Nonspecific Granulomatous Prostatitis Research Articles

Strong PD-L1 expression in granulomatous prostatitis.

The expression of programmed cell death ligand protein (PD-L1) is weakly investigated in non-tumoral and inflammatory prostatic pathology. The diagnosis of granulomatous prostatitis (GP) rests on the recognition of localized or diffuse epithelioid granulomatous inflammation in prostatic tissue which is frequently difficult by conventional histological observation alone. PD-L1 expression in GP is not well studied so far. We studied PD-L1 expression in 17 GP cases (9 nonspecific GP, 5 Bacillus Calmette-Guérin induced prostatitis, 1 prostatic tuberculosis, and 3 cases of postsurgical prostatic granulomas). The control group included 10 radical prostatectomies of patients with high Gleason score prostate adenocarcinoma (PCa) and National Institutes of Health-category IV prostatitis (high-grade histologic prostatitis; HG-HP). All of the GP cases showed easily visible strong membranous PD-L1 expression (high levels of combined positive score) in localized and diffuse epithelioid granulomatous prostatic inflammation. None of the control cases showed the presence of significant PD-L1 expression in inflammatory infiltrates in HG-HP, tumor parenchyma, and stroma in PCa. The study presents the first attempt to examine PD-L1 expression in GP. Granulomatous inflammation in GP is easily identified when stained with PD-L1.

PD-L1 positive lympho-epithelial lesions in inflammatory prostate.

Ductal epithelial changes (lympho-epithelial lesions-LEL) in prostatic chronic inflammation (CI) are not well studied so far. to investigate LEL immediately adjacent to prostatic CI. We studied LEL in 144 prostatic surgical and autopsy specimens in various types of prostatic CI: NIH-category IV prostatitis (histologic prostatitis-HP), nonspecific granulomatous prostatitis (NSGP), and the reactive lymphoid infiltrates in the vicinity of benign prostatic hyperplasia (BPH) and prostate adenocarcinoma (PCa). CI is scored as low and high grade (LG, HG) according to the severity of inflammation. LEL was identified in all types of prostatic specimens and in all types of prostatic CI: in 70.9% of patients with HP; in 100% of cases with NSGP; in 68.7% and in 80% adjacent to BPH and PCa respectively. Statistical analysis showed a significant correlation of the presence of LEL with HG CI (p<0.001). LEL showed strong membranous PD-L1 expression. The study presents the first attempt to examine LEL in inflammatory human prostate. PD-L1 positive LEL have no diagnostic organ specificity, although they are a constant histological finding in HG prostatic CI. LEL, inducible after birth by CI, are an integral part of prostate-associated lymphoid tissue (PALT) and of the inflammatory prostatic microenvironment.

Clinical Significance of Caseating Granulomas Detected on Transrectal Ultrasound Biopsy of Prostate Gland: The Recommended Management

Introduction: The histopathological examination (HPE) findings of caseating granulomas from the transrectal ultrasound (TRUS) of prostate biopsy are rare. A high index of suspicion is necessary to diagnose a tuberculosis infection. Here, we present the clinical outcomes of patients and the practical management steps when encounter these findings. Methods: We conducted a retrospective analysis of three cases in a tertiary care centre and reviewed the available literature on the topic. Results: All patients were aged less than 55 years and were considered young adults. One patient presented with neurogenic systemic symptoms, and two patients presented with lower urinary tract symptoms. All patients had abnormal digital rectal examination findings that warranted a TRUS biopsy of the prostate. All biopsies reported caseating granuloma with multinucleated giant cells. Additional investigations led to the diagnosis of tuberculosis infections in two patients, and one patient was diagnosed as having non-specific granulomatous prostatitis. All patients were treated according to their specific diagnosis and recovered fully. Conclusion: The detection of caseating granuloma on prostate biopsy may lead to diagnoses of several conditions, either infective or non-infective in origin. Further investigation is mandatory to provide appropriate treatment.

Granulomatous prostatitis: A clinico-pathological series of 27 cases

Objectives: This study aimed to assess the incidence and discern the histomorphological spectrum of granulomatous prostatitis. Methods: A retrospective analysis of histopathological records of 1773 prostatic specimens received in the pathology department was done over a period of seven years. All histologically proven cases of granulomatous prostatitis were retrieved, the relevant clinical data were collected from patient records and the lesions were categorized accordingly. Results: Out of 1773 cases, 27 cases of granulomatous prostatitis were identified. The age range of these patients was between 50 and 89 years. Among the patients, non-specific granulomatous prostatitis (NSGP) was the most common followed by tubercular prostatitis, post-surgical prostatitis and xanthogranulomatous prostatitis. Three cases of post-surgical prostatitis were associated with malignancy. Serum prostate-specific antigen (PSA) levels ranged between 0.8 and 20.94 ng/mL (median 10.78 ng/mL). The diagnosis was made by histopathological examination of transrectal ultrasound (TRUS)-guided core biopsies, Trucut biopsies, transuretheral resection of prostate chips, prostatectomy and cystoprostatectomy specimens. Conclusion: In the present study, the incidence of granulomatous prostatitis was 1.5%. The patients usually present as hard nodules on digital rectal examination along with raised serum PSA levels. Carcinoma or benign prostatic hyperplasia was kept as a clinical diagnosis in these cases. Since the diagnosis of granulomatous prostatitis is made on histopathological examination only, meticulous histomorphological assessment is therefore required to reach a definitive diagnosis of granulomatous prostatitis.

A clinico-histopathological spectrum of Prostatic lesions at a tertiary care teaching institute

: Prostatic carcinoma is the second most common cause of cancer deaths in men and the incidence is increasing significantly in recent years, due to early screening measures. A study designed to identify the prostatic lesions spectrum as per histopathological classification.: 50 prostatic lesion samples collected in 10% formalin were subjected to H and E stain and the mean AgNOR counts were calculated.: Out of 50 specimens, 80% were benign and 20% belongs to malignancy. The mean age of patient’s benign and malignant lesions is 63.5 ± 9.2 years and 69.5 ± 8.5 years respectively (P=0.09). The most common clinical symptom of benign lesions was frequency in35 patients, followed by hesitancy and nocturia in 33 and 30 patients respectively. Serum PSA values above 10ng/ml were seen in 10 benign cases and 5 malignant cases (P=0.02). Out of 50 cases, 35 were BPH, 5 were non-specific granulomatous prostatitis, 8 prostatic adenocarcinoma, 1 case urothelial carcinoma and 1case with both prostatic adenocarcinoma and urothelial carcinoma were recorded. High grade PIN identified in 9 specimens and low grade PIN identified in 8 specimens. High grade PIN shows association with adenocarcinoma. Basal cell hyperplasia identified in 3 specimens. Tufting Pattern was observed in 2 specimens, flat Pattern observed in 4 specimens, and cribriform pattern observed in 1 specimen out of 9. Majority of patients diagnosed as conventional adenocarcinoma with a score of 9 (3 cases) followed by score of 8 (2 cases).: BHP is the most common non neoplastic prostate lesion, and commonly encountered in age group of 60- 70 years. In the current scenario, histopathological analysis of prostate specimens plays crucial role in both diagnosis and management.

Histopathology of nonspecific granulomatous prostatitis with special reference to eosinophilic epithelial metaplasia: Pathophysiologic, diagnostic and differential diagnostic correlations.

Recently, we publish two case reports about association of nonspecific granulomatous prostatitis (NSGP) and eosinophilic metaplasia (EM) in benign prostatic epithelium. There is no investigation of large series of this association in medical literature. Aim of the current study is to investigate the frequency of association of NSGP and prostatic EM in a large series of cases and their relationship with the basic prostate pathology: benign prostatic hyperplasia (BPH), National Institutes of Health-category IV prostatitis (so-called histologic prostatitis (HP)), and prostatic adenocarcinoma (PCa). A retrospective record review for NSGP was performed on a total of 2366 prostatic specimens of all types of material. All cases of NSGP were reviewed for the presence of EM, BPH, and HP. NSGP with EM-cases and control cases with high grade PCa with endocrine differentiation (so-called Paneth cell-like changes) were evaluated immunohistochemically. NSGP was found in nine cases (0.38%). EM was detected in benign perigranulomatous secretory epithelial cells in 100% of cases with NSGP and were closely associated with BPH and HP. Immunohistochemically, in 55.5% of cases with EM, there was weak focal apical false-positive staining for p504s. EM is a very common lesion in NSGP and reflects histologically a nonspecific cellular response, connected with repeated inflammation, in close relation with BPH and HP. We speculate that EM might serve as a morphological precursor of the immunologic phase of NSGP. This constant morphological finding could facilitate the histopathological differential diagnosis of NSGP with other types of granulomatous prostatitis and high grade PCa with or without endocrine differentiation.

Granulomatous prostatitis: clinical and histomorphologic survey of the disease in a tertiary care hospital.

BackgroundGranulomatous prostatitis is an uncommon entity that is diagnosed incidentally on histopathology and is broadly classified as nonspecific, specific, postsurgical (post-transurethral resection), or secondary to other rare systemic granulomatous diseases. Only very few studies are available in the literature that describe the clinical and histomorphological spectrum of the disease.MethodsA retrospective analysis of histopathological records of 1,181 prostatic specimens received in the pathology department was done over a period of 13 years (January 2003 to January 2016). All histologically proven cases of granulomatous prostatitis were retrieved, and relevant clinical data were collected from patients’ records. Epstein and Hutchins classification was used to categorize these cases.ResultsTwenty-two cases of granulomatous prostatitis were identified, accounting for an incidence of 1.86%. Among these, nonspecific granulomatous prostatitis (n = 10) was the most common followed by tubercular prostatitis (n = 5), posttransurethral resection of the prostate (n = 3), allergic (n = 2), and xanthogranulomatous prostatitis (n = 2). The age range of these patients was between 41 and 75 years, with the majority of patients in their 7th decade. Serum prostate-specific antigen levels ranged between 0.88 ng/mL and 19.22 ng/mL. Hard and fixed nodules were observed on digital rectal examination in 14 cases. Transrectal ultrasound revealed hypoechoic shadows in five cases.ConclusionDespite present-day advances in imaging modalities and serological investigations, it is virtually impossible to identify granulomatous prostatitis clinically. Histopathology remains the gold standard in diagnosing the disease. However, assigning an etiologic cause to the wide spectrum of granulomas in granulomatous prostatitis requires a pathologist’s expertise and proper clinical correlation for appropriate patient management.

Clinicopathological Overview of Granulomatous Prostatitis: An Appraisal.

Granulomatous prostatitis is a rare inflammatory condition of the prostate. Granulomatous prostatitis is important because, it mimics prostatic carcinoma clinically and hence the diagnosis can be made only by histopathological examination. To study the histomorphological features and to know the prevalence of granulomatous prostatitis. Histopathological records of 1,203 prostatic specimens received in the Department of the Pathology over a period of five years (June 2009 - June 2014). Seventeen cases of histopathologically, diagnosed granulomatous prostatitis were retrieved and reterospective data was collected from the patient's records. Out of 17 cases of granulomatous prostatitis, we encountered 9 cases of non-specific granulomatous prostatitis, 5 cases of xanthogranulomatous prostatitis and 3 cases of specific tubercular prostatitis. The common age ranged from 51-75 years (mean 63 years) with mean PSA level of 15.8ng/ml. Six patients showed focal hypoechoic areas on TRUS and 11 cases revealed hard and fixed nodule on DRE. Non-specific granulomatous prostatitis is the most common type of granulomatous prostatitis. There is no specific pattern of clinical, biochemical and ultrasound findings that allows the diagnosis of granulomatous prostatitis or differentiates it from prostatic carcinoma. Hence, histomorphological diagnosis is the gold standard in differentiating various prostatic lesions.

Mycobacterium abscessus Granulomatous Prostatitis

Infectious granulomatous prostatitis is uncommon, and most cases of granulomatous prostatitis are classified as nonspecific granulomatous prostatitis. From 2007 to 2009, 5 patients experienced poor wound healing after radical prostatectomy for prostate cancer at a specialist cancer center. Mycobacterium abscessus was cultured from the debridement specimens, and acid-fast-positive bacilli were identified histologically within the prostates. All 180 radical prostatectomy specimens from May 2007 to June 2009 were reviewed, and 7 additional cases with morphologies suspicious of M. abscessus granulomatous prostatitis (MAGP) were identified. The characteristic morphologic feature of MAGP was suppurative necrotizing granulomatous inflammation extensively (10% to 80% of the gland; mean, 39%) involving the prostate. The centers of MAGP were large areas of neutrophilic abscess and necrotic debris, which were surrounded by histiocytes, lymphocytes, plasma cells, scattered multinucleated giant cells, and eosinophils. In the adjacent areas, there was a lobular extension of mixed inflammatory infiltrates into dilated and ruptured ducts. Involvement of extraprostatic soft tissue and seminal vesicles/vas deferens was found in 9 and 4 cases, respectively. Acid-fast-positive bacilli were identified in 5 radical prostatectomies. Eleven patients had fresh tissue specimens stored at -150°C, and M. abscessus was cultured from 8 prostates. Random amplified polymorphic DNA-polymerase chain reaction showed the same clone for all isolates. After prostatectomy, 8 patients experienced prolonged wound healing, with urethrorectal fistula formation in 1 patient and a pelvic abscess in another. It is critical for pathologists to recognize MAGP and to distinguish it from the more common nonspecific granulomatous prostatitis and other granulomatous lesions within the prostate.

Benign mimickers and potential precursors of prostatic adenocarcinoma

The diagnosis of prostatic adenocarcinoma (PCa) in needle biopsy, especially when present in small amounts, is often challenging. Before making a malignant diagnosis, it is imperative to consider and rule out various benign processes that can simulate cancer. A useful method of classifying benign mimickers is in relationship to the major architectural patterns depicted in the Gleason diagram. The four major patterns are small gland, large gland, fused gland and solid nests and single cells. Most mimickers have small gland architecture and include atrophy, post-atrophic hyperplasia and atypical adenomatous hyperplasia. Normal anatomical and vestigial structures such as seminal vesicle/ejaculatory duct tissue, Cowper’s gland, verumontanum mucosal glands, mesonephric glands and paraganglionic tissue may be confused with PCa. Additionally, metaplastic and hyperplastic processes may be mistaken for PCa. Furthermore, inflammatory processes including non-specific granulomatous prostatitis, xanthoma and malakoplakia may simulate high-grade PCa. In addition to mimickers there are a number of putative precursors of PCa. High-grade prostatic intraepithelial neoplasia has been expensively studied and is thought to be a precursor of at least a subset of PCa. The pathologist’s awareness of the vast array of benign mimickers coupled with prudent use of immunohistochemistry is a critical step in the systematic approach to the diagnosis of PCa. Recognition of PCa precursors in pathological specimens may significantly impact patient management.

Nonspecific granulomatous prostatitis with prostatic adenocarcinoma

Granulomatous prostatitis is an infrequently seen entity in routine practice. One of its most common subtypes is nonspecific granulomatous prostatitis (NSGP), the etiology of which is still under debate. Such cases may be mistaken for adenocarcinoma clinically and radiologically. Histological resemblance to adenocarcinoma may arise when there is a xanthogranulomatous pattern or a prominence of epithelioid histiocytes. However, NSGP may rarely coexist with adenocarcinoma and it is critical to sample these cases thoroughly to exclude the presence of malignancy.

Granulomatous prostatitis linked to hla-drb1*1501

Methods: This is a single-institution, retrospective study from the historic records of 12 eligible patients, eight of whom agreed to participate. Genomic DNA was extracted from anticoagulated blood. Intermediate-resolution genotyping for HLA-A, B, and DRB alleles and high-resolution genotyping for select HLA DRB1 and DRB 3/4/5 alleles were performed by polymerase chain reaction amplification using group-specific probes and subsequent hybridizations of the amplicons with sequence specific oligonucleotide probe. High-resolution, allele-specific identification of HLA DR 15 was performed if patients were DR 15-positive by intermediate-resolution typing. Results: Seventy-five percent of white patients were HLA-DR 15-positive by intermediate-resolution typing versus 28.2% in the control group of 451 patients. Thirtythree percent of black patients were HLA-DR 15-positive compared with 25.8% of 89 black patients who served as the control group. The data suggest an association between HLA-DRB1*1501 in white men and granulomatous prostatitis. The data were consistent with a possible autoimmune etiology for nonspecific granulomatous prostatitis.

Nonspecific granulomatous prostatitis with calculous ductal ectasia and extensive Paneth cell‐like epithelial metaplasia

We present a case of nonspecific granulomatous prostatitis in combination with calculous ductal ectasia and extensive epithelial Paneth cell-like metaplasia in a TURP-specimen. Our report highlights the importance of calculous ductal obstruction and stasis of secretions in the etiopathogenesis of this type of prostatitis. The observed extensive Paneth cell-like metaplastic change in adjacent epithelial cells most likely represents a phenotypic adaptive mechanism directed against foreign antigens and nondegradable lipids in the stagnant intraluminal debris.

Nonspecific Granulomatous Prostatitis

Nonspecific granulomatous prostatitis (NSGP) is a relatively uncommon type of chronic inflammation of the prostate, frequently mistaken for carcinoma on digital rectal examination, trans-rectal ultrasound (TRUS) and serum PSA test. It is presently the most frequent variety of granulomatous prostatitis observed at histological examination. The present study reviews the trans-rectal US results and serum PSA levels of 20 patients with biopsy-proven NSGP. Physical findings, laboratory data and US indicated malignancy in all cases. Sonographically (TRUS), the lesions appeared as single or multiple hypoechoic nodules, mainly localised in the peripheral zone of the gland, mimicking carcinoma. Mean serum PSA values were 13.3 ng/ml (range from 3.5 to 34 ng/ml), and only one patient had a value lower than 4 ng/ml. A sufficiently long period of follow-up (mean 19 months; range from 7 to 48 months) with TRUS and PSA was only possible in 11/20 patients. In 8/11 cases, serum PSA returned within normal range, and in 5/11 patients the US features slowly resolved, the hypoechoic nodules disappearing. Final diagnosis can only be obtained by prostatic biopsy. Several questions remain unanswered regarding the relationship between chronic prostatitis and prostatic carcinoma, natural history, the need for specific therapy and also the follow-up of this disease.

Granulomatous prostatitis – an infrequent diagnosis

Granulomatous prostatitis is an unusual benign inflammatory process of the prostate. Clinically, it mimics prostatic carcinoma, thus requiring pathological examination for diagnosis. Histopathological records of 1353 prostate specimens received in the Department of Pathology, Government Medical College, Chandigarh, India, over a period of 8 years (1995-2002) were reviewed and 20 cases of granulomatous prostatitis were retrieved. Out of 20 cases of granulomatous prostatitis, we encountered 12 cases of non-specific granulomatous prostatitis, two cases of xanthogranulomatous prostatitis, two cases of tuberculous prostatitis, two cases of malakoplakia prostate and one case each of granulomatous prostatitis associated with adenocarcinoma prostate and post-surgical palisading granuloma. The diagnosis was made by histopathological examination of Trucut biopsy, transuretheral resection of prostate chips or retropubic prostatectomy specimen. In all the cases, granulomatous prostatitis was an incidental finding. Non-specific granulomatous prostatitis is the most common type of granulomatous prostatitis. Despite tuberculosis being very common in India, granulomatous prostatitis associated with tuberculosis is not common. Distinction between non-specific and infectious granulomatous prostatitis is important for therapeutic reasons.

GRANULOMATOUS PROSTATITIS LINKED TO HLA-DRB1*1501

Granulomatous prostatitis is characterized by a pattern of granulomatous inflammation in the prostate. In most cases the etiology is unknown. Based on the hypothesis that granulomatous prostatitis may be an autoimmune disease we performed intermediate and selective high resolution typing of HLA-DR in a group of patients with the disease and compared the frequency of class II HLA phenotypes to that in a control group of volunteer marrow donors in the military. Histological records from 1 institution from 1990 to 2000 revealed 12 patients with diffuse granulomatous prostatitis. Three patients were dead and 1 refused blood drawing. Peripheral blood from the remaining 8 patients was typed along with blood from an additional 3 identified at the practice of one of us from 1999 through 2002. All slides were reviewed by 1 pathologist. Intermediate resolution typing of HLA-A, B and DR was performed by polymerase chain reaction-sequence specific oligonucleotide probe. High resolution, allele specific identification of HLA DR15 was performed if patients were DR15 positive by intermediate resolution typing. There were 3 black and 8 white individuals identified with diffuse nonspecific granulomatous prostatitis. Six of 8 white patients (75%) were HLA-DR15 by intermediate resolution typing. One of the 3 black American patients (33%) was HLA-DR15. In the control group 127 of 451 white (28.2%) and 23 of 89 black (25.8%) volunteer marrow donors were HLA-DR15. The case-control comparison of white patients was significantly different (Fisher's exact test p = 0.0086). There were no statistically significant differences between case-control comparisons for any other HLA-DR phenotype. High resolution DR15 typing showed that the white patients were HLA-DRB1*1501 and the black patient was HLA-DRB1*1503. The data suggest an association between HLA-DRB1*1501 and granulomatous prostatitis. HLA-DR15 is strongly associated with other autoimmune diseases, notably multiple sclerosis. The data are consistent with an autoimmune etiology for nonspecific granulomatous prostatitis.

Prostatite granulomateuse (à propos de 6 cas)

A retrospectively series of six patients with non-specific granulomatous prostatitis is reported. The diagnosis was revealed by the histological examination trans-urethral resection or enucleated prostatique. Only histological examination is able to established the definitive diagnosis. This study and a review of literature permitted us to notice the various epidemiological, clinical, histological of this affection.

Telepathology diagnosis of prostate needle biopsies

We conducted a prospective analysis of the diagnostic accuracy of a static-image telepathology system (Roche RIAS, Elon College, NC) in the interpretation of needle biopsies of the prostate (NBx). Two hundred consecutive cases received in consultation were included. Each case was examined by one of the researchers (MHW), and images were captured either according to the areas of concern designated by the referring pathologist (set A; 100 cases) or according to the judgment of MHW (set B; 100 cases). The other researcher (JIE) daily rendered diagnoses first on the video images and then by direct microscopy. Accuracy of video diagnosis was categorized as 0 (correct), 1 (minor error), 2 (major error), or 3 (deferred). An average of 5.49 images were captured per case in set A, and 5.28 for set B. Seventy-seven, 9, 9, and 5 cases were categorized as 0, 1, 2, and 3, respectively, for set A, and 78, 17, 1, and 4 cases, respectively, for set B. Video versus direct diagnoses for the type 2 errors were five carcinoma versus markedly atypical, two carcinoma versus atypical one carcinoma versus nonspecific granulomatous prostatitis, and two benign versus atypical. In these difficult NBx, telepathology allowed an essentially correct diagnosis in almost all of the cases. The number of images required was reasonable, and the images were of excellent quality. However, the accuracy varied from set A to set B, with the fractions of nondeferred cases that were given an essentially correct video diagnosis totaling 91% and 99%, respectively ( P < .01). Accuracy of telepathology diagnosis using static images may depend on the person capturing the images, even in the case of small biopsies.

Nonspecific granulomatous prostatitis

Nonspecific granulomatous prostatitis is a relatively rare disorder of the prostate. We encountered 4 cases of this type of chronic inflammation, including 1 case of xanthogranulomatous prostatitis. In all cases the diagnosis was made by histologic examination of specimens obtained by transurethral resection, retropubic prostatectomy, or transrectal needle biopsy. Echography revealed a hypoechoic lesion in the case of xanthogranulomatous prostatitis, while the other cases showed no specific findings except for the associated adenomas. The major symptoms were frequency and dysuria caused by urinary tract infection or benign prostatic hyperplasia associated with the granulomatous prostatitis.

Granulomatous Prostatitis Following Bacillus Calmette-Guerin Immunotherapy of Bladder Cancer

Granulomatous prostatitis is a recognized complication of intravesical bacillus Calmette-Guerin immunotherapy of superficial bladder cancer. Of 32 patients receiving such therapy 13 underwent prostatic core biopsy and/or fine needle aspiration for clinical indications. Prostatic induration or nodularity developed in 12 patients and 1 underwent biopsy for staging of known prostatic carcinoma. Granulomatous prostatitis was found in 100 per cent of those patients who underwent biopsy or aspiration, indicating that the incidence of this finding is at least 41 per cent following bacillus Calmette-Guerin immunotherapy. Acid-fast bacilli were demonstrated within the prostate of 3 patients with granulomatous prostatitis. The mean interval between the initiation of therapy and diagnosis of granulomatous prostatitis was 11.5 months. Bacillus Calmette-Guerin related granulomas of the prostate may be differentiated histologically from nonspecific granulomatous prostatitis, allergic prostatitis and postoperative granulomas. The clinical implications of these findings are discussed. (J. Urol, 140: 751-754, 1988)