Prostate-type gland in the epididymis

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.

Giant solitary tumor in the true pelvis: atypical prostatic adenomyomatosis

We report about a 32-year-old patient presenting with a large pelvic mass. Sonographic and radiological findings were inconclusive. Open tumorectomy of the mass weighing 500 g was performed. Intraoperative fresh-frozen sections revealed no clear signs of malignancy. Decisive histology and immunohistochemistry led to the diagnosis of benign ectopic prostatic adenomyomatosis. The histology and possible etiologies of this rare finding are discussed.

Basaloid carcinoma of epididymis

A case of basaloid carcinoma of the right epididymis in a 22-year-old Saudi man is described. The tumor presented as a painless swelling of 2 months' duration. Right inguinal orchiectomy has been performed. Microscopically, the stroma was widely infiltrated by tumor cells, with marked apoptosis and necrosis. The tumor cells were rather uniform and basaloid and contained many abnormal mitoses. The tumor was positive for keratin and contained tight intercellular junctions by ultrastructural examination. The patient was tumor free at last follow-up.

Ectopic prostate tissue within the processus vaginalis: insights into prostate embryogenesis

We report an 11-year-old boy who presented with a scrotal mass superior to the epididymis in the processus vaginalis. The mass consisted of prostate tissue, including glands and fibromuscular stroma, communicating with a spermatocele. Strong immunostaining for prostate-specific antigen was seen in the glandular epithelium. Immunostaining for peanut agglutinin highlighted the luminal plasma membrane in a subset of epithelial cells, mainly those located around the periphery of the nodule. To the best of our knowledge, this represents the first report of a pediatric patient with ectopic prostate tissue located outside the urinary tract and the first instance altogether of ectopic prostate noted at this location. The young age of the patient, the lesion's constituents, and its location suggest that the finding represents a disorder of development.

Prostate Gland–like Epithelium in the Epididymis: A Case Report and Review of the Literature

Aberrant prostatic tissue occurs commonly in the adult male urethra and bladder. Ectopic prostatic tissue occurring outside the urinary system is rare. One case with scattered prostate-type glands in epididymis has been reported in the literature. We report a related case, in which the presence of prostate gland–like epithelium was recognized in epididymal glands in routine histology and was confirmed by subsequent immunohistochemical analysis using prostate-specific antigen. We then examined 23 additional orchiectomy specimens for the presence of prostate-like epithelium. The possibility of this being true ectopia versus an unusual metaplastic change is discussed.

Prostatic tissue in mature cystic teratomas of the ovary: a report of four cases, including one with features of prostatic adenocarcinoma, and cytogenetic studies

Four cases of mature cystic teratoma that contained prostatic tissue are reported. The ovarian tumors occurred in patients from 17 to 38 (mean 31) years of age and had no unusual clinical or gross aspects. The microscopic findings for the most part were typical of a mature cystic teratoma, but they also contained foci of prostatic tissue that ranged from 0.2 to 1.9 cm in greatest dimension. In these areas there was a lobular arrangement of medium-sized acini lined by cuboidal to columnar cells with pale cytoplasm and round nuclei with inconspicuous nucleoli except focally in one case as noted below. Basal cells were seen focally. The prostatic acini lay in a paucicellular fibromuscular stroma. In two cases thick layers of disorganized smooth muscle covered by transitional-like pseudostratified epithelium, resulting in an appearance resembling fetal bladder wall, were present next to the prostatic glands. One tumor also contained prostatic-type acini, which haphazardly infiltrated the stroma over an area approximately 5 mm in maximal dimension. The acini, a few of which contained intraluminal flocculent eosinophilic material, were lined by cells with eosinophilic to amphophilic focally granular cytoplasm and had nuclei that were enlarged compared with the benign-appearing, prostatic-type acini in the four cases and had focally prominent nucleoli. Basal cells were not identified in these infiltrating glands. Grading this focus according to the approach in the prostate, the morphology was that of a Gleason grade 3 of 5 adenocarcinoma. Immunohistochemical stains of the putative prostatic epithelial cells confirmed their nature by showing immunoreactivity for prostatic-specific antigen in the lining epithelial cells in all four cases and for prostatic-specific acid phosphatase in the one case tested. The high molecular cytokeratin stain, 34betaE12, highlighted basal cells to a variable extent in the three cases containing only benign prostatic tissue. Material was not available to immunostain for basal cells in the case with carcinoma. Cytogenetic studies were performed in two cases and showed that the great majority of the nuclei of the nonprostatic and prostatic tissue had an XX karyotype but from 3% to 5% of the nuclei displayed trisomy for the X chromosome. A small number of cases of prostatic tissue in ovarian teratomas have previously been documented but none had morphologic features of carcinoma.

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.

Ectopic prostatic tissue outside the urinary tract: a case report

A 64-year-old man with a 4-month history of dysuria and urinary frequency had a mass behind the bladder. The preoperative diagnosis was a tumor of the left seminal vesicle, but a histologic examination revealed benign prostatic tissue. This is the seventh reported case of ectopic prostatic tissue situated outside the urinary tract.

Early detection of recurrent prostate cancer with an ultrasensitive chemiluminescent prostate-specific antigen assay

OBJECTIVES

Treatment failure after radical prostatectomy is most commonly heralded by an increase in serum prostate-specific antigen (PSA) to detectable levels. We evaluated the clinical utility of an ultrasensitive chemiluminescent PSA assay.

METHODS

We evaluated the assay in banked sera obtained from 170 men after radical prostatectomy. Controls consisted of 142 females, 29 men who had undergone cystoprostatectomy without evidence of prostate cancer, and 25 men without evidence of recurrent disease at least 5 years after prostatectomy for organ-confined disease. Lead time to diagnosis of recurrence was based on comparisons with the IMx or Tandem E assays using a cutoff of 0.1 ng/mL (100 pg/mL).

RESULTS

The biologic level of detection of this assay is 8 pg/mL. Serum PSA levels were undetectable in 82.4% of females, 86.2% of the cystoprostatectomy patients, and 96% of the radical prostatectomy controls. After radical prostatectomy, PSA levels were undetectable at last check in 104 of 168 (61.9%) men. In the 24 men with prostate cancer recurrence, the enhanced sensitivity of 8 pg/mL provided a mean lead time based on conservative calculations of 12.7 to 22.5 months over conventional assays. Thirty-four of the 41 men with detectable PSA levels and no evidence of disease recurrence had PSA levels of 30 pg/mL or less.

CONCLUSIONS

PSA levels are undetectable in most men who do not have recurrence of disease after radical prostatectomy. Low but detectable serum PSA levels less than or equal to 30 pg/mL can be produced by nonmalignant sources of PSA. PSA assays with enhanced sensitivity can detect recurrent prostate cancer with significant lead time over conventional assays.