Mills Ch35 Prostate

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CHAPTER 35:  Prostate

The same problems are seen in needle biopsies, where the artifact is presumably due to compression rather than heat. The presence of artifact is usually limited to loss of nuclear detail and is more subtle because areas of severe tissue distortion are not often represented. The regions of the prostate sampled by TUR and by needle biopsy are also quite different. Most needle biopsies represent posterior peripheral zone tissue. Unless a spe- cial effort is made, as in a transition zone–directed needle biopsy (49), the needle seldom reaches the more anterior portions of the gland. In a majority of the cases, TUR specimens consist of tran- sition zone tissue, urethral and periurethral tissues, bladder neck fragments, and anterior fibromuscular stroma (44) with variable amounts of peripheral zone tissue. On rare occasions, central zone fragments may be sampled and show the dis- tinctive architectural and cytologic features described above. They may be accompanied by fragments of ejaculatory duct/ seminal vesicle and the tiny tubular outgrowths from the walls of these structures may be misinterpreted as adenocarcinoma when seen in tangential sections that do not reveal the main lumen (Fig. 35.38). This impression of carcinoma may be fur- ther encouraged by the frequent presence of enlarged dark nuclei with bizarre contours in the seminal vesicle and ejacu- latory duct epithelium (Fig. 35.39). The presence of golden brown cytoplasmic granules, which may be few and incon- spicuous, may help to establish the benign diagnosis. ACKNOWLEDGMENT The content of this chapter builds upon the prodigious work of the late Dr. John E. McNeal, who in a series of manuscripts and mono- graphs from the 1970s through the early 1990s, defined the modern FIGURE 35.38  Benign tubular invaginations from the wall of the ejacu- latory duct showing architectural (small crowded acini) and cytologic (focal prominent nucleoli) features that suggest carcinoma. Focal yellow- brown cytoplasmic pigment, as seen in the upper right–hand portion of the figure, is characteristic of this epithelium.

FIGURE 35.39  Benign ejaculatory duct/seminal vesicle–type epithelium demonstrating bizarre enlarged hyperchromatic nuclei.

approach to prostatic anatomy. Although this current iteration has been reorganized to focus on anatomic structures as they relate to the evaluation of prostate cancer in routine prostatectomy speci- mens today, it is based on Dr. McNeal’s principles and the previous editions that he authored. REFERENCES 1. McNeal JE. Developmental and comparative anatomy of the prostate. In: Grayhack J, Wilson J, Scherbenske M, eds. Benign Prostatic Hyperplasia. DHEW Publication No. (NIH) 76–1113 . Washington, DC: Department of Health, Education and Welfare; 1975:1–10. 2. Cunha GR, Donjacour AA. Mesenchymal–epithelial interac- tions in the growth development of the prostate. In: Lepor H, Ratliff TL, eds. Urologic Oncology . Boston: Kluwer Academic; 1989:159–175. 3. McNeal JE, Stamey TA, Hodge KK. The prostate gland: Morphology, pathology, ultrasound anatomy. Monogr Urol 1988;9:36–54. 4. McNeal JE. Anatomy of the prostate and morphogenesis of BPH. Prog Clin Biol Res 1984;145:27–53. 5. McNeal JE. The prostate and prostatic urethra: A morpho- logic synthesis. J Urol 1972;107:1008–1016. 6. McNeal JE. Regional morphology and pathology of the prostate. Am J Clin Pathol 1968;49:347–357. 7. McNeal JE. Origin and evolution of benign prostatic enlarge- ment. Invest Urol 1978;15:340–345. 8. Samaratunga H, Montironi R, True L, et al; ISUP Prostate Cancer Group. International Society of Urological Pathology (ISUP) Consensus Conference on Handling and Staging of Radical Prostatectomy Specimens. Working group 1: Specimen handling. Mod Pathol 2011;24:6–15. 9. Berney D, Wheeler TM, Grignon DJ, et al; ISUP Prostate Cancer Group. International Society of Urological Pathology (ISUP) Consensus Conference on Handling and Staging of Radical Prostatectomy Specimens. Working group 4: Seminal vesicles and lymph nodes. Mod Pathol 2011;24:39–47.