Difference between revisions of "Granulomatous prostatitis"

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#redirect [[Prostate_gland#Granulomatous_prostatitis]]
{{ Infobox diagnosis
| Name      = {{PAGENAME}}
| Image      = Granulomatous_inflammation_of_bladder_neck.jpg
| Width      =
| Caption    = Granulomatous prostatitis. [[H&E stain]].
| Micro      = [[Granuloma]]s
| Subtypes  =
| LMDDx      = disseminated granulomatous diseases
| Stains    =
| IHC        =
| EM        =
| Molecular  =
| IF        =
| Gross      =
| Grossing  =
| Site      =
| Assdx      =
| Syndromes  =
| Signs      =
| Symptoms  =
| Prevalence =
| Bloodwork  =
| Rads      =
| Endoscopy  =
| Prognosis  =
| Other      =
| ClinDDx    = other types of [[prostatitis]]
}}
'''Granulomatous prostatitis''', also known as '''prostatic granuloma''' and '''prostate gland granuloma''', is a common benign finding the prostate.
 
==General==
*Common.
*Usually secondary to BCG treatment of [[urinary bladder cancer|bladder cancer]].
*Several classifications exist<ref name=pmid17092284>{{Cite journal  | last1 = Uzoh | first1 = CC. | last2 = Uff | first2 = JS. | last3 = Okeke | first3 = AA. | title = Granulomatous prostatitis. | journal = BJU Int | volume = 99 | issue = 3 | pages = 510-2 | month = Mar | year = 2007 | doi = 10.1111/j.1464-410X.2006.06585.x | PMID = 17092284 | URL = http://onlinelibrary.wiley.com/doi/10.1111/j.1464-410X.2006.06585.x/full }}</ref> - the most commonly used is by ''Epstein & Hutchins''.
 
===Epstein & Hutchins classification===
The groupings:<ref name=pmid6432674>{{Cite journal  | last1 = Epstein | first1 = JI. | last2 = Hutchins | first2 = GM. | title = Granulomatous prostatitis: distinction among allergic, nonspecific, and post-transurethral resection lesions. | journal = Hum Pathol | volume = 15 | issue = 9 | pages = 818-25 | month = Sep | year = 1984 | doi =  | PMID = 6432674 }}</ref>
#Non-specific.
#*No cause identified, usu. incidentally discovered.
#*Most common.
#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.
#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:
#*#[[Wegener granulomatosis]].
#*#[[Churg-Strauss syndrome]].
 
==Microscopic==
Features:
*[[Granulomas]] in the prostate - '''key feature'''.
**Palisading granulomas with a necrotic core (similar to a [[rheumatoid nodule]]) consistent a prior TURP.<ref name=pmid6703198/>
*+/-Eosinophils.
 
===Images===
<gallery>
Image:Granulomatous_inflammation_of_bladder_neck.jpg | Granulomatous inflammation of the prostate/bladder neck - low mag. (WC/Nephron)
Image:Granulomatous_inflammation_of_bladder_neck_high_mag.jpg | Granulomatous inflammation of the prostate/bladder neck - high mag. (WC/Nephron)
</gallery>
==Stains==
*[[GMS stain]].
*[[Ziehl-Neelsen stain]].
 
Note:
*Stains are indicated when there is a suspicion of an infective etiology based on histomorphology or clinical information (e.g. immunosuppression).
 
==Sign out==
===Post-TURP===
<pre>
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.
</pre>
 
===Idiopathic===
<pre>
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.
</pre>
 
==See also==
*[[Prostate gland]].
*[[Genitourinary pathology]]
 
==References==
{{Reflist|2}}


[[Category:Diagnosis]]
[[Category:Diagnosis]]
[[Genitourinary pathology]]

Revision as of 20:45, 29 June 2013

Granulomatous prostatitis
Diagnosis in short

Granulomatous prostatitis. H&E stain.
LM Granulomas
LM DDx disseminated granulomatous diseases
Clin. DDx other types of prostatitis

Granulomatous prostatitis, also known as prostatic granuloma and prostate gland granuloma, is a common benign finding the prostate.

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]

  1. Non-specific.
    • No cause identified, usu. incidentally discovered.
    • Most common.
  2. Post-TURP.
  3. Specific.
    • Identifiable infectious agent, usu. BCG (in the context of treating bladder cancer), rarely tuberculosis and even more rarely various fungi and syphilis.
  4. Allergic granulomatous prostatitis.

Microscopic

Features:

  • Granulomas in the prostate - key feature.
    • Palisading granulomas with a necrotic core (similar to a rheumatoid nodule) consistent a 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 or clinical information (e.g. immunosuppression).

Sign out

Post-TURP

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.

See also

References

  1. ↑ 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.
  2. ↑ 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. ↑ 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.
  4. ↑ URL: http://www.humpath.com/spip.php?article18010. Accessed on: 26 September 2012.

Genitourinary pathology

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