1/35. Transperineal magnetic resonance image guided prostate biopsy.PURPOSE: We report the findings of a transperineal magnetic resonance image (MRI) guided biopsy of the prostate in a man with increasing prostate specific antigen who was not a candidate for a transrectal ultrasound guided biopsy. MATERIALS AND methods: Using an open configuration 0.5 Tesla MRI scanner and pelvic coil, a random sextant sample was obtained under real time MRI guidance from the peripheral zone of the prostate gland as well as a single core from each MRI defined lesion. The patient had previously undergone proctocolectomy for ulcerative colitis and, therefore, was not a candidate for transrectal ultrasound guided biopsy. Prior attempts to make the diagnosis of prostate cancer using a transurethral approach were unsuccessful. RESULTS: The random sextant samples contained benign prostatic hyperplasia, whereas Gleason grade 3 3 = 6 adenocarcinoma was confirmed in 15% and 25% of the 2 cores obtained from the MRI targeted specimens of 2 defined lesions. The procedure was well tolerated by the patient. CONCLUSIONS: Transperineal MRI guided biopsy is a new technique that may be useful in detecting prostate cancer in men with increasing prostate specific antigen who are not candidates for transrectal ultrasound guided biopsy.- - - - - - - - - - ranking = 1keywords = gland (Clic here for more details about this article) |
2/35. A seminal vesicle cyst complicated with a tumor like nodular mass of benign proliferating prostatic tissue: a case report with ultrastructural and immunohistochemical studies.We report a seminal vesicle cyst complicated with a tumor-like nodular mass of benign proliferating prostatic tissue. The patient was a 53-year-old Japanese man. A cyst of approximately 4.5 cm in diameter was discovered at the left seminal vesicle area. In the inner part of the cyst, a papillary nodular mass of 0.7 cm in diameter was seen. Under the clinical diagnosis of a seminal vesicle cyst with a tumorous mural nodule, the patient underwent resection of the seminal vesicle cyst to rule out the possibility that the nodular mass in the cyst was a neoplasm of an especially malignant nature. Microscopic examination of the excised specimen revealed a small dome-like nodular mass on the luminal surface of the cyst consisting of nodular proliferation of benign tubular gland tissue with various configurations. Conventional histologic, immunohistochemical, and ultrastructural analysis showed the proliferating cells in the nodular mass consisted of the benign prostate type. It is extremely important to differentiate between a benign proliferation and a malignant one, when the nodular mass is found in the seminal vesicle cyst.- - - - - - - - - - ranking = 1keywords = gland (Clic here for more details about this article) |
3/35. Paneth cell-like metaplasia of the prostate gland.We report two cases of Paneth cell-like metaplasia of the prostate gland, one in poorly differentiated carcinoma and the second in benign hyperplasia. By light microscopy, the Paneth-like cells were indistinguishable from paneth cells found in the normal small intestine and ultrastructurally showed electron-dense granules typical of paneth cells. Immunohistochemical stains were positive for prostate-specific antigen and prostatic acid phosphatase and negative for lysozyme and alpha 1-antitrypsin. The clinical significance of Paneth cell-like metaplasia is unknown and may represent an example of the multipotential metaplastic capability of actively dividing cells.- - - - - - - - - - ranking = 5keywords = gland (Clic here for more details about this article) |
4/35. "Alphabet soup" and the prostate: LUTS, BPH, BPE, and BOO.The patient described, though not typical, is one among many of those of the aging male population in whom their primary care physicians will increasingly diagnose diseases affecting the prostate gland. Primary care physicians then will offer first-line therapy not only for prostatic diseases but also for concurrent sexual and erectile dysfunction. This brief primer for primary care physicians "unscrambles" the alphabet in a "soup" of initialisms and acronyms for lower urinary tract symptoms, benign prostatic hyperplasia, benign prostatic enlargement, and bladder outlet obstruction.- - - - - - - - - - ranking = 1keywords = gland (Clic here for more details about this article) |
5/35. Basal cell proliferations of the prostate other than usual basal cell hyperplasia: a clinicopathologic study of 23 cases, including four carcinomas, with a proposed classification.Basaloid proliferations of the prostate with morphologic patterns other than usual basal cell hyperplasia are rare, and the distinction between benign and malignant lesions has been difficult. We describe 23 such lesions and classify them into two groups: adenoid cystic-like hyperplasia and adenoid cystic or basaloid carcinoma. Adenoid cystic-like hyperplasia (n = 19) was characterized by an older age at presentation (mean, 71.8 years), transition zone location with background of nodular hyperplasia, multifocality, lobulation, circumscription, and small acini with occasional hyalinization. A cribriform pattern limited to small- and medium-sized glands, squamous metaplasia, and hypercellular myxoid stroma were occasionally seen. Adenoid cystic carcinoma (n = 3) was characterized by a younger age at presentation (mean, 46.0 years), peripheral zone involvement, and large acini that were often dilated and exhibited extensive interanastomoses, prominent intraglandular hyalinization, perineural invasion, and extraprostatic extension. Basaloid carcinoma (n = 1) showed infiltration between normal glands, perineural invasion, and extraprostatic extension but lacked a cribriform architecture. The degree of cytologic atypia and mitotic rate overlapped between the hyperplasia and carcinoma cases. Both hyperplastic lesions and adenoid cystic carcinomas showed a basal cell phenotype with strong immunoreactivity to cytokeratins 14 and 34betaE12, but the basaloid carcinoma was negative for these markers. In all cases, the proliferating basal cells were nonreactive for myoepithelial and prostatic secretory cell markers. The 8 patients with adenoid cystic-like hyperplasia with available follow-up information had no progression of disease (mean follow-up period, 8.6 years). One patient with adenoid cystic carcinoma died with widespread metastases, but the 3 other patients with carcinomas had no disease progression (mean follow-up period, 7.0 years). In conclusion, most florid basaloid proliferations of the prostate fall into one of two categories. In the first, there is a clear association with nodular hyperplasia (adenoid cystic-like hyperplasia) and, although cytologic atypia and mitoses may be seen, they are present within a lesion that retains an orderly, vaguely nodular (noninfiltrative) pattern. The second group of cases (adenoid cystic and basaloid carcinoma) shows a widespread, haphazard infiltrative growth pattern. This study suggests that adenoid cystic carcinomas are biologically indolent following prostatectomy but have a low risk of distant metastasis.- - - - - - - - - - ranking = 3keywords = gland (Clic here for more details about this article) |
6/35. Giant multilocular cystadenoma of the prostate: a rare differential diagnosis of benign prostatic hyperplasia.We report a case of giant multilocular cystadenoma of the prostate in a 43-year-old man. This is a rare benign entity of the prostate imitating symptoms of benign prostatic hyperplasia and originates from the prostate with extensive spread into the pelvis. Histologically, prostatic glands and cysts lined by cuboid to columnar epithelial cells with basally located nuclei are characteristic. Immunohistochemical staining is positive for prostate-specific antigen in the epithelial cells. Giant multilocular prostatic cystadenoma should be taken into account in the differential diagnosis in any case of a large cystic mass originating from the prostate.- - - - - - - - - - ranking = 1keywords = gland (Clic here for more details about this article) |
7/35. Simultaneous tumour-like, atypical basal cell hyperplasia and acinar adenocarcinoma of the prostate: a comparative morphological and genetic approach.Basal cell tumours of the prostatic gland are rare, and the classification is difficult. In the present case report, a large, tumour-like proliferation of atypical basaloid cells was found incidentally in a prostatectomy specimen that otherwise contained a conventional acinar adenocarcinoma. The basaloid cells displayed a solid or adenoid-cystic growth pattern and strongly expressed high-molecular-weight cytokeratins and bcl-2. A high Ki-67 index was recorded within the atypical basaloid cells, by far exceeding the one counted in the conventional adenocarcinoma. However, there were no definite criteria for a malignant behaviour of the basal cell tumour. Comparative genomic hybridisation from microdissected tumour cells yielded losses at the short arms of chromosomes 8 and 12 in the conventional adenocarcinoma and a normal karyotype in the basal cell tumour. The pathological findings favoured the diagnosis of an atypical basal cell hyperplasia.- - - - - - - - - - ranking = 1keywords = gland (Clic here for more details about this article) |
8/35. Extraperitoneal laparoscopic prostatectomy (adenomectomy) for obstructing benign prostatic hyperplasia: transvesical and transcapsular (Millin) techniques.PURPOSE: We describe extraperitoneal laparoscopic resection of large prostatic adenomas (<100 g) as an alternative to open simple prostatectomy by both the transcapsular or Millin and the transvesical approaches. patients AND methods: We have performed more than 20 laparoscopic prostatectomies (adenomectomies) for benign prostatic hyperplasia (BPH) for glands >100 g. The initial two cases, with follow-up longer than 1 year, are included in this report. Using an extraperitoneal approach, enucleation of the obstructing prostatic lobes was performed with the aid of a Harmonic Scalpel and laparoscopic claw forceps. Hemostatic sutures were placed at 5 and 7 o'clock. The urethrovesical junction (transvesical) or capsulotomy (Millin) were closed in an interrupted fashion using intracorporeal sutures. RESULTS: Both procedures were successful. The total operative time was 180 minutes for first the case and 120 minutes for the second. The adenoma removed was approximately 138 g in the first case and 102 g in the second case. The estimated blood loss was <50 mL and <200 mL, respectively. The postoperative courses were unremarkable. Analgesic requirements were minimal, and the patient was discharged on postoperative day 2 and 3, respectively. A follow-up examination at 1, 3, 6, and 12 months showed that the flow rate is >20 mL and the postvoiding residual volume 0, with normal continence and sexual potency in both men. CONCLUSIONS: Extraperitoneal laparoscopic simple prostatectomy is a simple straightforward technique. Minimal bleeding, a reduced transfusion rate, shorter hospitalization, and faster recovery are additional advantages. This minimally invasive technique is a reasonable alternative to open simple prostatectomy for large glands with reduced morbidity.- - - - - - - - - - ranking = 2keywords = gland (Clic here for more details about this article) |
9/35. Autoimmune phenomena following prostatectomy.BACKGROUND: Benign prostatic hypertrophy is the most common benign tumor in males, resulting in prostatectomy in 20-30% of men who live to the age of 80. There are no data on the association of prostatectomy with autoimmune phenomena in the English-language medical literature. OBJECTIVES: To report our experience with three patients who developed autoimmune disease following prostatectomy. patients: Three patients presented awith autoimmune phenomenon soon after a prostectomy for BPH or prostatic carcinoma: one had clinically diagnosed temporal arteritis, one had leukocytoclastic vasculitis, and the third patient developed sensory Guillian-Barre syndrome following prostatectomy. CONCLUSIONS: In view of the temporal association between the removal of the prostate gland andthe autoimmune process, combined with previously known immunohistologic features of BPH, a cause-effect relationship probably exists.- - - - - - - - - - ranking = 1keywords = gland (Clic here for more details about this article) |
10/35. Laparoscopic simple prostatectomy.Classically, surgical options for very large prostate glands, not amenable to transurethral resection, include suprapubic or retropubic simple prostatectomy and holmium laser enucleation of the prostate (HoLEP). We present a case managed with a laparoscopic simple prostatectomy. Technical considerations are discussed as well as possible advantages of this approach including decreased blood loss, faster patient recovery and improved visualization.- - - - - - - - - - ranking = 1keywords = gland (Clic here for more details about this article) |
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