Granulomatous prostatitis

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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

Granulomatous prostatitis, also known as prostatic granuloma and prostate gland granuloma, is an uncommon benign finding of 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.

Note:

  • ‡ May also be seen post-biopsy.[5]

Gross/Imaging

  • MRI findings may mimic significant prostate cancer (PI-RADS 4 or 5).[6]

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

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 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

  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.
  5. URL: http://webpathology.com/image.asp?n=6&Case=15. Accessed on: May 10, 2016.
  6. 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.