|Year : 2004 | Volume
| Issue : 2 | Page : 167-168
Ectopic prostatic tissue presenting as a bladder mass
VD Trivedi, SA Salve, P Dangle, A Sawant, Gadgil, G Nelivegi
Department of Urology, Lokmanya Tilak Municipal Medical College and Hospital, Mumbai, India
V D Trivedi
Department of Urology, Lokmanya Tilak Municipal Medical College and Hospital Sion, Mumbai - 400 022
Source of Support: None, Conflict of Interest: None
Keywords: Benign prostatic hyperplasia, bladder neoplasm.
|How to cite this article:|
Trivedi V D, Salve S A, Dangle P, Sawant A, Gadgil, Nelivegi G. Ectopic prostatic tissue presenting as a bladder mass. Indian J Urol 2004;20:167-8
| Case Report|| |
A 58-year-old farmer presented with profuse hematuria of 3-days' duration. He gave no history of passage of clots or tissue bits, urinary tract infection or lower urinary tract symptom. The patient gave past history of transurethral resection (TUR) of the prostate being done for benign prostatic hyperplasia (BPH) 3 years ago. Examination of the patient was unremarkable with flat normal prostate on per rectal examination. All biochemical investigations including serum prostate specific antigen were within normal limits.
Ultrasonography showed 8 x 6 x 5 cm nodular mass arising from the posterolateral wall of the bladder. Upper tracts were normal. Computed tomography (CT) scan showed the mass to be enhancing and homogenous arising from the left lateral wall with no evidence of nodes [Figure - 1],[Figure - 2]. The patient was taken up for TUR of bladder tumor with a provisional diagnosis of carcinoma of the bladder. A large nodular mass arising from the left lateral wall of the bladder was noted. The prostate showed minimal lateral lobe enlargement and a TUR biopsy of the mass was taken. The biopsy report revealed BPH with no evidence of any malignancy. Following the report, rest of the mass was resected transurethrally; with uneventful postoperative recovery.
| Comments|| |
Ectopic prostatic tissue is very rarely reported. The most common sites found are in the posterior urethra (100 cases), near the verumontanum (12), bulbous urethra (7), bladder (13), posterior to bladder (3) and penile urethra (3). 
In the bladder, ectopic prostatic tissue can be found in 2 sites: Sub-cervical glands in the submucosal layer (described by Albarran) and a deeper group of glands separated from the submucosal layer by the muscular layer (described by Low sely).  Gutierrez and Nesbit  proposed 3 possible etiologies for the existence of ectopic tissue.
- They could represent structures arising during embryonic development and normally undergoing regression but are stimulated to grow later in life.
- Misplaced nests of prostatic tissue.
- Metaplasia of transitional epithelium to glandular epithelium occurring as a response to chronic inflammation.
Histologically, the glands in ectopic prostatic tissue are distinguished from the normal prostatic tissue by the lack of definitively arranged surrounding connective tissue stroma or muscle fibers but the glands stain positive for acid phosphatase.  However, in contrast to the reports in literature, the histopathology of the mass revealed BPH in this case.
This patient presented with hematuria and bladder mass. The presenting symptom of ectopic prostatic tissue almost always is gross painless hematuria, dysuria, frequency and hemospermia.  Although an extremely rare possibility, ectopic prostatic tissue can present with painful hematuria. Diagnosis of this condition is possible after histopathological reports are available. Treatment of this lesion is resection and recurrence is rare.
| References|| |
|1.||Congleton I, Thomason WB. Painless hematuria and urethral discharge secondary to ectopic prostate. J Urol 1989; 142: 1554-5. |
|2.||Gutierrez J, Nesbit RM. Ectopic prostatic tissue in bladder. J Urol 1967; 98: 474-8. [PUBMED] |
[Figure - 1], [Figure - 2]