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Difference between revisions of "Granulomatous prostatitis"
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# | {{ 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]] | |||