Benign Mimics of Prostate Carcinoma

  • Rajal B. ShahEmail author
  • Ming Zhou


The diagnosis of prostate carcinoma, especially when present in a limited amount in biopsy, is often challenging because numerous benign conditions have architectural and cytological features overlapping with and mimicking carcinoma. These mimics include various anatomic structures, inflammatory and reactive conditions, and pathophysiological conditions, including atrophy, hyperplasia, and metaplasia. Many of these lesions are readily recognized and separated from malignancy, but some may cause potential diagnostic difficulties.

A useful approach to classifying benign mimics is based on major growth patterns of prostate carcinoma outlined in the Gleason grading system. This approach provides a conceptual framework for considering differential diagnoses. Three major growth patterns are encountered: small well-formed gland pattern mimicking Gleason pattern 3 carcinomas; cribriform growth pattern mimicking Gleason pattern 4 carcinomas; and poorly formed/fused gland/nest/single cell pattern mimicking Gleason pattern 4 or 5 carcinomas. Most benign lesions mimic small gland (acinar) adenocarcinoma; however, mixture of growth patterns is also commonly encountered.

Before establishing a cancer diagnosis, pathologists should always consider and rule out various benign lesions that mimic carcinoma. Immunohistochemical markers should be utilized to support the morphological impression, and one should be aware about pitfalls and limitations of markers. This chapter outlines an overall approach, classification, description of pathologic features, and diagnostic pitfalls of each benign entity.


Atrophy Postatrophic hyperplasia Partial atrophy Proliferative inflammatory atrophy PIA Atrophic adenocarcinoma Mucinous metaplasia Cowper’s gland Foamy gland adenocarcinoma Gleason grading system Cribriform growth pattern Acinar adenocarcinoma Nephrogenic adenoma Basal cell hyperplasia Basal cell adenoma Radiation atypia Adenosis Atypical adenomatous hyperplasia AAH Diffuse adenosis Sclerosing adenosis Nephrogenic adenoma Seminal vesicle/ejaculatory duct epithelium Verumontanum mucosal gland hyperplasia Mesonephric remnant hyperplasia Nonspecific granulomatous prostatitis Chronic lymphocytic leukemia CLL Xanthoma Malakoplakia Paraganglia Central zone Transition zone Clear cell cribriform hyperplasia Transurethral resection TURP 


  1. 1.
    Algaba F, Trias I. Mimickers of prostate cancer in needle biopsies. Anal Quant Cytopathol Histpathol. 2015;37:57–64.PubMedGoogle Scholar
  2. 2.
    Hameed O, Humphrey PA. Pseudoneoplastic mimics of prostate and bladder carcinomas. Arch Pathol Lab Med. 2010;134:427–43.PubMedGoogle Scholar
  3. 3.
    Netto GJ, Epstein JI. Benign mimickers of prostate adenocarcinoma on needle biopsy and transurethral resection. Surg Pathol Clin. 2008;1:1–41.CrossRefGoogle Scholar
  4. 4.
    Srigley JR. Benign mimickers of prostatic adenocarcinoma. Mod Pathol. 2004;17:328–48.CrossRefGoogle Scholar
  5. 5.
    Trpkov K. Benign mimics of prostatic adenocarcinoma. Mod Pathol. 2018;31:S22–46.CrossRefGoogle Scholar
  6. 6.
    Herawi M, Parwani AV, Irie J, Epstein JI. Small glandular proliferations on needle biopsies: most common benign mimickers of prostatic adenocarcinoma sent in for expert second opinion. Am J Surg Pathol. 2005;29:874–80.CrossRefGoogle Scholar
  7. 7.
    Humphrey PA. Variants of acinar adenocarcinoma of the prostate mimicking benign conditions. Mod Pathol. 2018;31:S64–70.CrossRefGoogle Scholar
  8. 8.
    Brimo F, Epstein JI. Immunohistochemical pitfalls in prostate pathology. Hum Pathol. 2012;43:313–24.CrossRefGoogle Scholar
  9. 9.
    Kunju LP, Rubin MA, Chinnaiyan AM, Shah RB. Diagnostic usefulness of monoclonal antibody P504S in the workup of atypical prostatic glandular proliferations. Am J Clin Pathol. 2003;120:737–45.CrossRefGoogle Scholar
  10. 10.
    Shah RB. Clinical applications of novel ERG immunohistochemistry in prostate cancer diagnosis and management. Adv Anat Pathol. 2013;20:117–24.CrossRefGoogle Scholar
  11. 11.
    Shah RB, Kunju LP, Shen R, LeBlanc M, Zhou M, Rubin MA. Usefulness of basal cell cocktail (34betaE12 + p63) in the diagnosis of atypical prostate glandular proliferations. Am J Clin Pathol. 2004;122:517–23.CrossRefGoogle Scholar
  12. 12.
    De Marzo AM, Marchi VL, Epstein JI, Nelson WG. Proliferative inflammatory atrophy of the prostate: implications for prostatic carcinogenesis. Am J Pathol. 1999;155:1985–92.CrossRefGoogle Scholar
  13. 13.
    De Marzo AM, Platz EA, Epstein JI, Ali T, Billis A, Chan TY, et al. A working group classification of focal prostate atrophy lesions. Am J Surg Pathol. 2006;30:1281–91.CrossRefGoogle Scholar
  14. 14.
    Shah R, Mucci NR, Amin A, Macoska JA, Rubin MA. Postatrophic hyperplasia of the prostate gland: neoplastic precursor or innocent bystander? Am J Pathol. 2001;158:1767–73.CrossRefGoogle Scholar
  15. 15.
    Przybycin CG, Kunju LP, Wu AJ, Shah RB. Partial atrophy in prostate needle biopsies: a detailed analysis of its morphology, immunophenotype, and cellular kinetics. Am J Surg Pathol. 2008;32:58–64.CrossRefGoogle Scholar
  16. 16.
    Lotan TL, Epstein JI. Diffuse adenosis of the peripheral zone in prostate needle biopsy and prostatectomy specimens. Am J Surg Pathol. 2008;32:1360–6.CrossRefGoogle Scholar
  17. 17.
    Tian W, Dorn D, Wei S, Sanders RD, Matoso A, Shah RB, et al. GATA3 expression in benign prostate glands with radiation atypia: a diagnostic pitfall. Histopathology. 2017;71(1):150–5.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Robert J Tomsich Pathology and Laboratory Medicine InstituteCleveland ClinicClevelandUSA
  2. 2.Tufts Medical CenterBostonUSA

Personalised recommendations