Prostatic Stromal Hyperplasia With Atypia Follow up Study of 18 Cases

Document Sample
Prostatic Stromal Hyperplasia With Atypia Follow up Study of 18 Cases Powered By Docstoc
					                  Prostatic Stromal Hyperplasia With Atypia
                                               Follow-up Study of 18 Cases
                 Deloar Hossain, MD, FRCPC; Isabelle Meiers, MD; Junqi Qian, MD; Gregory T. MacLennan, MD;
                                                David G. Bostwick, MD, MBA

● Context.—Prostatic stromal hyperplasia with atypia is a                erate chronic inflammation. Stromal cells displayed intense
rare lesion that can be mistaken for sarcoma because of                  immunoreactivity for androgen receptors and vimentin,
the presence of atypical, bizarre, degenerative myocyte nu-              but moderate reactivity for desmin and actin. There were
clei.                                                                    3 local recurrences, with a mean follow-up of 6.3 years
   Objective.—To determine the diagnostic criteria and                   (range, 0.5–14 years), but none developed evidence of sar-
clinical significance of prostatic stromal hyperplasia with               comatous transformation or malignancy.
atypia.                                                                     Conclusions.—Prostatic stromal hyperplasia with atypia
   Design.—Eighteen cases of prostatic stromal hyperplasia               is a rare, benign lesion, composed of degenerative myo-
with atypia were reviewed from the consultation file of one
                                                                         cytes with atypia that is histologically and clinically remi-
of the authors (D.G.B.).
   Results.—Prostatic stromal hyperplasia with atypia con-               niscent of benign counterparts in the myometrium, breast,
sists of 1 or more ill-defined, uncircumscribed, hyperplas-               vulva, vagina, and elsewhere. Recognition of this distinc-
tic stromal nodules, with variable numbers of atypical, bi-              tive entity should allow separation from phyllodes tumor
zarre giant cells, with vacuolated nuclei, smudged chro-                 and sarcoma of the prostate. The phrase stromal tumor of
matin, and frequent multinucleation infiltrating around be-               uncertain malignant potential is inappropriate for this be-
nign acini. There was a hypocellular, loose, myxoid stromal              nign tumor, and its use is discouraged.
matrix, with ectatic hyalinized vessels and mild to mod-                    (Arch Pathol Lab Med. 2008;132:1729–1733)


P   rostatic stromal hyperplasia with atypia (PSHA) is a
     rare lesion that can be mistaken for sarcoma because
of the presence of bizarre, degenerative myocyte nuclei.1–10
                                                                         study.11 The current report expands our initial series to 18
                                                                         cases and includes longer mean follow-up (6.3 years). Our
                                                                         findings underscore the apparent benign nature of PSHA.
The nuclear abnormalities are identical to those of sym-
plastic leiomyoma of the myometrium, raising concern
about sarcoma, particularly in limited samples, such as                                  MATERIALS AND METHODS
needle biopsies. The diagnostic criteria and clinical sig-
nificance of this lesion are not well established, and fea-                  We identified 18 cases of PSHA seen in consultation between
tures that separate this lesion from sarcoma are not fully               1981 and 2006 by one of the authors (D.G.B.). All hematoxylin-
defined.                                                                  eosin–stained sections were available in each case, as was a to-
   Previously, we reported6 11 cases of this unusual, soft               luidine blue–stained slide from 2 cases. Clinical information and
tissue lesion of the prostate, with a mean follow-up of 2.9              follow-up were obtained from the medical records and referring
years. That study included 7 other cases of prostatic leio-              physicians in all cases.
myoma with atypia (reported initially as stromal hyper-                     Immunohistochemical stains were performed in 10 cases. Four-
                                                                         micrometer sections were prepared from formalin-fixed, paraffin-
plasia with atypia, leiomyoma-like pattern) that are ex-
                                                                         embedded tissue samples. Immunohistochemical staining was
cluded from the present study; those cases and other re-                 perf
				
DOCUMENT INFO
Description: CONTEXT: Prostatic stromal hyperplasia with atypia is a rare lesion that can be mistaken for sarcoma because of the presence of atypical, bizarre, degenerative myocyte nuclei. OBJECTIVE: To determine the diagnostic criteria and clinical significance of prostatic stromal hyperplasia with atypia. DESIGN: Eighteen cases of prostatic stromal hyperplasia with atypia were reviewed from the consultation file of one of the authors (D.G.B.). RESULTS: Prostatic stromal hyperplasia with atypia consists of 1 or more ill-defined, uncircumscribed, hyperplastic stromal nodules, with variable numbers of atypical, bizarre giant cells, with vacuolated nuclei, smudged chromatin, and frequent multinucleation infiltrating around benign acini. There was a hypocellular, loose, myxoid stromal matrix, with ectatic hyalinized vessels and mild to moderate chronic inflammation. Stromal cells displayed intense immunoreactivity for androgen receptors and vimentin, but moderate reactivity for desmin and actin. There were 3 local recurrences, with a mean follow-up of 6.3 years (range, 0.5-14 years), but none developed evidence of sarcomatous transformation or malignancy. CONCLUSIONS: Prostatic stromal hyperplasia with atypia is a rare, benign lesion, composed of degenerative myocytes with atypia that is histologically and clinically reminiscent of benign counterparts in the myometrium, breast, vulva, vagina, and elsewhere. Recognition of this distinctive entity should allow separation from phyllodes tumor and sarcoma of the prostate. The phrase stromal tumor of uncertain malignant potential is inappropriate for this benign tumor, and its use is discouraged.
BUY THIS DOCUMENT NOW PRICE: $6.95 100% MONEY BACK GUARANTEED
PARTNER ProQuest LLC
ProQuest creates specialized information resources and technologies that propel successful research, discovery, and lifelong learning.