Inflammatory Conditions III

Postbiopsy Granlomas: 

• After 9 days to 52 months of transurethral resection.
• Although its much more common to have granulomatous rxn following TUR similar linear granulomas may rarely develop following a needle bx. 
• Postbiopsy granulomas are composed of central region of fibrinoid necrosis surrounded by palisading epithelioid histiocytes.
• In contrast to infectious granulomas, the necrosis in postbiopsy granulomas often contains ghost lıke structures of  vessels, acini and stroma.
• Wedge shaped granulomas , irregularity of their shapes (granulomas) distinguishes these granulomas from  infectious granulomas.
• Postbiopsy granulomasalso  rarelyoccur following a needle bx.
• The postbiopsy granulomas appears to be a rxn to altered epithelium and stroma from the trauma of previous cautery.

• Posrbiopsy granulomas are asymptomatic, incidental findings requiring no treatment.

Systemic Granulomatous Prostatitis:   

• Cases with eosinophilia such as allergic granulomatous prostatitis - Church Strauss ,without eosinophlia- Wegener
• Histopathology; multiple, small , ovoid, granulomas surrounded by numerous eosinophils.
• Regularity of size and shape of these granulomas, the eosinophilic necrosis within the granulomas and extensive infiltration of eosinophils throughout stroma, not just surrounding the granulomas , seperate this entitiy from that of postbiopsy ranulomas with eosinophils.

 *Source: Biopsy Interpretation of the Prostate -Jonathan I. Epstein

Inflammatory Conditions II

Granulomatous Prostatitis:
*infectious granulomas
*nonspesific granulomatous prostatitis
*postbiopsy resection granulomas
*systemic granulomatous prostatitis

Mycotic Prostatitis:

• Immuncompromised hosts 
• Blastomycosis, coccidiomycosis, cryptococcosis (most common)

Mycobacterial Prostatitis:

• Can be seen in systemic tbc but nowadays its commonly seen in as a complication of BCG immunotherapy for superficialbladder carcionoma.
• Hitologically the findings in BCG prostatitis are indistinguishable from those of tbc prostatitis occuring as a result of systemic infection.

Nonspesific Granulomatous Prostatitis:

• In 25387 benign specimens of the %5
• In the etiologyof this lession is thought to be rxn to bacterial toxins, cell debris, and secretions spilling into the stroma fro blocked ducts.
• Mimics prostate carcinoma on rectal examination and USG.
• Earliest lesions; dilated ducts and acini filled with neutrophils, debris, foamy histiocytes and desquamated epithelial cells. Rupture of these ducts and acini results in a localized gralunomatous and chronic inflammatory rxn. Older lesions of nonspesific granulomatous prostatitis show a more prominent fibrous component.
• Treated with warm sitz baths, fluids and antibiotics.
• Although small abscesses may be present at the center of nodules of nonspesific granulomatous prostatitis, caseous necrosis is absent.

*Source: Biopsy Interpretation of the Prostate -Jonathan I. Epstein

Inflammatory Conditions I

Acute and Chronic Prostatic Inflammation:

• Diagnosed clinically and treated by antibiotics.
• Acute prostatitis ; - sheets of neutrophils within the acini  -intraductal desquamated cellular debris - stromal edema ad hyperemia
• The biopsy of TUR of a man with clinical acute prostatitis is contraindicated, can result in sepsis or other complications such as stricture.
• Should be diagnosed as "prostate tissue with acute inflammation"
• Prostatic abscesses ; bladder outlet obstruction secondary to a lower urinary tract infection, usually due to coliform organisms. Much less frequently dissemination from skin -stafilococcus or complication of biopsy or instrumentation.
• Chronic inflammation (in BPH) and chronic prostatitis distinguish is difficult
• Prostatitis may lead to serum PSA elevation.
• We comment on the histologic presence of chronic inflamation only when its prominent.

Malokoplakia: 

• As in bladder majority of man prostatic malokoplakia have urinary infection , most frequently with E.coli.
• In USG  prostatic induration and hipoechoic lesion.
• Michaelis Gutmann bodies 

*Source: Biopsy Interpretation of the Prostate -Jonathan I. Epstein