Published online Jun 26, 2022. doi: 10.12998/wjcc.v10.i18.6009
Peer-review started: November 2, 2021
First decision: April 7, 2022
Revised: April 19, 2022
Accepted: April 30, 2022
Article in press: April 30, 2022
Published online: June 26, 2022
Sclerosing adenopathy of the prostate is a focal proliferative lesion, and the same name is also proposed for the prostate lesion due to its similarity in appearance to sclerosing adenopathy of the breast. Due to the presence of dense small acini in the proliferative stroma, the morphology is similar to that of prostate adenocarcinoma, which brings great challenges to both imaging diagnosis and pathological diagnosis. In addition, a small proportion of sclerosing adenopathy of the prostate co-exists with adenocarcinoma, which makes the diagnosis of this lesion more difficult. So far, there is still a lack of a large number of clinical data sample libraries for clinical pathologists to study in-depth, and further exploration is needed in the future. Since we are aware of the importance of this lesion morphology, the clinical features, pathological morphology, and immunohistochemical phenotype of prostate sclerosing lesions were retrospectively analyzed in this study to further increase the importance of this lesion.
The objective is to investigate the clinicopathological features, diagnosis, and immunohistochemical phenotypes that distinguish prostate sclerosing adenopathy from other conditions.
This study explores the clinicopathological features, diagnosis, and immunohistochemical phenotypes that distinguish prostate sclerosing adenopathy from other conditions. We believe that our study makes a significant contribution to the literature because we show that this condition is benign, does not require treatment, and is not a precancerous condition of prostate cancer. However, notably, many of the cases encountered to date have had a short follow-up period, and this condition may often co-exist with other unrelated cancers in older men.
The clinical data, laboratory tests, pathological morphology, and immunohistochemical phenotypes of 12 cases of prostatic sclerosing adenopathy were retrospectively analyzed, and the relevant literature was reviewed.
The authors summarized the age, clinical symptoms, medical history, serum total prostate-specific antigen (PSA) value, surgical findings, surgical methods, follow-up time, and follow-up results of 12 patients with prostate sclerosing adenopathy in detail (Table 1). The results of the study showed that the patients were all elderly men, with an average age of 71.7 years. The patients had symptoms of hematuria, frequent urination, urgency, and dysuria to varying degrees. Different degrees of prostate hyperplasia was seen during digital rectal examination and surgery, and the bladder was the most common. Lateral lobe hyperplasia is predominant. The mean postoperative follow-up time was 27.6 mo, and only 1 patient died of bladder cancer. In addition, 11 of the 12 patients had PSA values within the normal reference range. From the above description, it is not difficult to find that the clinical features of sclerosing adenopathy of the prostate are similar to those of benign prostatic hyperplasia and prostate cancer, and most of the patients' PSA values are Within the normal range, suggesting that sclerosing adenopathy may be a benign lesion. Pathologically, the lesions are very complex, with single or mixed glandular tubular, cord-like and linear structures, and focal distribution in benign prostate glands. Unlike prostate adenocarcinoma, immunohistochemical Expression of the basal cell (such as P63, CK5/6) and myoepithelial (Calponin, S100, SMA) markers, provides a very meaningful value for the identification of the two. In practice, when it is difficult to identify prostate sclerosing adenopathy and prostate cancer, we can use immunohistochemical markers to distinguish them. In addition, we can also use immunohistochemical PSA, and PSAP to identify sclerosing adenopathy and other neoplastic lesions such as nephrogenic adenoma. The above pathological characteristics can provide effective help for the follow-up in-depth study of the prostate. However, even though we performed a comprehensive systematic analysis of sclerosing adenopathy of the prostate, this study has some limitations. First, although we predicted a certain relationship between sclerosing adenopathy of the prostate and PSA values, there is still a lack of direct evidence for the two relevance of the person. Secondly, the sample size of this study is too small, and it is necessary to further supplement the sample size and explore it in depth. Finally, whether sclerosing adenopathy is a precancerous lesion of prostate cancer also lacks direct evidence to further prove. These issues need to be further explored in future work.
Sclerosing adenopathy of the prostate is a morphological abnormality with characteristic histological features and immunohistochemical profiles. All the available evidence indicates that it is a benign condition that does not require treatment and is not a precancerous condition of prostate cancer. It is important to note, however, that many of the cases encountered to date have had a short follow-up period, and that it may often co-exist with other unrelated cancers in older men. The pathogenesis of this lesion is unclear, but its most striking feature seems to be the ability of cells to differentiate and proliferate. Studying and better understanding the features of sclerosing adenopathy should lead to its appropriate conservative management.
Patients should be informed that long-term follow-up and observation are required. If the PSA value increases significantly compared to the original value, and clinical symptoms such as frequent urination, urgency, dysuria, hematuria, and dysuria appear, patients should promptly see their doctor, since they may have prostate cancer.