|
|
REVIEW ARTICLE |
|
|
|
| Year : 2002 | Volume
: 19
| Issue : 1 | Page : 16-19 |
| |
Granulomatous prostatitis - an infrequent diagnosis
RPS Punia, Amanjit, Harsh Mohan, AS Bawa
Department of Pathology & Surgery, Govt. Medical College, Chandigarh, India
Correspondence Address:
Harsh Mohan
Department of Pathology, Govt. Medical College, Sarai Building, Sector 32-A, Chandigarh - 160 047
India
 Source of Support: None, Conflict of Interest: None  | Check |
 Abstract | | |
Granulomatous prostatitis is a rare disorder of prostate. We encountered 10 cases of'grmudomatous prostatitis consisting of 5 cases of non-specific granulomatous prostatitis, 2 cases of xanthogranulomatous prostatitis, I case of tuberculous prostatitis, I case of malakoplakia prostate and I case of granulomatous prostatitis associated with adenocarcinoma prostate. The diagnosis was made by histopathologic examination of trucut biopsy, TURP chips or retropubic prostatectomy specimen. In all the cases, granulomatous prostatitis was an incidental finding.
Keywords: Prostate; Granulomatous Prostatitis; Infective; Non-Specific Granulomatous Prostatitis; Histology
How to cite this article:
Punia R, Amanjit, Mohan H, Bawa A S. Granulomatous prostatitis - an infrequent diagnosis. Indian J Urol 2002;19:16-9 |
| Introduction | |  |
Granulomatous prostatitis is an unusual benign inflammatory process encountered only occasionally. It was first described by Tanner and Mc Donald in 1943 [1] who reported an incidence of 3.3% of granulomatous prostatitis in inflammatory lesions. Clinically, it presents as hard fixed nodule and mimics prostatic carcinoma on digital rectal examination. [2] The diagnosis is made by histopathological examination only. Out of the various types non-specific granulomatous prostatitis is the most common type. [3],[4] We present 10 cases of granulomatous prostatitis which were diagnosed on hi stop athologi cal examination of TURP chips, needle biopsy and suprapubic prostatectomy specimens.
| Material and Methods | | |
The study was conducted on 10 cases of granulomatous prostatitis retrieved from the histopathologic record on Department of Pathology, Govt. Medical College, Chandigarh over a period of 6 years (1995-2000). Clinical information like presenting complaints, physical findings and laboratory investigations were recorded. Sections from each case were stained with haematoxylin and eosin, Gomori's stain, PAS with and without diastase digestion and Ziehl Neelsen stain.
| Results | | |
Clinical data and histopathologic features of cases is given in [Table - 1]. The age of the patients ranged from 50 to 81 years with a mean of 66.4 years. The most frequent symptoms were increased frequency of micturition, with or without retention. On digital rectal examination, the prostate was firm and nodular in 8 cases while in 2 cases, there was hard fixed nodule which was suspicious of malignancy. In no case granulomatous prostatitis was mentioned as a possible diagnosis. Distribution of specimens submitted for histopathological examination was as follows : TURP chips 7 cases, suprapubic prostatectomy 2 cases, trucut biopsy I case. There was no history of previous prostatic surgery in any of the cases.
Histopathological Findings
Granulomas in 6 cases were focal and diffuse in 4 cases. In 5 cases there were periglandular granulomas composed of neutrophils, eosinophils, histiocytes, lymphocytes and foreign body giant cells [Figure - 1]. In 2 cases granulomas showed focal areas of foamy histiocytic collections in the background of hyperplastic prostate [Figure - 2]. In one case there were multiple epithelioid cell granulomas with Langhans' and foreign body type of giant cells and central areas of caseous necrosis [Figure - 3]. ZN stain for acid fast bacilli was negative. In one case granulomas were composed of macrophages which showed intracellular PAS-positive Michaeli s- Gutmann bodies [Figure - 4]. In one case of adenocarcinoma prostate, there were focal granulomas composed of histiocytes, lymphocytes and foreign body type of giant cells. The cases were classified on the basis of histopathological findings [Table - 2].
| Discussion | | |
Granulomatous prostatitis is an uncommon entity, classification of which is controversial. It has been recently classified into following types: idiopathic (non-specific), infective, iatrogenic (post surgery), malakoplakia and cases associated with systemic granulomatous disease and allergy.[3],[4],[5]
Non-specific granulomatous prostatitis (NSGP) is the most common type. Its etiology is not clear; it may result from foreign body response to colloidal substances, bacterial products, refluxed urine or from an immunological response to extraductal prostatic secretions arising from ducts obstructed by hyperplasia. [3],[7] It is important to differentiate NSGP from specific granulomatous prostatitis as this type is a self-limiting benign condition, while the latter requires treatment . [6]
Infectious granulomatous prostatitis can be caused by Mycobacterium tuberculosis (which was previously the most common type resulting from tuberculous cystitis or miliary tuberculosis), [8] Treponema pallidum, viruses [9] and various fungi. [10],[11] Xanthogranulomatous prostatitis is usually an incidental finding and has been associated with hyperlipidemia. It has to be differentiated from clear cell carcinoma. [12] Iatrogenic granulomatous prostatitis is usually attributed to previous transurethral resection and is due to reaction to altered epithelium and stroma resulting from trauma and surgery. These granulomas tend to disappear with passage of time. [3],[4] Malakoplakia is a rare granulomatous disease of prostate characterized by intracellular Michaelis-Gutmann bodies it is associated with defect in intracellular lysosomal digestion of bacteria. [13] Granulomatous prostatitis associated with adenocarcinoma is a non-specific type of granulomatous prostatitis. [4],[14]
It is difficult to manage patients of granulomatous prostatitis. Non-specific granulomatous prostatitis resolves naturally, whereas infectious granulomatous prostatitis requires medical treatment. Surgical management of granulomatous prostatitis leads to complications like vesical neck contracture[13] and requires repeat resection. [15]
Our study supports the notion that NSGP is the most common type as observed by other workers. Despite tuberculosis being very common in India. granulomatous prostatitis associated with tuberculosis is not common.
| References | | |
| 1. | Tanner FH, Me Donals JR. Granulomatous prostatitis : a histologic study of a group of granulomatous lesions collected from prostate -lands. Arch Pathology Lab Med 1943: 36: 358-370.  |
| 2. | Stillwell TJ. Engen DE. Farrow GM. The clinical spectrum of granulomatous prostatitis : a report of 200 cases. J Urol 1987: 138: 320-323. |
| 3. | Bryan RL. Newman J, Campbell A. Fitzgerald G. Kadow C. O'Brien JM. Granulomatous prostatitis : a clinicopathological study. Histopathology 1991; 19: 453-457. |
| 4. | Epstein JI. Hutchins GM. Granulomatous prostatitis: distinction among allergic. non-specific and post-transurethral resection lesions. Hum Path 1984: 15: 818-825. |
| 5. | Lopez-Plaza 1. Bostwick DG. Granulomatous prostatitis. In Bostwick DG (ed.). Contemporary Issues In Surgical Pathology. Pathology of the Prostate. I"ed. Edinburgh, Churchill Livingstone. 1990: 19-28. |
| 6. | O'Dea MJ, Hunting DB, Greene LF. Non-specific granulomatous prostatitis. J Urol 1977: 118: 58-60. |
| 7. | Schmidt JD. Non-specific granulomatous prostatitis : classification. review and report of cases. J Urol 1965: 94: 607-615. |
| 8. | O'Dea MJ. Moore SB. Greene LF. Tuberculous prostatitis. Urology 1978: 11: 483-485. |
| 9. | Clason AE. McGeorge A, Garland C. Abel BJ. Urinary retention and granulomatous prostatitis following sacral herpes zoster infection : a report of 2 cases and review of literature. Br J Urol 1982; 54: 166-167. |
| 10. | Gritti EJ, Cook FE, Spencer HB. Coccidioidomycosis granuloma of prostate, a rare manifestation of the disseminated disease. J Urol 1963:89:249. |
| 11. | Hinchey WW. Someren A. Cryptococcal prostatitis. Am J Clin Path 198k75:257. |
| 12. | Sebo TJ. Bostowick DG. Farrow GM. Prostatic xanthoma : a mimic of prostatic adenocarcinoma. Hum Path 1994: 25: 386. |
| 13. | Kelalis PP. Greene LF. Harrison EG. Granulomatous prostatitis. a mimic of carcinoma of prostate. JAMA 1965: 191: 287. |
| 14. | Presti B. Weidner N. Granulomatous prostatitis and poorly differentiated adenocarcinoma : their distinction with the use of immunohistochemical methods. Am J Clin Path 1991; 95: 330-334. |
| 15. | Keuhnilian JG. Guida PM, Pearce JM. Marshall VF. Experiences with granulornatous prostatitis. J Urol 1964: 91: 173. |
[Figure - 1], [Figure - 2], [Figure - 3], [Figure - 4]
[Table - 1], [Table - 2]
| This article has been cited by | | 1 |
Tuberculosis of the prostate and seminal vesicles |
|
| Joseph, J., Narayanan, H., Babu, H., Praveen, A. | | Journal of the Hong Kong College of Radiologists. 2010; 13(1): 40-42 | | [Pubmed] | |
|
|
|
|
