Difference between revisions of "Granulomatous prostatitis"
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{{ Infobox diagnosis | {{ Infobox diagnosis | ||
| Name = {{PAGENAME}} | | Name = {{PAGENAME}} | ||
| Image = Granulomatous_inflammation_of_bladder_neck.jpg | | Image = Granulomatous_inflammation_of_bladder_neck.jpg | ||
| Width = | | Width = | ||
| Caption = Granulomatous prostatitis. [[H&E stain]]. | | Caption = Granulomatous prostatitis. [[H&E stain]]. | ||
| Micro = [[ | | Micro = [[granuloma]]s +/- eosinophils | ||
| Subtypes = | | Subtypes = non-specific, post-TURP, specific, allergic | ||
| LMDDx = disseminated granulomatous diseases | | LMDDx = disseminated granulomatous diseases | ||
| Stains = | | Stains = [[GMS stain]], [[Ziehl-Neelsen stain]] | ||
| IHC = | | IHC = | ||
| EM = | | EM = | ||
| Line 14: | Line 14: | ||
| Gross = | | Gross = | ||
| Grossing = | | Grossing = | ||
| Site = | | Site = [[prostate gland]] | ||
| Assdx = | | Assdx = | ||
| Syndromes = | | Syndromes = | ||
| Clinicalhx = | |||
| Signs = | | Signs = | ||
| Symptoms = | | Symptoms = | ||
| Prevalence = | | Prevalence = uncommon | ||
| Bloodwork = | | Bloodwork = | ||
| Rads = | | Rads = may be [[PI-RADS]] 4 or 5 | ||
| Endoscopy = | | Endoscopy = | ||
| Prognosis = | | Prognosis = dependent on underlying etiology | ||
| Other = | | Other = | ||
| ClinDDx = other types of [[prostatitis]] | | ClinDDx = other types of [[prostatitis]], [[prostate carcinoma]] | ||
}} | }} | ||
'''Granulomatous prostatitis''', also known as '''prostatic granuloma''' and '''prostate gland granuloma''', is | {{ Infobox external links | ||
| Name = {{PAGENAME}} | |||
| EHVSC = 10148 | |||
| pathprotocols = | |||
| wikipedia = | |||
| pathoutlines = | |||
}} | |||
'''Granulomatous prostatitis''', also known as '''prostatic granuloma''' and '''[[prostate gland]] granuloma''', is an uncommon benign finding of the prostate. | |||
==General== | ==General== | ||
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#*No cause identified, usu. incidentally discovered. | #*No cause identified, usu. incidentally discovered. | ||
#*Most common. | #*Most common. | ||
#Post-[[TURP]]. | #Post-[[TURP]]. ‡ | ||
#*Palisading [[granuloma]] with necrotic core (histology similar to a [[rheumatoid nodule]]<ref name=pmid6703198>{{Cite journal | last1 = Mies | first1 = C. | last2 = Balogh | first2 = K. | last3 = Stadecker | first3 = M. | title = Palisading prostate granulomas following surgery. | journal = Am J Surg Pathol | volume = 8 | issue = 3 | pages = 217-21 | month = Mar | year = 1984 | doi = | PMID = 6703198 }}</ref><ref>URL: [http://www.humpath.com/spip.php?article18010 http://www.humpath.com/spip.php?article18010]. Accessed on: 26 September 2012.</ref>) +/- eosinophils. | #*Palisading [[granuloma]] with necrotic core (histology similar to a [[rheumatoid nodule]]<ref name=pmid6703198>{{Cite journal | last1 = Mies | first1 = C. | last2 = Balogh | first2 = K. | last3 = Stadecker | first3 = M. | title = Palisading prostate granulomas following surgery. | journal = Am J Surg Pathol | volume = 8 | issue = 3 | pages = 217-21 | month = Mar | year = 1984 | doi = | PMID = 6703198 }}</ref><ref>URL: [http://www.humpath.com/spip.php?article18010 http://www.humpath.com/spip.php?article18010]. Accessed on: 26 September 2012.</ref>) +/- eosinophils. | ||
#Specific. | #Specific. | ||
| Line 46: | Line 54: | ||
#*Usually associated with eosinophils. | #*Usually associated with eosinophils. | ||
#*Examples: | #*Examples: | ||
#*#[[Wegener granulomatosis | #*#[[Granulomatosis with polyangiitis]] (Wegener granulomatosis). | ||
#*#[[Churg-Strauss syndrome]]. | #*#[[Eosinophilic granulomatosis with polyangiitis]] (Churg-Strauss syndrome). | ||
Note: | |||
*‡ May also be seen post-biopsy.<ref>URL: [http://webpathology.com/image.asp?n=6&Case=15 http://webpathology.com/image.asp?n=6&Case=15]. Accessed on: May 10, 2016.</ref> | |||
==Gross/Imaging== | |||
*MRI findings may mimic significant prostate cancer ([[PI-RADS]] 4 or 5).<ref name=pmid28238033>{{Cite journal | last1 = Rais-Bahrami | first1 = S. | last2 = Nix | first2 = JW. | last3 = Turkbey | first3 = B. | last4 = Pietryga | first4 = JA. | last5 = Sanyal | first5 = R. | last6 = Thomas | first6 = JV. | last7 = Gordetsky | first7 = JB. | title = Clinical and multiparametric MRI signatures of granulomatous prostatitis. | journal = Abdom Radiol (NY) | volume = 42 | issue = 7 | pages = 1956-1962 | month = Jul | year = 2017 | doi = 10.1007/s00261-017-1080-0 | PMID = 28238033 }}</ref> | |||
==Microscopic== | ==Microscopic== | ||
Features: | Features: | ||
*[[Granulomas]] in the prostate - '''key feature'''. | *[[Granulomas]] in the prostate - '''key feature'''. | ||
**Palisading granulomas with a necrotic core (similar to a [[rheumatoid nodule]]) consistent a prior TURP.<ref name=pmid6703198/> | **+/-Palisading granulomas with a necrotic core (similar to a [[rheumatoid nodule]]) - consistent a with prior TURP.<ref name=pmid6703198/> | ||
*+/-Eosinophils. | *+/-Eosinophils. | ||
| Line 60: | Line 74: | ||
Image:Granulomatous_inflammation_of_bladder_neck_high_mag.jpg | Granulomatous inflammation of the prostate/bladder neck - high mag. (WC/Nephron) | Image:Granulomatous_inflammation_of_bladder_neck_high_mag.jpg | Granulomatous inflammation of the prostate/bladder neck - high mag. (WC/Nephron) | ||
</gallery> | </gallery> | ||
==Stains== | ==Stains== | ||
*[[GMS stain]]. | *[[GMS stain]]. | ||
| Line 65: | Line 80: | ||
Note: | Note: | ||
*Stains are indicated when there is a suspicion of an infective etiology based on histomorphology or clinical information (e.g. immunosuppression). | *Stains are indicated when there is a suspicion of an infective etiology based on histomorphology ([[necrosis]]) or clinical information (e.g. immunosuppression). | ||
==Sign out== | ==Sign out== | ||
===Post-TURP=== | ===Post-TURP=== | ||
<pre> | |||
Prostate Tissue, Transurethral Resection of the Prostate (TURP): | |||
- Benign prostatic tissue with glandular and stromal proliferation. | |||
- Palisading granulomas with necrotic cores and scarring, see comment. | |||
COMMENT: | |||
The granuloma morphology is consistent with post-TURP changes. | |||
</pre> | |||
====Block letters==== | |||
<pre> | <pre> | ||
PROSTATE GLAND, TRANSURETHRAL RESECTION OF THE PROSTATE (TURP): | PROSTATE GLAND, TRANSURETHRAL RESECTION OF THE PROSTATE (TURP): | ||
| Line 95: | Line 120: | ||
Infectious etiologies of granulomatous disease should be considered clinically. | Infectious etiologies of granulomatous disease should be considered clinically. | ||
</pre> | |||
===Isolated granuloma without necrosis=== | |||
<pre> | |||
D. PROSTATE, RIGHT MEDIAL INFERIOR, BIOPSY: | |||
- BENIGN PROSTATE TISSUE; | |||
- ACUTE AND CHRONIC INFLAMMATION; | |||
- FOCAL GIANT CELLS AND AN ISOLATED GRANULOMA WITHOUT APPARENT NECROSIS. | |||
COMMENT: | |||
The granuloma (Part D) is histologically favoured to be nonspecific (as | |||
most prostate granulomas are); however, this finding should be interpreted | |||
within the clinical context. | |||
</pre> | |||
===Periprostatic foreign body-type=== | |||
<pre> | |||
D. PROSTATE, RIGHT MEDIAL MIDZONE, BIOPSY: | |||
- BENIGN PROSTATE TISSUE; | |||
- FOREIGN BODY-TYPE GRANULOMA, NON-NECROTIZING, SEE COMMENT. | |||
COMMENT: | |||
The granuloma appears to be within the periprostatic soft tissue. It consists | |||
of multinucleated (foreign body-type) giant cells, hyaline material, and rare | |||
interspersed neutrophils. No necrosis is identified. This finding may represent | |||
a reaction to displaced epithelium. | |||
</pre> | </pre> | ||
| Line 105: | Line 156: | ||
[[Category:Diagnosis]] | [[Category:Diagnosis]] | ||
[[Genitourinary pathology]] | [[Category:Genitourinary pathology]] | ||
Latest revision as of 15:19, 5 May 2019
Granulomatous prostatitis, also known as prostatic granuloma and prostate gland granuloma, is an uncommon benign finding of the prostate.
| Granulomatous prostatitis | |
|---|---|
| Diagnosis in short | |
 Granulomatous prostatitis. H&E stain. | |
|
| |
| LM | granulomas +/- eosinophils |
| Subtypes | non-specific, post-TURP, specific, allergic |
| LM DDx | disseminated granulomatous diseases |
| Stains | GMS stain, Ziehl-Neelsen stain |
| Site | prostate gland |
|
| |
| Prevalence | uncommon |
| Radiology | may be PI-RADS 4 or 5 |
| Prognosis | dependent on underlying etiology |
| Clin. DDx | other types of prostatitis, prostate carcinoma |
| Granulomatous prostatitis | |
|---|---|
| External resources | |
| EHVSC | 10148 |
General
- Common.
- Usually secondary to BCG treatment of bladder cancer.
- Several classifications exist[1] - the most commonly used is by Epstein & Hutchins.
Epstein & Hutchins classification
The groupings:[2]
- Non-specific.
- No cause identified, usu. incidentally discovered.
- Most common.
- Post-TURP. ‡
- Palisading granuloma with necrotic core (histology similar to a rheumatoid nodule[3][4]) +/- eosinophils.
- Specific.
- Identifiable infectious agent, usu. BCG (in the context of treating bladder cancer), rarely tuberculosis and even more rarely various fungi and syphilis.
- Allergic granulomatous prostatitis.
- Usually associated with eosinophils.
- Examples:
- Granulomatosis with polyangiitis (Wegener granulomatosis).
- Eosinophilic granulomatosis with polyangiitis (Churg-Strauss syndrome).
Note:
- ‡ May also be seen post-biopsy.[5]
Gross/Imaging
Microscopic
Features:
- Granulomas in the prostate - key feature.
- +/-Palisading granulomas with a necrotic core (similar to a rheumatoid nodule) - consistent a with prior TURP.[3]
- +/-Eosinophils.
Images
Granulomatous inflammation of the prostate/bladder neck - low mag. (WC/Nephron)
Granulomatous inflammation of the prostate/bladder neck - high mag. (WC/Nephron)
Stains
Note:
- Stains are indicated when there is a suspicion of an infective etiology based on histomorphology (necrosis) or clinical information (e.g. immunosuppression).
Sign out
Post-TURP
Prostate Tissue, Transurethral Resection of the Prostate (TURP): - Benign prostatic tissue with glandular and stromal proliferation. - Palisading granulomas with necrotic cores and scarring, see comment. COMMENT: The granuloma morphology is consistent with post-TURP changes.
Block letters
PROSTATE GLAND, TRANSURETHRAL RESECTION OF THE PROSTATE (TURP): - BENIGN PROSTATIC TISSUE WITH GLANDULAR AND STROMAL PROLIFERATION. - PALISADING GRANULOMA WITH NECROTIC CORE, SEE COMMENT. COMMENT: This is morphologically consistent with a post-TURP granuloma.
Idiopathic
A-L. PROSTATE GLAND, RIGHT LATERAL SUPERIOR, RIGHT MEDIAL SUPERIOR, RIGHT LATERAL MIDZONE, RIGHT MEDIAL MIDZONE, RIGHT LATERAL INTERIOR, RIGHT MEDIAL INFERIOR, LEFT LATERAL SUPERIOR, LEFT MEDIAL SUPERIOR, LEFT LATERAL MIDZONE, LEFT MEDIAL MIDZONE, LEFT LATERAL INTERIOR, LEFT MEDIAL INFERIOR, CORE BIOPSIES: - BENIGN PROSTATE TISSUE; - GRANULOMATOUS PROSTATITIS, NON-NECROTIZING, SEE COMMENT. COMMENT: Granulomatous prostatitis is usually idiopathic. Other possibilities include: post-procedural granulomatous inflammation (e.g. post-TURP, BCG treatment), allergic prostatitis and infections. Infectious etiologies of granulomatous disease should be considered clinically.
Isolated granuloma without necrosis
D. PROSTATE, RIGHT MEDIAL INFERIOR, BIOPSY: - BENIGN PROSTATE TISSUE; - ACUTE AND CHRONIC INFLAMMATION; - FOCAL GIANT CELLS AND AN ISOLATED GRANULOMA WITHOUT APPARENT NECROSIS. COMMENT: The granuloma (Part D) is histologically favoured to be nonspecific (as most prostate granulomas are); however, this finding should be interpreted within the clinical context.
Periprostatic foreign body-type
D. PROSTATE, RIGHT MEDIAL MIDZONE, BIOPSY: - BENIGN PROSTATE TISSUE; - FOREIGN BODY-TYPE GRANULOMA, NON-NECROTIZING, SEE COMMENT. COMMENT: The granuloma appears to be within the periprostatic soft tissue. It consists of multinucleated (foreign body-type) giant cells, hyaline material, and rare interspersed neutrophils. No necrosis is identified. This finding may represent a reaction to displaced epithelium.
See also
References
- ↑ Uzoh, CC.; Uff, JS.; Okeke, AA. (Mar 2007). "Granulomatous prostatitis.". BJU Int 99 (3): 510-2. doi:10.1111/j.1464-410X.2006.06585.x. PMID 17092284.
- ↑ Epstein, JI.; Hutchins, GM. (Sep 1984). "Granulomatous prostatitis: distinction among allergic, nonspecific, and post-transurethral resection lesions.". Hum Pathol 15 (9): 818-25. PMID 6432674.
- ↑ 3.0 3.1 Mies, C.; Balogh, K.; Stadecker, M. (Mar 1984). "Palisading prostate granulomas following surgery.". Am J Surg Pathol 8 (3): 217-21. PMID 6703198.
- ↑ URL: http://www.humpath.com/spip.php?article18010. Accessed on: 26 September 2012.
- ↑ URL: http://webpathology.com/image.asp?n=6&Case=15. Accessed on: May 10, 2016.
- ↑ Rais-Bahrami, S.; Nix, JW.; Turkbey, B.; Pietryga, JA.; Sanyal, R.; Thomas, JV.; Gordetsky, JB. (Jul 2017). "Clinical and multiparametric MRI signatures of granulomatous prostatitis.". Abdom Radiol (NY) 42 (7): 1956-1962. doi:10.1007/s00261-017-1080-0. PMID 28238033.