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Year : 2015 | Volume : 3 | Issue : 3 | Page : 237 - 237  


Letter to the Editor
Leiomyomatous differentiation of benign prostatic hyperplasia (BPH): A Rare entity
  1. Mahesh Kumar1, CH. Krishna Reddy2, V. Indira3

1 & 2Assistant Professor,  3 Professor & HOD, Department of Pathology, Malla Reddy Institute of Medical Sciences, Suraram, Hyderabad.

Corresponding Author:

Dr. K. Mahesh Kumar

Email: doctormaheshgoud@gmail.com

Sir,

In general, leiomyoma arising from the uterus is the most common benign tumor in the body and minute leiomyomatous nodules are found rather commonly in benign hyperplasia of the prostate. But true leiomyoma of the prostate is rare. According to the definition of  Kaufman and Berneike (1) , leiomyoma of the prostate means: a circumscribed or encapsulated mass of the smooth muscle, 1 cm or more in diameter, containing varying amounts of fibrous tissue but devoid of glandular elements and which is either obviously prostatic or juxta prostatic in origin and position.

 A 71 year old male patient came to the hospital with complaints of classical symptoms of increased frequency of urine, urgency and hesitancy in passing urine. Patient has these complaints since 16 years, but never presented to a clinician.Since few month the problem became severe and having recurrent fever which made him to consult a physician. On per rectal digital examination, prostate gland is grossly enlarged, enlargement is 15-20 times the normal size. Prostate specific antigen (PSA) raised and corresponding to the levels of benign hyperplasia of the prostate (BPH) but not to the prostate cancer. Ultrasound of the abdomen and pelvis also showed grossly enlarged prostate gland. Patient was posted for transurethral resection of prostate and the excised prostatic tissue was sent for histopathological examination (HPE). We received multiple fleshy gray white to pinkish soft tissue bits altogether measuring 15 x 13 x 11 cm, cut section showed homogenous fleshy appearance. Representative areas were taken and processed.

 

On microscopy, multiple sections studied showed tumor tissue arranged in interlacing bundles and fascicles. Individual cells are spindle shaped and oval with plump normochromatic nuclei and moderate eosinophilic cytoplasm.

 

 Leiomyomatous stromal nodules of the prostate are not infrequently found in benign nodular hyperplasia of the prostate and have been reported in 11.0-25.4% of surgically resected prostate cases (2, 3). Pure leiomyomas of the prostate are more unusual and 61 cases had been reported up to 1997(4). The features of pure leiomyomas include an absence of a glandular component and the presence of a capsule or pseudocapsule; these may or may not be accompanied by benign prostatic hyperplasia(4,5). Atypical or bizarre leiomyoma (ALM) of the prostate can occur; but it  is an extremely rare disease entity and contains multinucleated giant cells and pleomorphic cells with smudged nuclear details, probably representing degenerative changes. The largest case reported is that of  Neupert (6) in which the surgical specimen weighed 3.6 kg and in two other cases, resected tissues weighed over 500 gr. In our case, the entire mass which we received in pieces weighed around 800 grams.There are numerous theories regarding the pathogenesis of leiomyoma of the prostate. Infection and inflammation, chronic prostatitis, arteriosclerosis, embryonal an Iagen and Mullerian duct fibers are considered the cause or origin of leiomyoma of the prostate. We experienced a rare case of prostatic leiomyoma and could return him to the ordinary social life by operative procedures.

In conclusion, we suggest that leiomyomatous differentiation of the prostate is a benign entity; however one has to be accurate in accessing the pleomorphism of the cells , existence of the multinucleated giant cells and mitotic activity to label it as Atypical bizarre Leiomyomas( ALM ) of the prostate which is considered as a borderline malignant entity.

 

REFERENCES:

 

  1. Kaufman, J. J., and Berneike, R. Leiomyoma of the prostate. J. Urol. 65: 297, 1951
  2. Patch FS, Rhea LJ. Leiomyoma of the prostate gland. Br J Urol 1935;7: 213-28.
  3. Michaels MM, Brown HE, Favino CJ. Leiomyoma of the prostate. Urology 1974; 3: 617-20.
  4. Khalil KH, Rix GH, McBrien MP, Al-Rufaie HK. Bizarre leiomyoma of the prostate. Br J Urol 1997; 79: 660.
  5. Leonard A, Baert L, Van Praet F, Van de Voorde W, Van Poppel H, Lauweryns J. Solitary leiomyoma of the prostate. Br J Urol 1988; 62:184.
  6. Neupert: Prostamyom. Zentralbl. f. Chir. 58: 1071, 1931.




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