CASE OF THE WEEK
2019-44 / DECEMBER 23 (CONTRIBUTOR: ANKUR SANGOIÂ )
76 y/o M, presents with hematuria. On cystoscopy, bladder lesion found and biopsied.
Quiz
1. What is the correct diagnosis?
   a.  prostatic ductal adenocarcinoma
   b. papillary urothelial neoplasm
   c. prostatic-type polyp
   d. nephrogenic adenoma
   e. papillary/polypoid cystitis
1. c
1. Prostatic type polyp
Prostatic-type polyps have also been described in the literature as “ectopic prostatic tissue.” They consist of papillary/polypoid epithelial proliferations composed of prostatic-type secretory glandular cells (positive for prostatic markers) surrounded by basal cells. In addition, urothelial cells may be seen admixed within them giving the impression of a second cell population.
The typical clinical presentation for these lesions is hematuria. The age of presentation is wide. The most common site of occurrence is the prostatic urethra followed by the urinary bladder (usually the trigone, as in this case). Recognizing these lesions as benign is crucial, with prostatic ductal adenocarcinoma the most important misdiagnoses to avoid (lack 2-cell population; usually more cellular with complex architecture, prominent nucleoli, and atypia).
Remick DG Jr, Kumar NB. Benign polyps with prostatic-type epithelium of the urethra and the urinary bladder. A suggestion of histogenesis based on histologic and immunohistochemical studies.
Am J Surg Pathol. 1984 Nov;8(11):833-9.
Chan JK, Chow TC, Tsui MS. Prostatic-type polyps of the lower urinary tract: three histogenetic types?
Histopathology. 1987 Aug;11(8):789-801.
Ankur Sangoi
El Camino Hospital, Mountain View, CA
asangoi2@yahoo.com
Bladder
bladder, prostatic polyp, ectopic prostate