A historical perspective on the role of stroma in the pathogenesis of benign prostatic hyperplasia

This review summarizes the concept that the neo-formation of ductal-acinar architecture in the pathogenesis of benign prostatic hyperplasia (BPH) is due to the reactivation of embryonic inductive activity by BPH stroma, an idea enunciated by John McNeal. The concept is the synthesis of McNeal's astute pathological inference based upon developmental biology and supported by the mesenchymal–epithelial interaction studies. In a broader context, McNeal's concept of framing epithelial pathogenesis in terms of developmental biological principals has been extended more recently into the field of carcinogenesis under the umbrella of tumor microenvironment.