Adenomatous prostate node (adenoma) is a benign tumor that develops from the glandular tissue of the organ. It is based on prostate hyperplasia (enlargement). Men over 60 years of age are most often affected. By age 80, the prevalence of adenoma is 70-80%.
Risk factors for developing the disease are chronic prostatitis, hormonal changes and old age. The relationship between STIs, sexual activity, alcoholism and nodule formation has not been established. If left untreated, adenoma leads to acute urinary retention, renal failure and other complications.
Signs
Clinical symptoms of the presence of an adenomatous node are:
- Frequent mictions. Patients may urinate 15-20 times during the day. The urge to go to the toilet is often painful.
- Nocturia (excessive urination at night). The night diuresis of sick men exceeds the norm (1/3 of the daily value).
- Decreased rate of urine excretion during voiding.
- Delay in the start of migrations. Patients have to push to empty the bladder.
- Intermittent mictions. In healthy men, urine is released continuously until the bladder is empty.
- Urine is released drop by drop at the end of micturition.
- Feelings of the presence of a large amount of residual urine.
- Imperative urges.
- Incontinence (leakage) of urine.
- Increasing the time of mictations.
Types and stages
There are 3 stages of formation of adenomatous nodes. At the early (compensated) stage, the process of urination is disrupted. Characterized by sluggishness of the stream, frequent urges and nocturnal movements. On examination, the gland is densely elastic and increased in size. Upon palpation, the median sulcus is clearly visible. There is no pain during digital rectal examination. At stage 1 of the disease, the bladder is completely emptied. The duration of this stage is 1-3 years.
Stage 2 is characterized by the following disorders:
- bladder enlargement;
- tissue degeneration;
- severe disturbances in the act of urination;
- muscle hypertrophy and decreased elasticity;
- a large amount of residual urine;
- dilation of the urinary tract;
- kidney dysfunction;
- involuntary release of urine.
Adenoma of the 3rd stage (decompensation) is characterized by distension of the bladder, the development of renal failure, the release of urine drop by drop, its cloudiness, severe pain and a constant desire to empty the bladder. In the absence of proper care, sick men die due to kidney failure.
Diagnosis and treatment
If adenomatous nodes are suspected, you will need:
- Interview (collection of life history and medical history).
- General and biochemical blood tests.
- Blood test for PSA (prostate antigen). With adenoma, this indicator is sharply increased.
- Palpation of the prostate and abdomen. During the procedure, the size and presence of pain are determined.
- Ultrasonography. It is carried out through the anus and the anterior abdominal wall. The prostate, bladder and kidneys are examined. Ultrasound allows you to examine the stromal tissue. With adenoma, a hypoechoic zone and proliferation of glandular tissue are detected.
- Uroflowmetry (a method for assessing the rate of urine excretion using a special apparatus).
- Biopsy.
- Cytological and histological analyses.
- Excretory urography.
- Cystography (x-ray examination of the bladder).
- Cystomanometry (determination of pressure in the bladder).
- CT or MRI.
Differential diagnosis is carried out with prostatitis, abscess, stones and malignant neoplasms.
In the presence of an adenomatous node of the prostate gland, conservative or surgical treatment is carried out.
Treatment methods for benign prostatic hyperplasia are:
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- Use of medications. Alpha-adrenergic receptor blockers (Terazosin, Cornam, Setegis, Doxazosin-FPO, Cardura, Artezin, Kamiren XL, Alfuzosin, Dalfaz), 5-alpha reductase inhibitors (Avodart, Dutasteride Bacter, Finasteride, Alfinal, Penester, Proscar), antibiotics may be prescribed. (in case of infection), interferon preparations, vascular preparations (Trental), herbal remedies (Prostamol Uno), suppositories (Prostatilen), antispasmodics and painkillers.
- Physiotherapy.
- Dieting.
Folk remedies do not give good results. For nodes in the prostate and disorders of the urodynamics of the lower urinary tract, surgical intervention is most effective. Surgery is indicated for urinary retention, renal failure, stones, hematuria and urinary tract infection.
If an adenomatous prostate node is detected, the following can be done:
- open prostatectomy (total removal of the gland);
- transurethral resection (minimally invasive treatment);
- electrovaporization (evaporation of tissue using a roller electrode);
- electroincision (dissection of bladder and gland tissue);
- laser therapy (vaporization and coagulation);
- microwave thermotherapy (low temperature exposure);
- radiofrequency destruction;
- arterial embolization;
- stenting (used to drain the bladder).
If the nodes in the prostate cannot be removed using the standard method, then palliative therapy (cystostomy) is performed.
During examination, many women are diagnosed with an adenomatous pathological node in the uterus. Most women do not even suspect what this diagnosis can mean for them, which is why they perceive it as a real sentence. In this article we will take a closer look at the features of adenomyosis and its specific consequences for women's health.
What is the disease?
Adenomyosis, in fact, is a special growth of the endometrium. This condition refers to pathological processes and, as a rule, causes the development of infertility and tumors.
Quite often, the causes of this disease are various types of surgical interventions in the organ, or hormonal imbalances. In addition, its development can be affected by heavy physical activity and irregular sex life.
Symptoms of the disease
There are quite a lot of symptoms that help establish the fact of the formation of this disease. These include:
- Spotting discharge.
- Heavy menstrual bleeding.
- Disruptions in the menstrual cycle.
- Bloating.
- Pain during sexual intercourse.
All these signs can appear one at a time, or they can appear in groups.
Stages of development
This disease is characterized by gradual development. This is due to the fact that the uterus itself consists of several layers. With the development of this disease, endometrial cells actively grow and absorb intermediate tissues that separate them from the body of the organ.
In total, experts distinguish 4 stages of development of this disease:
- Penetration of cells into the intermediate layer of the organ.
- Penetration of cells into the muscular layer of the uterus.
- Damage to more than half of the muscular layer of the uterus.
- Penetration of cells into the abdominal cavity.
Typically, the effectiveness of treatment is determined by how quickly the disease is detected.
Doctors distinguish 3 types of this disease:
- Diphyus. It is characterized by a uniform spread of the lesion throughout the organ.
- Focal. The disease develops in certain areas.
- Nodal. The development of the disease occurs in the form of the development of special nodes.
Features of the nodular form of the disease
The nodular type of this disease is a special development pattern in which an adenomatous benign node is formed in the uterus from affected endometrioid tissue. As a rule, these nodes are not connected to the uterine cavity.
Most often, the seals are located in the muscle layer of the organ, and their size varies from 1 to 5 cm.
These nodes differ in that they do not have capsules, but the endometrium undergoes cyclical changes, which leads to the accumulation of blood in the nodes. This provokes a significant enlargement of the uterus in the period before menstruation.
The main feature of this form of the disease is that during its development all the symptoms are pronounced.
Signs of nodular type
Nodular adenomyosis has its own characteristic signs. These include:
- Pain before menstruation.
- Disruptions of the menstrual cycle.
- Spotting.
- Enlargement of the uterus.
- Infertility.
As a rule, the manifestation of such a symptom is due to hyperestrogenism. In addition, a fertilized egg cannot be implanted into the organ due to its deformation.
We are undergoing examination
This disease is diagnosed during a gynecological examination. It is worth noting separately that during palpation, nodes of this kind are quite difficult to distinguish from myomatous formations.
Diagnostics
Therefore, specialists usually prescribe a number of additional studies:
- Ultrasound examination.
- Hysteroscopy.
Only based on the results of various studies can a diagnosis be made as accurately as possible.
Dangerous consequences
The main negative manifestation of this disease is that the cells of the endometrial layer during its development can actively spread throughout the body if they do not meet the so-called immune barrier along the way. It is this factor that allows adenomyosis to be classified as a malignant tumor. As a rule, it is the determination of the benign quality of the disease that makes it possible to predict its further development.
Another very unpleasant consequence of adenomyosis is infertility. In the absence of proper treatment, the disease can lead to the development of a form of infertility that cannot be treated.
A fairly common complication observed with this disease is the formation of so-called fistulas. This phenomenon implies the formation of peculiar passages from the uterus to the abdominal cavity.
It is also impossible not to mention that it is quite difficult to cure this disease. In turn, therapy can cause a number of complications. For example, during treatment with surgery, the growth layer of the endometrium may be damaged, which will lead to infertility.
Another complication is anemia. With this disease, menstrual bleeding is heavy. In addition, discharge is observed in the middle of the cycle. These factors can lead to the development of anemia.
How is adenomyosis treated?
The nodular form of this disease is most often treated with surgery. If the disease develops in a woman of reproductive age, then specialists first of all try to preserve the reproductive function of the organ.
As a rule, the intervention is carried out in the form of laparoscopy. This operation allows you to remove the seals without causing significant damage to the organ. In addition, in order to maintain the shape of the uterus after surgery, special sutures are applied.
The main difficulty during such an operation is that the specialist does not see certain edges of the node. Also, another complication is that there is an inflammatory process in the uterus.
To summarize, we can say that a disease such as adenomyosis occurs very often in women. In most cases, it passes without any symptoms, so it is diagnosed quite late. One of the most severe forms of this disease is nodular. This is due to the fact that with it the symptoms are most pronounced. In addition, treatment of this type of disease is carried out only by surgery. Diagnosing the development of nodular adenomyosis is not easy, which is why when the first signs appear, you should consult a doctor.
Despite the abundance of methods in modern medicine aimed at curing prostate adenoma, folk remedies remain effective and efficient.
What is prostate adenoma
Prostate adenoma (benign prostatic hyperplasia) is a disease in which an increase in the size of the prostate gland occurs with simultaneous thickening of its tissue.
As a result of the growth of adenomatous nodes, compression and a change in the curvature of the urethra occurs, resulting in a dysfunction of urination when it ceases to give pleasure, which is the first symptom of the disease.
Only men suffer from prostatic hyperplasia, and with age this disease is observed in an increasing number of patients, reaching a value of 70% at the age of 60 years and 85% at the age of 70 years.
To date, the causes of prostate adenoma have not been precisely established. There was no correlation between the occurrence of the disease and sexual activity, sexual orientation, sexually transmitted diseases, tobacco and alcohol use.
When the first symptoms of prostate adenoma appear, you need to see a urologist who, depending on the degree of advancedness of the disease, will prescribe medication, non-operative or surgical treatment.
Traditional medicine also allows you to cure this disease, some of which will be discussed further.
Pumpkin
Pumpkin is a leader among traditional medicines that can resist prostate adenoma. Moreover, it is an indispensable product in the treatment of this disease.
A glass of freshly prepared pumpkin pulp, taken daily for two weeks, will alleviate the condition of a patient with an advanced form of prostate adenoma and cure in the case of the initial stage of the disease. Adding honey to a glass of pumpkin juice is welcome.
Pumpkin seeds are no less useful. An important condition is that they should not be, but only slightly dried.
After peeling 100 g of seeds with a preserved pale green shell, eat them throughout the day, either whole or in crushed form. The duration of consumption of pumpkin seeds is at least a month.
Another recipe for using pumpkin. Grind 500 g of dried and peeled pumpkin seeds in a meat grinder.
Add 200 g to the resulting mixture, mix it thoroughly, and then roll them into balls with a diameter of about 2 cm and hide them in the freezer.
Twice a day, half an hour before meals, eat one ball. Do not rush to swallow it, you need to chew and dissolve it for 2-3 minutes.
Having eaten all the prepared balls of pumpkin seeds and honey, you can be sure that prostate adenoma is guaranteed to leave you alone.
Celandine
To prepare the tincture, pour 200 g of 1 tablespoon of celandine herb and let it brew for 10 days in a dark place, then strain.
Take daily in the morning before meals. The dosage is as follows: on the first day of use, drop 1 drop of tincture into a glass, on the second day of use – 2 drops, and so on.
Within 30 days, increase the content of the tincture to 30 drops, and then over the next month, reduce the number of drops by one every day. On the 60th day of the course, take 1 drop of tincture with water, after which stop treatment.
Chestnuts
Tea made from chestnut shells effectively treats prostate adenoma. To prepare it, remove the green shell along with the needles from the chestnut, chop and use as tea leaves.
In the fall, when the chestnuts ripen, turn brown and begin to fall off, an equally effective medicine can be prepared from their peels.
After removing the brown peel from the chestnuts, pour 0.5 liters of boiled water in the amount of 3 tablespoons and let it brew for 8 hours. Strain the resulting infusion and boil for 10 minutes.
Take the product three times a day before meals, 30 drops. The course of treatment is until the decoction ends (about a month to a month and a half). After a two-month break, repeat the course. Number of treatment courses – 3.
Special exercises
It is very useful in the morning after performing a light 2-3 minute massage of the perineal area, stimulating the work of the prostate gland and preventing congestion in it.
Then you need to stand with your feet together and squat down, bending your knees by about a third.
Alternately move your knees, putting your left and your right forward. The duration of the exercise is 3-4 minutes.
Sitting on the floor on your buttocks, place your bent legs forward, using the work of your abdominal and back muscles, slightly lift one buttock and move it 5-10 cm forward. Then perform the same movement with the other buttock.
This exercise is called “butt walking.” To begin with, 1 minute of such “walking” will be more than enough; over time, the load can be gradually increased.
By the way, men who lead an active and mobile lifestyle suffer from prostate adenoma much less often than their sedentary peers.
Take care of yourself! Be always healthy!
Adenomatous prostate nodes are quite often diagnosed in males over 50 years of age. Of course, they can be detected in younger people, but this diagnosis is more common among older patients. The term “adenomatous node” refers to benign tissue hyperplasia or, more simply, prostate adenoma.
Why do knots appear?
Many patients are concerned about the question of why adenomatous nodes develop at all, what contributes to their formation? Doctors today cannot name with absolute certainty any one leading cause, and therefore identify several factors at once that can lead to negative processes. These include:
- presence of genetic predisposition;
- exposure to adverse environmental factors (consumption of carcinogens with food and drink in large quantities, air pollution, etc.);
- the presence of hormonal disorders in the male body (mainly the predominance of estrogens over testosterone);
- long-term neglect of various chronic diseases of the genitourinary system (cystitis, prostatitis, etc.);
- the presence of foci of chronic infection in the body, bacterial contamination of the prostate.
Most often, when it comes to prostate hypertrophy, doctors agree that the process began due to the adverse effects of not one, but several factors at once.
The disease develops gradually, first making itself felt in old age. In this case, there is a risk of degeneration of a benign tumor into a malignant one (for example, prostate blastoma may develop).
Developmental stages and symptoms
Prostate nodes go through several stages in their development, differing in the severity of symptoms. Speed 
The development of the disease in different men can vary significantly, but it is important to know that adenomas always grow slowly. If the tumor grows quickly, then it is not an adenoma, but cancer.
Among the stages of development, there are three main ones.
If the proliferation of the glandular layer of tissue in the prostate gland is diagnosed in a timely manner, treatment is successful in almost 100% of cases. That is why, when the first symptoms appear, indicating the initial stage of the disease, it is recommended to consult a doctor for help.
A doctor in a hospital setting will be able to recommend the examinations necessary to confirm the diagnosis, and then select the optimal treatment method. When nodes are detected in the prostate gland, a tissue biopsy is considered mandatory. It helps to determine whether there are malignant tumor processes in the body or whether prostate adenoma was discovered.
Treatment methods
If doctors have discovered nodes in the prostate gland, it is recommended to begin their treatment as early as possible. In the initial stages, in most cases it is possible to manage with the help of medications and physiotherapeutic procedures. 5-alpha reductase inhibitors and alpha-blockers can be used as drugs, under the influence of which 
The size of the gland decreases, the pressure on nearby organs stops.
In some cases, adenomatous nodes turn out to be very resistant to the effects of drugs and, despite all efforts, continue to increase in size. In this case, the issue of surgical intervention is resolved. During the operation, either part of the prostate gland together with the node, or the entire organ can be removed. The decision on the extent of the operation is made by the doctor.
Folk remedies can also be used as additional treatment methods. Before using them, consult a specialist and obtain his approval.
The presence of adenomatous nodes in the prostate is not a death sentence for a person. Although this pathology is associated with a number of unpleasant symptoms, it is highly treatable if the patient takes care of his own health in a timely manner and seeks help from a doctor.
The evolution of the prostate gland continues until puberty, and then it undergoes involution, against the background of which the likelihood of developing adenoma or cancer increases. The incidence of prostate adenoma is 10% in men 40 years of age and up to 84% in men over 60 years of age. The incidence of prostate cancer in men over 50 years of age ranges from 12 to 46%.
Prostate adenoma. Prostate adenoma is an enlargement of the prostate gland caused by an increase in glandular and interstitial tissue. Prostate adenoma has a number of synonyms - benign prostatic hyperplasia, benign enlargement of the prostate gland, prostatic hypertrophy, adenomatous hypertrophy, nodular hyperplasia. The growth of adenoma occurs from peri- and paraurethral glands, which are not functionally connected with the glandular structures of the true prostate gland and are separated from them by a layer of smooth muscle tissue. With the growth of prostate adenoma, spherical masses of adenomyofibromatous tissue are formed - adenomatous nodes, displacing the true gland to the periphery of the organ, turning it into a thin layer of tissue of a fibroglandular structure. The layer of fibrous tissue located between the adenomatous and compressed tissue of the true gland is called the “surgical” capsule. The size of prostate adenoma does not always correspond to the clinical picture of the disease, but the identification of small, medium and large adenomas has a certain practical significance in diagnosis, treatment planning and assessment of the expected results of surgical intervention.
A prostate adenoma weighing less than 20 - 25 g is considered small, from 25 to 80 g - medium, over 80 g - large, and exceeding 250 - 300 g - giant. Adenomatous nodes are initially localized in the peri- and paraurethral region proximal to the seminal tubercle. The further direction of growth and configuration of prostate adenoma depend on the resistance of the surrounding tissue of the true gland and bladder neck. The acquired form and position of prostate adenoma determine the characteristics of the course of the disease and symptoms. In this regard, knowledge of the direction of growth of nodes is of great practical importance. According to the shape and nature of distribution, they distinguish between bilobar (bilateral) prostate adenoma, middle lobe prostate adenoma, a combination of a bilobar with a middle lobe adenoma, a subcervical adenoma, a combination of a bilobe with a subcervical adenoma.
The bilobar form of prostate adenoma is the most common. The sizes of the resulting lateral lobes are usually unequal due to the preferential growth of adenomatous nodes in one direction. On a cross-section of a prostate adenoma, consisting of lateral lobes, the urethra running between them can be traced with significantly altered contours due to compression by adjacent spheroidal adenomatous nodes of various sizes. The lateral lobes of the prostate adenoma in front and behind are connected by connective tissue-muscular adhesions, spreading further along the surface of the prostate adenoma, forming its capsule. The progression of growth of adenomatous nodes ultimately causes a change in the elasticity of the prostate gland and maximum compression of its capsule. In this case, the adenomatous mass is enclosed between the “surgical” and the true capsule of the gland. Bilobar prostate adenoma is characterized by extravesical growth, which explains the small volume of residual urine determined in patients in this group. Urinary retention develops with severe concomitant disorders of the urodynamics of the lower urinary tract. A digital rectal examination reveals a significantly enlarged area with relatively symmetrically located lateral lobes; median and lateral grooves are pronounced on the posterior and lateral surfaces of the gland.
Middle lobe prostate adenoma develops from the glands of a small wedge-shaped portion of the gland, corresponding to its isthmus and located posterior to the neck of the bladder between the vas deferens. This localization creates conditions for the early development of an obstruction to the outflow of urine and dysfunction of the internal sphincter. In this regard, clinically, middle lobe prostate adenoma is characterized by a significant volume of residual urine. The size of the prostate gland in middle lobe prostate adenoma cannot be accurately determined by digital rectal examination. The incidence of midlobe prostate adenoma is especially high in men 40 - 60 years old (about 80%).
In older men, the most common combination is bilobar and middle lobe prostate adenoma. The middle lobe in this type of prostate adenoma occurs due to the growth of submucosal nodes, which reach large sizes near the neck of the bladder, where they can be traced along the midline in the form of a solitary adenomatous mass. In this case, much earlier than with bilobar prostate adenoma, the internal sphincter of the urethra expands, which creates conditions for the spread of adenomatous nodes into the cavity of the bladder. Thus, this type of prostate adenoma is characterized by a combination of extra- and intravesical growth of adenomatous nodes. A digital rectal examination reveals a large prostate gland, soft consistency with an increase in volume towards the base and smoothness of the median groove. With predominant intravesical growth, digital rectal examination makes it impossible to obtain a clear idea of the size of the gland. Clinically, the combination of bi- and middle-lobe prostate adenoma is manifested by a significant volume of residual urine and complete urinary retention.
In some cases, adenomatous nodes, developing from the glands of the urethra below the bladder neck, spread through the internal opening of the neck into the lumen of the bladder. In this case, the base of the adenoma is localized distal to the neck of the bladder, and the movable “leg” or “stem” is located in the cavity of the bladder. This type of prostate adenoma is designated subcervical. The moving part of the subcervical prostate adenoma often wedges into the lumen of the internal sphincter and forms a kind of valve covering the lumen of the bladder neck, the posterior wall of which is significantly deformed. Clinically, the disease is characterized by a significant volume of residual urine. Subcervical prostate adenoma is not detected by digital rectal examination.
Trilobar prostate adenoma - a combination of bilobar and subcervical - is one of the most common types. In this case, the adenoma consists of lateral lobes and a stalk-like protrusion of the middle lobe, penetrating through the expanded opening of the internal sphincter into the cavity of the bladder. Clinically, this type of prostate adenoma is characterized by a significant volume of residual urine, a tendency to bleeding when instruments are passed into the bladder through the urethra, and difficult catheterization of the bladder. The clinical course of the disease is more severe than with bilobar prostate adenoma, which is due to the rapid increase in the volume of residual urine. Due to severe disturbances in the urodynamics of the lower urinary tract, bladder function is not restored after an episode of acute urinary retention.
The growth of adenomatous nodes may be limited by the internal sphincter of the bladder. In this case, adenomatous nodes spreading in the subtrigonal direction lift the bottom of the bladder and displace the opening of the internal sphincter. The subtrigonal type of prostate adenoma, as well as the selective growth of adenomatous nodes anterior to the urethra, is a rare variant.
A growing adenoma causes a number of topographic and anatomical changes in the urethra. Characteristically, the prostatic part is lengthened to 4.5 - 6 cm, mainly due to the portion of the posterior wall located above the seminal tubercle. Due to the difference in the degree of elongation of the anterior and posterior walls of the canal, its dimensions change in the anteroposterior and transverse directions. As a result, the anterior curvature of the canal concavity increases, which leads to a significant curvature of its course. Due to the uneven development of the lateral lobes and the protrusion of adenomatous nodes into the lumen of the urethra, it acquires a zigzag shape. The transverse diameter of its prostatic part decreases, especially in the middle section, as the increasing lateral lobes compress it. In the cystic form of the adenoma, the canal takes the form of a vertical fissure, sometimes developing in the posterior section. The neck of the bladder with prostate adenoma is deformed, it almost always turns out to be raised upward, takes the form of a slit limited by two lateral ridges, or an opening in the form of a three-rayed star if there are three lobes. Sometimes the hole is covered by the middle lobe of the prostate adenoma, forming a kind of valve. With the development of the middle lobe of prostate adenoma, the posterior wall of the cystic neck is deformed, which takes on a wide variety of shapes. The shape of the bladder changes quite quickly due to a depression formed behind the bladder neck, limited on one side by a protruding adenoma, and on the other by the posterior wall of the bladder.
Changes in the wall of the bladder are characterized by the development of trabeculae, represented by hypertrophied muscle fibers protruding into the cavity of the bladder, between which there are depressions - diverticula. When infection occurs, thickening and fibrosis of the mucous membrane, small cell infiltration, increased vascular development, and interstitial hemorrhages are observed. As the adenoma grows, the capacity of the bladder increases and often reaches 1 liter or more.
The ureters dilate, lengthen and become tortuous, periureteritis develops, the lower part of the ureter is deformed and takes the shape of a fishhook. With increasing chronic urinary retention, expansion of the cups and pelvis occurs, and ureterohydronephrosis and pyelonephritis may subsequently develop.
A cross-section of a prostate adenoma shows the surrounding capsule, the thickness of which varies in different areas (up to 5 mm). The capsule is usually formed by circular fibers of connective tissue, from the inner surface of which septa extend into the mass of the adenoma. The adenoma itself consists of many round nodes of greater or lesser size (spheroidal bodies), which are glandular-stromal formations.
Histologically, prostate adenoma consists of proliferating glandular epithelium, fibrous and smooth muscle tissue. In the morphogenesis of prostate adenoma, a significant role belongs to primary hyperplasia of periurethral fibromuscular tissue. In the initial stage, prostate adenoma is formed from fibromyomatous or myomatous components, forming nodules in the periurethral area, into which hyperplastic periurethral glands subsequently grow, resulting in large adenomatous nodes that can have a fibroblastic, fibromuscular, fibroadenomatous and fibromyoadenomatous structure. Fibroblastic nodules are usually localized in the submucosal epithelial tissue surrounding the prostatic urethra distal to the seminiferous tubercle. They are equipped with a dense network of blood vessels, and therefore are called fibrovascular nodes. In the tissue of removed adenomatous nodes, not true fibrous nodes, but nodes of a fibrovascular structure are more often detected. Fibromuscular nodes should be distinguished from nodes consisting primarily of smooth muscle tissue and only a small part of fibrous tissue. Nodes of this type are characterized by inflammatory infiltration with numerous histiocytes and plasma cells, which can simulate the histological picture of granulomatous prostatitis, leukemic and lymphoid prostatic infiltration. In such cases, it is necessary to carefully examine the patient to exclude blood diseases or nonspecific granulomatous prostatitis.
In the tissue of the removed prostate adenoma there are large nodes consisting of smooth muscle tissue (leiomyomas). According to light and transmission electron microscopy, the structure of these nodes is characterized by spiral-shaped stripes of typical smooth muscle fibers against a background of relatively scanty stroma consisting of collagen. In the absence of coloration specific to smooth muscle tissue, nodes of this type are called stromal. They consist of stellate-shaped cells resembling smooth muscle cells, most often found in the periurethral tissue or in close proximity to the nodes of the glandular structure, they are the most characteristic component of the histological picture of prostate adenoma and in some cases, reaching large sizes, compress its glandular structures. As the stromal node grows, it penetrates into the glandular epithelium of prostate adenoma tissue, stimulating the proliferative process in it. This confirms the modern point of view about the role of stroma in the activation of the glandular epithelium of the prostate gland.
Fibroadenomatous nodes (fibroadenomatous hyperplasia) are the most common type of prostate adenoma, in which the epithelial component predominates. The inner surface of glandular formations is lined with single-layer cylindrical, cubic or flat epithelium. In the lumens of the glands, accumulations of epithelial remains, mucous fluid, amyloid bodies, and sometimes stones are observed. In adenomatous nodes of this type, the epithelium varies from cylindrical to flattened cubic, devoid of secretory activity and having lightly colored granular cytoplasm located on the main membrane not damaged by the pathological process. Fibroadenomatous nodes are clearly visible on the cut surface of the prostate adenoma in the form of areas of pale yellow color on the surrounding gray background of the stroma.
Fibryomyoadenomatous nodes, as well as fibroadenomatous nodes, are most often found in prostate adenoma tissue. In nodes of this type, foci of infarction and hemorrhage are often observed, resulting in a metaplastic reaction of the epithelium. Squamous metaplasia most often occurs in areas of prostate adenoma adjacent to infarctions, in the tissue of adenomatous nodes that have undergone transurethral resection, and in inflammatory foci. It may be mistaken for squamous carcinoma of the gland or bladder cancer with invasion into the gland. The distinctive histological characteristics of squamous carcinoma are cellular atypicality and nuclear anaplasia, while these features are absent in squamous metaplasia. Cribriform or solid-trabecular histological variant is a common type of fibromyoadenomatous node. Atypical cribrous hyperplasia in the form of small microscopic foci can be traced in the tissue of removed prostate adenoma in 10 - 60% of cases. The epithelium in these areas is characterized by weakly defined nuclei with the absence of protruding nucleoli; the glands take on the appearance of a lattice. Atypical cribriform hyperplasia in prostate adenoma tissue must be distinguished from cribriform structures of prostate cancer. A characteristic feature of the epithelial-cribriform variant of the fibromyoadenomatous node of prostate adenoma is the absence of signs of malignancy in the cell nuclei. It is very likely that the cribriform variant of the fibromyoadenomatous node observed in the tissue of prostate adenoma reflects a precancerous process.
In the tissue of the removed prostate adenoma, there are foci of atypical hyperplasia of the glands, reflecting the process of dysplasia developing in them. These changes are characteristic mainly of epithelial forms of prostate adenoma. Foci of dysplasia in prostate adenoma tissue are characterized by atypical glandular proliferation, cytological atypicality of the proliferating epithelium and disorganization of the morphological unity between the glandular epithelium and fibromuscular stroma. Dysplasia is considered as one of the stages of pathohistological changes preceding the development of prostate cancer. At the same time, the oncological significance of dysplasia is not sufficiently clear. In this regard, dysplasia cannot be identified with the initial stage of prostate cancer or cancer in situ. Dysplasia differs from the histological picture of prostate cancer in the absence of tissue invasion and compact growth of glandular structures extending beyond the lobule. Atypical hyperplasia can be expressed to varying degrees. With a mild degree, there are no changes in the histological picture of individual epithelial cells; There is only an increase in the number of small glands located in the correct order - acini - with no changes in their normal branching and pathological signs. A moderate degree is characterized by the appearance of clusters of enlarged glands with irregular contours, which give secondary growth to small, closely spaced acini. This degree differs from the mild degree by a violation of the cytoarchitecture of glandular structures. With a pronounced degree of atypical hyperplasia, changes occur in the structure of epithelial cells - nuclear chromatism, variability in the size of nuclei, compaction of the cytoplasm, which acquires a dark color. Detection of foci of dysplasia in the tissue of removed adenomatous nodes requires further monitoring of these patients, who are included in the group of increased risk of prostate cancer.