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Prostate

Granulomatous lesions

General


Reviewers: Gladell Paner, M.D. (see Reviewers page)
Revised: 12 February 2012, last major update February 2012
Copyright: (c) 2003-2012, PathologyOutlines.com, Inc.

General
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● Seen in 0.8% of benign prostate specimens and 0.3% of prostate needle biopsies
● Non-specific granulomatous prostatitis most common, comprising 50-78%
● Includes non-specific, post-procedural, iatrogenic, infectious, systemic and secondary granulomatous prostatitis (Hum Pathol 1984;15:818, BJU Int 2007;99:510)

Etiology
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● Post-procedural (post-transurethral resection and post-needle biopsy granulomas)
● Infectious causes include Bacillus Calmette-Guérin (BCG)-related granuloma, bacterial (Mycobacterium tuberculosis [most common], Treponema pallidum, Brucella abortus), fungal (blastomycosis, Cryptococcus), parasitic (schistosomiasis) and viral (Herpes zoster)
● Secondary to systemic granulomas such as allergic (eosinophilic) granulomatous prostatitis and Churg-Strauss syndrome

Clinical features
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● 2/3 occur at ages 50-70 years
● May present with irritative voiding symptoms (e.g urgency, frequency, dysuria), fevers or chills, but asymptomatic in 10%
● Firm nodular prostate on digital rectal examination may be suspicious for carcinoma
● PSA may be elevated
● May coexist with prostate carcinoma

Treatment
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● Most require no treatment
● May require prostatectomy to relieve obstructive symptoms
● Antibiotics for infections and steroids for systemic granulomas

Gross description
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● Firm yellow nodular prostate

Micro description
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● Non-specific: expansile nodular infiltrates usually involving entire lobules with epithelioid histiocytes, lymphocytes, plasma cells, neutrophils and variable eosinophilc infiltrates (Arch Pathol Lab Med 1997;121:724)
● Post-transurethral resection: resembles rheumatoid nodules with necrobiotic granolumas surrounded by palisaded histiocytes and frequent multinucleated giant cells (J Urol 1988;140:751)
● BCG-related: multiple caseating and non-caseating granulomas; acid-fast bacilli in 1/3
● Allergic: necrobiotic granulomas surrounded by palisaded histiocytes with variable eosinophilic infiltrates

End of Prostate > Granulomatous lesions > General


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