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We're talking about variations

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in benign prostatic hypertrophy.

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You've heard about, uh, classifying BPH

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according to the lobes that are involved,

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whether it's posterosuperior or anterior,

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retrourethral, preurethral, median lobe, lateral

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lobe, central lobe or central zone, et cetera.

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And these are refined and defined in other vignettes.

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My purpose in showing you this example of

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balanced enlargement behind the urethra

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and in front of the urethra is twofold.

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First, the posterosuperior component

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in the central zone of the central gland

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is enlarged, the retrourethral portion.

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It is prolapsing into the bladder.

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It's not strangulated at its neck, but it's producing

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marked trigonal stretching of the base of the bladder.

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That's problematic.

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My second reason for showing this case is that you

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might get frightened by these large, bright nodules.

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Back in the day, I witnessed these nodules being biopsied.

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When you have mature prostatic tissue

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that's hypertrophying, what's it gonna make?

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Secretory material.

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So, the rounder, and smoother, and brighter it

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is on T2, the less likely it is to be cancer.

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Because cancers are gonna be gray.

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Yes, there is such a thing as a

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mucinous adenocarcinoma of the prostate.

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But fortunately, it's quite rare.

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So prostate cancer is going

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to have a signal akin to this.

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Not this.

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So even though these nodules are

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weird, bright, large, in funky places.

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Look at these.

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They're exophytic.

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Look at these down here.

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They're, they're posterior to the gland.

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They're exophytic off the back of the gland.

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You can even see nodules like

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this in the peripheral zone.

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And we do.

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So, when you have smooth, round, hyperintense

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nodules on FASP and Echo, either 2D or 3D,

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that is not an indication of malignancy.

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It's an indication of BPH.

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It's the gray ones that are a little irregular,

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or have this smearing, charcoal-like effect, or

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boundary crossing across the surgical capsule.

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Those are the ones you have to worry about.

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So, two points in this case to summarize again.

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Trigonal stretching.

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At the base of the bladder, and multiple foci of

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stromal hyperplasia, making hyperintense nodules.

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They're a little bit scary, but benign,

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sometimes exophytic, on T2, fast spin echo MRI.