|Year : 2019 | Volume
| Issue : 2 | Page : 135-138
Incidental findings in the prostate above 50 years in an autopsy study in a tertiary care center from North India
Ramesh Kumar1, Navjot Kaur2, Jagjit Singh Chahal3, Manjit Singh Bal4, Ramesh Kundal5
1 Department of Pathology, Civil Hospital, Faridkot, Punjab, India
2 Department of Pathology, Dr. YSPGMC, Nahan, Himachal Pradesh, India
3 Department of Biochemistry, IGMC, Shimla, Himachal Pradesh, India
4 Department of Pathology, MM Medical College and Hospital, Solan, Himachal Pradesh, India
5 Department of Pathology, Government Medical College, Patiala, Punjab, India
|Date of Web Publication||14-May-2019|
Dr. Navjot Kaur
Set No. A-2, Parasnath Apartments, Near Yashwant Chowk, Nahan, Sirmaur - 173 001, Himachal Pradesh
Source of Support: None, Conflict of Interest: None
BACKGROUND: Autopsy study of the prostate is one of the vital subjects since diseases of the prostate are common among adults with some clinically asymptomatic during life.
AIMS: The purpose of our study was to find out the histological patterns, their frequency, and age distribution of prostatic lesions in the South-Eastern part of Punjab by analyzing prostate biopsies in persons above 50 years in routine medicolegal autopsy specimens.
MATERIALS AND METHODS: The present study was conducted on prostate glands removed from autopsies in 100 men aged 50 years and above who died of causes other than clinically diagnosed prostate disease. After removal, the prostate glands were fixed in 10% formalin, weighed, sectioned, and processed. Paraffin-embedded sections were stained with hematoxylin and eosin and systematically examined.
RESULTS: Age of the subjects ranged from 51 to 83 years. The distribution of prostatic lesions showed 76% of cases having benign prostatic hyperplasia (BPH) including 28% of cases with concomitant chronic prostatitis, followed by acute prostatitis (4%), adenocarcinoma (7%), transitional cell carcinoma (2%), prostatic intra-epithelial neoplasia (2%), prostatic infarction (2%), leiomyoma (1%) and 6% of cases having normal prostatic histology respectively.
CONCLUSION: BPH emerged as the most common lesion with fibroglandular hyperplasia as the commonest variant. Amongst the malignant lesions, adenocarcinoma was the frequently detected type.
Keywords: Autopsy, benign prostatic hyperplasia, histopathology, prostatic carcinoma, prostatitis
|How to cite this article:|
Kumar R, Kaur N, Chahal JS, Bal MS, Kundal R. Incidental findings in the prostate above 50 years in an autopsy study in a tertiary care center from North India. Int J Health Allied Sci 2019;8:135-8
|How to cite this URL:|
Kumar R, Kaur N, Chahal JS, Bal MS, Kundal R. Incidental findings in the prostate above 50 years in an autopsy study in a tertiary care center from North India. Int J Health Allied Sci [serial online] 2019 [cited 2019 Nov 17];8:135-8. Available from: http://www.ijhas.in/text.asp?2019/8/2/135/258184
| Introduction|| |
A wide range of neoplastic and nonneoplastic diseases may be associated with the prostate gland. Whereas nonneoplastic prostatic diseases are clinically important because of the negative health and social impact they may have on the patient, cancer of the prostate is the major health challenge, particularly in middle-aged men. The most frequently encountered diseases affecting the prostate are prostatitis, benign prostatic hyperplasia (BPH), and prostatic cancer. BPH is an extremely common disorder in men over the age of 50 years. Histologic evidence of BPH can be seen in approximately 20% of men aged 40 years, a figure that increases to 70% by the age of 60 years and to 90% by the age of 80 years. Prostatic carcinoma is globally the second most frequently diagnosed cancer and the sixth leading cause of cancer death in males. Prostate cancer is responsible for 3% of all deaths in men over the age of 55 years. The incidence of prostatic cancer increases rapidly with age than any other cancer. Thus, the numbers of prostate cancer cases are expected to increase, as average age of men is increasing. In India, it constitutes about 5% of all male cancers. Thus, measures should be taken for its early detection and treatment promising an improvement of the survival rates. It is in the light of this that our study was undertaken to evaluate the spectrum of various prostatic lesions, their frequency, and age distribution in persons above 50 years in routine medicolegal autopsy specimens.
| Materials and Methods|| |
The present prospective study was conducted over a period of 2 years in the department of pathology in a tertiary care hospital in North India on 100 autopsies of men above 50 years of age who died of nonprostate-related illnesses. Most of the patients had died due to roadside accidents, railway accidents, poisoning, or certain unknown causes. The clinical data wherever available were recorded on the predesigned proforma. The prostates were removed during postmortem examination and immediately fixed in 10% formalin. After proper fixation, the prostate glands were measured, weighed, and grossly examined. Any gross abnormalities such as increase in size or weight and nodular, cystic, or necrotic changes were noted. Multiple pieces from different areas were taken and processed, after which the sections were stained with hematoxylin and eosin (H and E) stain and examined microscopically for prostate disease. Deeper sections were examined wherever necessary. The final diagnosis was recorded and analyzed. The age distribution was also noted. The literature was searched for comparative data.
Well-preserved specimens of the prostate removed on autopsy of men aged above 50 years were included in the study.
Autolyzed prostate specimens were excluded from the study.
| Results|| |
The present prospective study was based on the histological examination of 100 prostate specimens removed from the dead above 50 years of age. The age ranged from 51 to 83 years with most of them being in the sixth decade (73%), followed by 20% in the seventh decade and 6% in the eighth decade. The only patient in the ninth decade was an 83-year-old man. The frequency of various prostatic lesions and their age distribution are shown in [Table 1].
Out of 100 prostate samples, the lowest and highest in terms of weight were 25 and 102 g, respectively.
Out of the 100 prostates studied, BPH (both with and without inflammation) was the most common prostatic lesion [Figure 1] and accounted for 76% of all cases. Among these, 48 cases had BPH alone, whereas 28 cases had BPH along with chronic prostatitis. On studying the decade-wise distribution of various prostatic lesions, it was observed that the incidence of BPH as well as carcinoma was found to be the highest in the sixth decade. Considering BPH cases, the most common variant was fibroglandular hyperplasia (68 cases), followed by basal cell hyperplasia (4 cases), atrophy-associated hyperplasia (2 cases), and stromal hyperplasia (2 cases) [Table 2].
|Figure 1: Benign prostatic hyperplasia – (a) Gross specimen of the prostate gland in BPH showing multiple variable-sized greyish-white nodules and microcystic areas. (b) Photomicrograph of BPH – Hyperplasia of prostate gland acini and dilatation of prostate glands (H and E, ×100)|
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Other less common benign lesions encountered were acute prostatitis (4 cases), infarct prostate (2 cases), and leiomyoma (1 case). Six cases showed normal histology.
Two cases showed features of high-grade prostatic intraepithelial neoplasia (PIN).
There were nine cases of prostate cancer. Adenocarcinoma was the most common histological subtype seen in seven cases, out of which four cases were in the sixth decade, two cases in the eighth decade, and one case in the ninth decade [Figure 2]. Some of the sections showed mucinous areas, squamous metaplasia, and neural invasion apart from the commonly seen histopathological features of prostatic carcinoma. The other histological subtype encountered was transitional cell carcinoma (TCC) which was seen in two cases both lying in the seventh decade.
|Figure 2: Photomicrograph of adenocarcinoma prostate. (a) The infiltrative pattern of growth along with areas of mucinous fibroplasia (H and E, ×40). (b) Perineural invasion by malignant glands (H and E, ×400)|
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| Discussion|| |
Diseases of the prostate are common causes of morbidity in adult males and show wide geographical and ethnic variations in incidence and mortality worldwide. BPH is the most common urological problem of aging men, manifested as severe obstruction in urinary flow with discomfort and pain. BPH is a complex disease from the etiological and pathogenesis point of view. Benign enlargement of the prostate gland is reported to be most common in blacks, Caucasians, and Jews but less frequent in males from the Far East. Prostate cancer ranks as the second most frequently diagnosed cancer in men worldwide, accounting for approximately 240,000 deaths annually. Despite its global reach, striking variances in the pattern of incidence and mortality by region and race have been observed. In the United States, African American men are at the highest risk of developing prostate cancer with an annual incidence 178/100,000; however, with respect to Asian Americans, this rate drops to 88.3/100,000., Within this subgroup, the South Asian population (Indian, Pakistani, Nepalese, Bangladeshi, and Sri Lankan) represents the third largest Asian American population in the United States. Prostate cancer incidences in this population have been reported to range from 3.9 to 9.1/100,000.,,
Only three pathologic processes affect the prostate gland with sufficient frequency to merit discussion: inflammation, benign nodular enlargement, and tumors. Of these three, the benign nodular enlargements are by far the most common and occur so often in advanced age that they can almost be construed as a “normal” aging process. Prostatic carcinoma is also an extremely common lesion in men and therefore merits careful consideration.
In a study conducted by Zare-Mirzaie et al., 149 men aged above 50 years who had died of different reasons and undergone autopsy were examined. The age range was 50–91 years and the weight of the prostate samples ranged from 20 to 112.3 g which were in concordance with the present study, in which the age range was 51–83 years and the weight ranged from 25 to 102 g.
A prospective autopsy study was undertaken by Okani et al., in which prostate glands were obtained from 79 adult males and their ages ranged from 30 to 86 years. The most common lesions were nodular hyperplasia (81%), followed by adenocarcinoma (6.3%) which was similar to that seen in the present study, with 100 adult males having age range of 51–83 years and the most common lesions being BPH (76%), followed by adenocarcinoma (7%).
Mittal et al. conducted a study on 185 prostate specimens. The predominant lesion noted was BPH in 92.97% cases and carcinoma in 7.02% cases. In the present study, BPH and carcinoma (adenocarcinoma and TCC) were found in 76% and 9% cases, respectively. The study of Mittal et al. is comparable with our study in terms of different variants of BPH which were reported as fibroglandular hyperplasia in 103 (55.62%) cases, focal basal cell hyperplasia in 10 (5.40%) cases, and atrophy-associated hyperplasia in 7 (3.78%) cases in the former study as compared to 68%, 4%, and 2%, respectively, in our study.
Abid et al. conducted a study on 100 prostatic autopsy samples in men above 50 years of age. Age ranged from 50 to 80 years which was almost the same as our study (51–83 years). BPH was the common pathological finding (92%), out of which 48 cases were associated with chronic nonspecific prostatitis, six cases were associated with low-grade PIN, and two cases were associated with infarction. Prostatic adenocarcinoma was detected in 6% of the cases. The study was similar to the present one as majority of the cases in both studies were in the sixth decade, BPH was the most common finding, and the most common association with BPH was chronic nonspecific prostatitis.
| Conclusion|| |
The autopsy procedure is completely elective without medical benefit or risk to the deceased on whom the procedure is performed. However, it is the family, medical profession, other patients, and society as a whole that stand to benefit. The benefits of the procedure to the family include knowledge of inherited or communicable diseases, reassurance that treatment decisions were well founded, and emotional solace in advancing medical science for the benefit of others. The autopsy provides benefit to the medical profession by serving as a teaching tool and as a source for expanding our understanding of the disease. These, in turn, are beneficial to other patients and society.
In the present study, BPH emerged as the most common lesion and fibroglandular hyperplasia the most common variant of BPH. Among the malignant lesions, adenocarcinoma was the most frequently detected type.
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Conflicts of interest
There are no conflicts of interest.
| References|| |
Okani C, Akang E, Ogunbiyi O. Incidence of sub-clinical prostatic disease at autopsy in the University College Hospital, Ibadan. Open J Urol 2013;3:80-6.
Anunobi CC, Akinde OR, Elesha SO, Daramola AO, Tijani KH, Ojewola RW, et al.
Prostate diseases in Lagos, Nigeria: A histologic study with tPSA correlation. Niger Postgrad Med J 2011;18:98-104. [Full text]
Epstein JI. The lower urinary tract and male genital system. In: Robbins and Cotran Pathologic Basis of Disease. 8th
ed. Philadelphia: W.B Saunders; 2010. p. 993-1002.
Dabir PD, Ottosen P, Høyer S, Hamilton-Dutoit S. Comparative analysis of three- and two-antibody cocktails to AMACR and basal cell markers for the immunohistochemical diagnosis of prostate carcinoma. Diagn Pathol 2012;7:81.
Scardino PT, Weaver R, Hudson MA. Early detection of prostate cancer. Hum Pathol 1992;23:211-22.
Carter HB, Coffey DS. The prostate: An increasing medical problem. Prostate 1990;16:39-48.
Consolidated Report of Population Based Cancer Registries 2001-2004: Incidence and Distribution of Cancer. Bangalore (IND): Coordinating Unit, National Cancer Registry Programme, Indian Council of Medical Research; 2006.
Mohammed AZ, Alhassan SU, Edino ST, Ochicha O. Histopathological review of prostatic diseases in Kano, Nigeria. Niger Postgrad Med J 2003;10:1-5. [Full text]
Konwar R, Chattopadhyay N, Bid HK. Genetic polymorphism and pathogenesis of benign prostatic hyperplasia. BJU Int 2008;102:536-44.
Bid HK, Konwar R, Singh V. Benign prostatic hyperplasia: Is it a growing public health concern for India? Indian J Med Sci 2008;62:373-4.
] [Full text]
Ferlay J, Shin HR, Bray F, Forman D, Mathers C, Parkin DM, et al.
Estimates of worldwide burden of cancer in 2008: GLOBOCAN 2008. Int J Cancer 2010;127:2893-917.
Jemal A, Siegel R, Xu J, Ward E. Cancer statistics, 2010. CA Cancer J Clin 2010;60:277-300.
Jemal A, Bray F, Center MM, Ferlay J, Ward E, Forman D, et al.
Global cancer statistics. CA Cancer J Clin 2011;61:69-90.
Hebert JR, Ghumare SS, Gupta PC. Stage at diagnosis and relative differences in breast and prostate cancer incidence in India: Comparison with the United States. Asian Pac J Cancer Prev 2006;7:547-55.
Zare-Mirzaie A, Balvayeh P, Imamhadi MA, Lotfi M. The frequency of latent prostate carcinoma in autopsies of over 50 years old males, the Iranian experience. Med J Islam Repub Iran 2012;26:73-7.
Mittal BV, Amin MB, Kinare SG. Spectrum of histological lesions in 185 consecutive prostatic specimens. J Postgrad Med 1989;35:157-61.
] [Full text]
Abid AH, Mohammad EJ, Abdulrazaq AA. Histopathological findings of prostatic autopsy in a sample of over 50 years old men in Baghdad, Iraq. Int Surg J 2017;4:3606-10.
McPhee SJ. Maximizing the benefits of autopsy for clinicians and families. What needs to be done. Arch Pathol Lab Med 1996;120:743-8.
Landefeld CS, Chren MM, Myers A, Geller R, Robbins S, Goldman L, et al.
Diagnostic yield of the autopsy in a university hospital and a community hospital. N Engl J Med 1988;318:1249-54.
[Figure 1], [Figure 2]
[Table 1], [Table 2]