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prostatic post-atrophic hyperplasia

Thursday 30 August 2012

Definition : Post-atrophic hyperplasia is a variant of atrophy that consists of small basophilic-appearing acini arranged in clusters or lobules. The tight packing of acini, often around a central duct, gives it a hyperplastic appearance.

At low magnification, it may be mistaken for adenocarcinoma; however, it lacks the cytologic features of cancer such as prominent nucleoli.

Synopsis

- Clusters of atrophic prostatic acini with proliferative changes.
- At low magnification, it may be mistaken for adenocarcinoma; however, they lack cytologic features of cancer such as prominent nucleoli.
- The majority of the glands show a prominent basal cell layer with the immunostain for high molecular weight cytokeratin 34bE12.
- Crowding of acini, nuclear enlargement, and the presence of scant cytoplasm imparts a basophilic appearance to post-atrophic hyperplasia.

Differential diagnosis

The distinction of post-atrophic hyperplasia from adenocarcinoma usually does not pose a diagnostic challenge.

In rare cases with somewhat overlapping features, the immunostains for basal-cell specific markers can help.

The IHC shows staining of basal cells with high molecular weight cytokeratin in the entire focus. In adenocarcinoma, the basal cell layer would be completely absent.

In contrast, foci of adenocarcinoma typically show abundant pale pink or amphophilic cytoplasm.

In challenging cases, the immunostain for high molecular weight cytokeratin is invaluable (see next image).

References

- Post-atrophic hyperplasia: A histologic mimic of adenocarcinoma. Am J Surg Pathol 19(9): 1068-1076, 1995 .

Links

- WebPathology

See also

- prostatic glandular hyperplasia

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