Hyperplasia of Mesonephric Remnants
Gladell P. Paner, MD
Mahesha Vankalakunti, MD
Key Facts
Terminology
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Tubular or acinar proliferation of putative mesonephric duct remnants containing characteristic intraluminal colloid-like material
Etiology/Pathogenesis
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During embryogenesis, mesonephric or wolffian duct gives rise to rete testis, epididymis, vas deferens, and seminal vesicles
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Mesonephric remnants may undergo proliferation
Clinical Issues
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Very rare, seen in 0.6% of TURP specimens
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Mean: 67 years old, range: 50-85 years
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Incidental histologic finding
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Typically in prostatic base but can extend into bladder neck and periprostatic soft tissues
Microscopic Pathology
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Lobular or infiltrative growth of tubules that often contains dense eosinophilic colloid-like material
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Lined by single layer of bland cuboidal cells with scant cytoplasm imparting “atrophic” appearance
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Nuclei are regular, round, and typically with inconspicuous nucleolus but can also be prominent
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Hyperplasia may be florid; tubules may appear to infiltrate between bladder neck muscle bundles and into periprostatic connective tissues
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Tubules may be seen intimately associated with nerves or ganglions
Ancillary Tests
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Colloid-like material is PAS(+) and PASD(+)
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PSA/PAP(-)
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Most are HMCK(34βE12)(+)
TERMINOLOGY
Definitions
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Tubular or acinar proliferation of putative mesonephric duct remnants containing characteristic intraluminal colloid-like material
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Histologically similar to mesonephric remnants that are well recognized in female genital tract
ETIOLOGY/PATHOGENESIS
Origin
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During embryogenesis, mesonephric or wolffian duct gives rise to rete testis, epididymis, vas deferens, and seminal vesicles
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Vestigial mesonephric duct remnants or rests can be seen more commonly in female genital tract and only rarely in male genital tract
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Mesonephric duct remnants may undergo proliferation or hyperplasia, the cause of which is not known
CLINICAL ISSUES
Epidemiology
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Incidence
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Very rare
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Seen in only 0.6% of transurethral resection of prostate (TURP) specimens
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Only 15 cases reported in literature
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Age
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Mean: 67 years old, range 50-85 years
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Site
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Described typically in prostatic base but may extend into bladder neck and periprostatic soft tissues
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Likely involves central region of prostate, since most are seen in TURP specimens
Presentation
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Incidental histologic finding
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Encountered mainly in patients treated for obstructive urinary symptoms due to benign prostate hyperplasia
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Few cases encountered in prostatectomy specimens for prostate adenocarcinoma
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Report of misdiagnosis as prostate adenocarcinoma
Treatment
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None required
Prognosis
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Benign course
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