title: Low grade urothelial carcinoma mimicking basal cell hyperplasia and transitional metaplasia in needle prostate biopsy.
abstract: OBJECTIVE
  The vast majority of urothelial carcinomas infiltrating the bladder are consistente with high-grade tumors that can be easily recognized as malignant in needle prostatic biopsies. In contrast, the histological changes of low-grade urothelial carcinomas in this kind of biopsy have not been studied.
  
  
  METHODS
  We describe the clinicopathologic features of two patients with low-grade bladder carcinomas infiltrating the prostate. They reported dysuria and hematuria. Both had a slight elevation of the prostate specific antigen and induration of the prostatic lobes. Needle biopsies were performed. At endoscopy bladder tumors were found in both cases.
  
  
  RESULTS
  Both biopsies showed nests of basophilic cells and cells with perinuclear clearing and slight atypia infiltrating acini and small prostatic ducts. The stroma exhibited extensive desmoplasia and chronic inflammation. The original diagnosis was basal cell hyperplasia and transitional metaplasia. The bladder tumors also showed low-grade urothelial carcinoma. In one case, the neoplasm infiltrated the lamina propria, and in another, the muscle layer. In both, a transurethral resection was performed for obstructive urinary symptoms. The neoplasms were positive for high molecular weight keratin (34BetaE12) and thrombomodulin. No metastases were found in either of the patients, and one of them has survived for five years.
  
  
  CONCLUSIONS
  The diagnosis of low-grade urothelial carcinoma in prostate needle biopsies is difficult and may simulate benign prostate lesions including basal cell hyperplasia and urothelial metaplasia. It is crucial to recognize low-grade urothelial carcinoma in needle biopsies because only an early diagnosis and aggressive treatment can improve the prognosis for these patients.
authors.affiliation: Departamento de Patología, Instituto Nacional de Ciencias Médicas y Nutrición, Distrito Federal, Mexico.
authors.forename: Julian
authors.initials: J
authors.lastname: Arista-Nasr
authors.affiliation: Departamento de Patología, Instituto Nacional de Ciencias Médicas y Nutrición, Distrito Federal, Mexico.
authors.forename: Braulio
authors.initials: B
authors.lastname: Martinez-Benitez
authors.affiliation: Departamento de Patología, Instituto Nacional de Ciencias Médicas y Nutrición, Distrito Federal, Mexico.
authors.forename: Leticia
authors.initials: L
authors.lastname: Bornstein-Quevedo
authors.affiliation: Departamento de Patología, Instituto Nacional de Ciencias Médicas y Nutrición, Distrito Federal, Mexico.
authors.forename: Elizmara
authors.initials: E
authors.lastname: Aguilar-Ayala
authors.affiliation: Departamento de Patología, Instituto Nacional de Ciencias Médicas y Nutrición, Distrito Federal, Mexico.
authors.forename: Claudia Natalia
authors.initials: CN
authors.lastname: Aleman-Sanchez
authors.affiliation: Departamento de Patología, Instituto Nacional de Ciencias Médicas y Nutrición, Distrito Federal, Mexico.
authors.forename: Raul
authors.initials: R
authors.lastname: Ortiz-Bautista
mesh_terms: D000368:Aged; D001707:Biopsy, Needle; D002295:Carcinoma, Transitional Cell / Q000473:pathology*; D003937:Diagnosis, Differential; D006801:Humans; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D011467:Prostate / Q000473:pathology; D017430:Prostate-Specific Antigen / Q000097:blood; D011470:Prostatic Hyperplasia / Q000473:pathology*; D011471:Prostatic Neoplasms / Q000473:pathology* / Q000556:secondary*; D001749:Urinary Bladder Neoplasms / Q000473:pathology*; D019459:Urothelium / Q000473:pathology*
chemical_list: D017430:Prostate-Specific Antigen