Indian Journal of Urology Users online:280  
IJU
Home Current Issue Ahead of print Editorial Board Archives Symposia Guidelines Subscriptions Login 
Print this page  Email this page Small font sizeDefault font sizeIncrease font size


 
REVIEW ARTICLE
Year : 2002  |  Volume : 19  |  Issue : 1  |  Page : 16-19
 

Granulomatous prostatitis - an infrequent diagnosis


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
Login to access the Email id

Source of Support: None, Conflict of Interest: None


Rights and PermissionsRights and Permissions

 
   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

How to cite this URL:
Punia R, Amanjit, Mohan H, Bawa A S. Granulomatous prostatitis - an infrequent diagnosis. Indian J Urol [serial online] 2002 [cited 2019 Nov 18];19:16-9. Available from: http://www.indianjurol.com/text.asp?2002/19/1/16/20286



   Introduction Top


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 Top


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 Top


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 Top


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 Top

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.  Back to cited text no. 1    
2.Stillwell TJ. Engen DE. Farrow GM. The clinical spectrum of granu­lomatous prostatitis : a report of 200 cases. J Urol 1987: 138: 320­-323.  Back to cited text no. 2    
3.Bryan RL. Newman J, Campbell A. Fitzgerald G. Kadow C. O'Brien JM. Granulomatous prostatitis : a clinicopathological study. His­topathology 1991; 19: 453-457.  Back to cited text no. 3    
4.Epstein JI. Hutchins GM. Granulomatous prostatitis: distinction among allergic. non-specific and post-transurethral resection lesions. Hum Path 1984: 15: 818-825.  Back to cited text no. 4    
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.  Back to cited text no. 5    
6.O'Dea MJ, Hunting DB, Greene LF. Non-specific granulomatous prostatitis. J Urol 1977: 118: 58-60.  Back to cited text no. 6    
7.Schmidt JD. Non-specific granulomatous prostatitis : classification. review and report of cases. J Urol 1965: 94: 607-615.  Back to cited text no. 7    
8.O'Dea MJ. Moore SB. Greene LF. Tuberculous prostatitis. Urol­ogy 1978: 11: 483-485.  Back to cited text no. 8    
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.  Back to cited text no. 9    
10.Gritti EJ, Cook FE, Spencer HB. Coccidioidomycosis granuloma of prostate, a rare manifestation of the disseminated disease. J Urol 1963:89:249.  Back to cited text no. 10    
11.Hinchey WW. Someren A. Cryptococcal prostatitis. Am J Clin Path 198k75:257.  Back to cited text no. 11    
12.Sebo TJ. Bostowick DG. Farrow GM. Prostatic xanthoma : a mimic of prostatic adenocarcinoma. Hum Path 1994: 25: 386.  Back to cited text no. 12    
13.Kelalis PP. Greene LF. Harrison EG. Granulomatous prostatitis. a mimic of carcinoma of prostate. JAMA 1965: 191: 287.  Back to cited text no. 13    
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.  Back to cited text no. 14    
15.Keuhnilian JG. Guida PM, Pearce JM. Marshall VF. Experiences with granulornatous prostatitis. J Urol 1964: 91: 173.  Back to cited text no. 15    


    Figures

  [Figure - 1], [Figure - 2], [Figure - 3], [Figure - 4]
 
 
    Tables

  [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]



 

Top
Print this article  Email this article
Previous article Next article

    

 
   Search
 
   Next article
   Previous article 
   Table of Contents
  
    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
    [PDF Not available] *
    Citation Manager
    Access Statistics
    Reader Comments
    Email Alert *
    Add to My List *
* Registration required (free)  


    Abstract
    Introduction
    Material and Methods
    Results
    Discussion
    References
    Article Figures
    Article Tables

 Article Access Statistics
    Viewed6105    
    Printed103    
    Emailed0    
    PDF Downloaded0    
    Comments [Add]    
    Cited by others 1    

Recommend this journal

HEALTHWARE INDIA