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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]]. | ||
| Line 17: | Line 17: | ||
| 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 = dependent on underlying etiology | | 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. | ||
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#*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. | ||
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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]]. | ||
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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): | ||
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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> | ||
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[[Category:Diagnosis]] | [[Category:Diagnosis]] | ||
[[Genitourinary pathology]] | [[Category:Genitourinary pathology]] | ||