • Angioma
  • Angiosarcoma
  • Melanoma in-situ or regressed melanocytic lesion
  • Leiomyoma variant
  • Pseudoangiomatous stromal hyperplasia

Diagnosis:

Pseudoangiomatous stromal hyperplasia

Comment:

Pseudoangiomatous stromal hyperplasia case in the prostate has not been previously reported in the literature.  Histologically, this lesion resembles the pseudoangiomatous stromal hyperplasia in the breast and has the features described above. The differential diagnosis includes angioma, angiosarcoma, Kaposi's sarcoma, and leiomyoma variant. Positive staining of CD34 in pseudovascular spaces and negative staining for CD31 and factor VIII effectively exclude a typical vascular neoplasm. Negative HHV8 staining rules out Kaposi sarcoma. The positive staining for SMA and desmin support the smooth muscle phenotype. Further imaging study of the prostate on size of the lesion and its relationship with the surrounding prostate may be useful.

References:

1)       AbdullGaffar B. Pseudoangiomatous stromal hyperplasia of the breast. Arch Pathol Lab Med. 2009 Aug;133(8):1335-8.

2)       Ferreira M, Albarracin CT, Resetkova E. Pseudoangiomatous stromal hyperplasia tumor: a clinical, radiologic and pathologic study of 26 cases. Mod Pathol. 2008 Feb;21(2):201-7.