Prostatic Metaplasia of the Vagina and Uterine Cervix: An Androgen-associated Glandular Lesion of Surface Squamous Epithelium

Prostatic-type differentiation in the lower female genital tract is encountered rarely and its causes and clinical associations are not well established. Within the vagina, reports to date have invariably described ectopic prostatic-type differentiation as restricted to the lamina propria. We recently encountered a patient receiving testosterone for gender dysphoria whose vaginectomy specimen showed a prostatic glandular proliferation within the surface epithelium. To elucidate its potential association with androgen exposure, we sought similar lesions, resected over a 26-year period, from patients with exogenous or endogenous androgen excess. Thirteen cases were identified, involving the vagina (n=12) and exocervix (n=1). The most common clinical context was gender dysphoria with long-term testosterone therapy; the lesion was present in 7 of 8 gender-dysphoric patients examined. Four other patients had congenital disorders of sexual development associated with endogenous androgen excess (congenital adrenal hyperplasia, 46,XY disorder of sexual development, and ovotesticular disorder of sexual development). Two had no known exposure to androgen excess. Immunohistochemically, glands stained for NKX3.1 (100% of cases), androgen receptor (100%), CK7 (92%), and prostate-specific antigen (69%). Follow-up (median duration, 11 mo) showed no masses or neoplasia. We propose the designation “androgen-associated prostatic metaplasia” for this form of prostate tissue w...
Source: The American Journal of Surgical Pathology - Category: Pathology Tags: Original Articles Source Type: research

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Publication date: Available online 29 August 2020Source: Reproductive BioMedicine OnlineAuthor(s): Ahmad Badeghiesh, Sara Ismail, Haitham Baghlaf, Eva Suarthana, Michael H. Dahan
Source: Reproductive BioMedicine Online - Category: Reproduction Medicine Source Type: research
Congenital adrenal hyperplasia (CAH) with 17 α-hydroxylase deficiency is a rare disease; patients often require lifetime cortisol treatment. In this case report, we presented a patient with CAH and 17α-hydroxyl...
Source: BMC Endocrine Disorders - Category: Endocrinology Authors: Tags: Case report Source Type: research
CONCLUSION: We determined etiologies in 86.3% of children with non-CAH PAI through specific clinical and laboratory findings with/without molecular analysis of candidate genes. ALD was the most common etiology. Nowadays, advanced molecular analyse can be utilized to establish a specific genetic diagnosis of PAI for patients who have no specific diagnostic features. PMID: 32938577 [PubMed - as supplied by publisher]
Source: JCRPE Journal of Clinical Research in Pediatric Endocrinology - Category: Endocrinology Tags: J Clin Res Pediatr Endocrinol Source Type: research
ConclusionsWe have developed and validated a comprehensive NGS-based assay for detection of variants inCYP21A2 gene in patients with 21-OH CAH. We describeCYP21A2 mutation spectrum and novel variants in a large cohort of Indian patients with CAH.
Source: Endocrine - Category: Endocrinology Source Type: research
To assess opinions of females with CAH, and parents of females with CAH, about designating this population “intersex,” particularly in legislation about genital surgery during childhood.
Source: Journal of Pediatric Urology - Category: Urology & Nephrology Authors: Source Type: research
Treatment of children with classic congenital adrenal hyperplasia (CAH) is a difficult balance between hypercortisolism and hyperandrogenism. Biochemical monitoring of treatment is not well defined.
Source: Metabolism - Clinical and Experimental - Category: Biomedical Science Authors: Source Type: research
Disorders of sex development (DSD) are conditions where genetic, gonadal, and/or internal/external genital sexes are discordant. In many cases, serum testosterone determination is insufficient for the differential diagnosis. Anti-Müllerian hormone (AMH), a glycoprotein hormone produced in large amounts by immature testicular Sertoli cells, may be an extremely helpful parameter. In undervirilized 46,XY DSD, AMH is low in gonadal dysgenesis while it is normal or high in androgen insensitivity and androgen synthesis defects. Virilization of a 46,XX newborn indicates androgen action during fetal development, either from t...
Source: Frontiers in Endocrinology - Category: Endocrinology Source Type: research
Although sufficient evidence is present to support early feminizing genitoplasty, we still have deficient evidence that deferred treatment after age of consent is associated with the best outcome. We still lack evidence concerning many perspectives including the psychological aspect to parents and growing child, outcome of deferred surgery, its complications and its outcome and whether satisfaction of patients with such deferred surgery will be obtained or not.
Source: Journal of Pediatric Urology - Category: Urology & Nephrology Authors: Tags: Letter to the Editor Source Type: research
With interest I have read the article by Elsayed and colleagues on the outcomes of genital surgery in girls with Congenital Adrenal Hyperplasia (CAH) before versus after the age of two [1]. The authors validly mention the unsettled debate on performing genital surgeries on girls with virilized genitalia before the age of consent. In their study the authors, rather than providing conclusive arguments, exhibit the many pitfalls and biases of studying the outcomes of those that received this treatment.
Source: Journal of Pediatric Urology - Category: Urology & Nephrology Authors: Tags: Letter to the Editor Source Type: research
CONCLUSIONS: Physicians handling neonates with faltering growth, particularly in the initial six weeks of life, should be suspicious of mineralocorticoid insufficiency either as isolated hypoaldosteronism or in the context of congenital adrenal hyperplasia. Essential investigations should be performed and appropriate treatment should be administered promptly without awaiting for the hormonal profile results. Interpretation of the clinical picture and the hormonal profile will guide the analysis of candidate genes. Primary selective hypoaldosteronism is a rare, life threatening disease, but still with an unknown overall pop...
Source: Endocrine Regulations - Category: Endocrinology Tags: Endocr Regul Source Type: research
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