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CASE REPORT
Year : 2000  |  Volume : 17  |  Issue : 1  |  Page : 61-62
 

Basal cell hyperplasia of prostate - an entity a urologist must know


Department of Urology, Medical College, Kottayam, India

Correspondence Address:
Suresh Bhat
Deptartment of Urology, Medical College, Kottayam - 686 008
India
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Source of Support: None, Conflict of Interest: None


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   Abstract 

We report 2 cases of basal cell hyperplasia of prostate, which is an uncommon and elusive lesion. It is commonly associated with benign prostatic hyperplasia (BPH) and may sometimes be mistaken for malignancy. The know­ledge about this disease helps in the correct diagnosis and avoidance of unnecessary or overtreatment.


Keywords: Prostate; Prostate Diseases.


How to cite this article:
Bhat S, Thomas A, Nazar M, Joseph GC, Dharmaraj. Basal cell hyperplasia of prostate - an entity a urologist must know. Indian J Urol 2000;17:61-2

How to cite this URL:
Bhat S, Thomas A, Nazar M, Joseph GC, Dharmaraj. Basal cell hyperplasia of prostate - an entity a urologist must know. Indian J Urol [serial online] 2000 [cited 2019 Jul 23];17:61-2. Available from: http://www.indianjurol.com/text.asp?2000/17/1/61/41024



   Case 1 Top


A 25-year-old male presented with low back ache, su­prapubic pain and mild dysuria of about 1-year's dura­tion. His voiding was normal. Except for a similar episode about 3 years prior to this which was treated with a course of antibiotics, he had no significant past illness. Physicals were negative. Digital rectal examination showed a firm grade 1 enlargement of the prostate. Lab investigations were normal. Urine culture, urine AFB culture were nor­mal. X-ray KUB and ultrasonography of upper urinary tract were normal. Prostatic biopsy revealed basal cell hyperplasia [Figure 1]. Patient was treated with a course of an­tibiotics for 1 month. Followed up at 3 years, he remained asymptomatic.


   Case 2 Top


This 72-year-old man was referred following acute re­tention of urine. On digital rectal examination a firm nodu­lar prostate was felt. Serum PSA was within normal limits. He underwent TURP. Histopathological examination of the specimen showed benign prostatic hyperplasia with basal cell hyperplasia.


   Comments Top


The prostatic epithelium in the human is composed of 3 major cell types: epithelial cells, basal cells and neuroen­docrine cells. The basal cells are small and round with a scanty cytoplasm but with dark nuclei. They are less dif­ferentiated and almost devoid of secretory products. They are rich in keratin (types 4, 5, 6) and constitute less than 10% of epithelial cell numbers. They are situated in be­tween the secretory cells and rest on the basement mem­brane. The plasma membrane is rich in ATPase suggesting that these cells may be involved in active transport. They produce basemant membrane. Prostatic basal cells do not display myo-epithelial differentiation in contrast to basal cells in the breast, salivary glands, pancreas, etc. Its role in the production of the secretory cells is still controver­sial. [1] Basal cells are negative for prostate specific antigen (PSA) and prostatic acid phosphatase (PAP). Basal cell proliferation in the prostate gland exhibits a morphologic continuum ranging from focal basal cell hyperplasia (BCH) in the setting of nodular hyperplasia to florid adenoid ba­sal cell tumor (ABCT). These diverse proliferations have been referred to by many names including fetalisation of prostate, embryonal hyperplasia, basal cell tumour, basal cell adenoma, basaloid carcinoma, adenoid cystic carci­noma etc.

BCH of the prostate may present as one of 2 types: small nests of basal cells or larger cellular aggregates which mimic more aggressive tumors. [2] Typical BCH consists of a proliferation of basal cells 2 or more cell layers thick at the periphery of prostate glands and acini. Frequently the proliferation may be more than 2-cell-layers thick pro­truding into the acinar lumen. The hyperplastic cells are larger than the usual cells. They are surrounded by a few concentric layers of compressed stroma, often associated with chronic inflammation. The nests vary from solid to cystically dilated glands. Small foci of BCH often occur within hyperplastic acini but are rarely noticed unless florid. Large areas of BCH occur as closely packed nests and often suggest the possibility of carcinoma espe­cially, since basal cells commonly have recognizable nucleoli. This concern is enhanced when the lesion fails to react with PSA & PAP, atypical nuclei are present in its cells, or the margins of the hyperplastic nests are poorly demarcated in suboptimally preserved tissue. In contrast to most cases of transitional cell hyperplasia, BCH occurs in terminal ducts & acini of peripheral glands & its cells often exhibit a perpendicular orientation to the basement membrane. BCH frequently involves only part of the gland & occasionally protrudes into the lumen. In the largest series of BCH described by Cleary et al [3] all patients were above 60 years and had BPH in addition to BCH. 2 pa­tients had concomitant carcinoma prostate foci. One of our cases is of interest in that the patient was young and had no voiding problems. The prostate felt firm on DRE. BCH is most often seen as a secondary change in benign prostatic hyperplasia (BPH). In BPH, the BCH is seen at the margin of the nodule and infarcts. Other associated lesions include chronic inflammation, calcification, clear cell changes and squamous metaplasia. [4] All the cells in BCH display intense cytoplasmic immunoreactivity with keratin 34 beta E 12. [4] As acini of prostatic adenocarcinoma lack basal cells, this staining is useful in confirming the diagnosis of Ca prostate. Normal prostatic basal cells do not display immunoreactivity for PSA, PAP or S-100 Pro­tein. Young et al [5] and Jacobs et all have reported con­comitant BCH and carcinoma prostate.

The differential diagnosis of BCH includes transitional cell hyperplasia, squamous metaplasia, transitional cell carcinoma of the prostate, adenocarcinoma of prostate and, adenoid cystic carcinoma of prostate. [7]

 
   References Top

1.Partin AW, Coffey Ds. Benign prostatic hyperplasia. In: Walsh PC, Retik AB, Vaughan DA, Wein AJ (eds.). Campbell's Urology (7th ed.). Saunders 1998; 1381-1428.  Back to cited text no. 1    
2.Sesterhenn I, Mostofi FK, Davis CJ. Basal cell hyperplasia and Basal cell carcinoma. Lab Invest 1987; 56: 71A.  Back to cited text no. 2    
3.Cleary KR, Choi HY, Ayala AG. Basal cell hyperplasia of the pros­tate. Am J Clin Pathol 1983; 80: 850-854.  Back to cited text no. 3  [PUBMED]  
4.Devaraj LT, Bostwick DG. Atypical basal cell hyperplasia of the prostate. Am J Surg Pathol 1993; 17: 645-659.  Back to cited text no. 4  [PUBMED]  
5.Young RH, Frierson HF, Mills SE et al. Adenoid cystic-like tumour of the prostate gland: A report of two cases and review of the litera­ture on "Adenoid Cystic Carcinoma" of the prostate. Am J Clin Pathol 1988; 89: 49-56.  Back to cited text no. 5    
6.Jacobs DM, Weiss MA. Basal cells of prostate in fine-needle aspi­ration. Am J Clin Pathol 1987; 88: 503-506.  Back to cited text no. 6  [PUBMED]  
7.Golomb J, Lewin KJ. Basal cell hyperplasia of prostate: an elusive lesion? Urology 1992; 40: 245-248.  Back to cited text no. 7  [PUBMED]  


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