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.
"The causes of NSGP have remained unclear. Some studies attribute it to the autoimmune reaction associated with HLA- DRB1 . It might be a response to invasion of foreign bodies, such as colloidal substances, bacterial products, and refluxed urine; it might also result from an immunological response to extraductal prostatic secretions arising from ducts obstructed by hyperplasia . "
[Show abstract][Hide abstract] ABSTRACT: Granulomatous prostatitis, characterized by chronic granulomatous inflammation in the prostate, is rare. Xanthogranulomatous prostatitis is an even rarer granulomatous inflammation. We present a 74-year-old man who presented with lower urinary tract symptoms and elevated prostate specific antigen. A transrectal ultrasonography-guided prostate biopsy was performed, and pathological results showed foamy macrophage and inflammatory cell infiltrates, which were a distinctive feature of xanthogranulomatous prostatitis. We also present the characteristics of magnetic resonance imaging in xanthogranulomatous prostatitis which has never been previously described.
"It is thought to represent a reaction to inflammatory products and altered prostatic secretions released from obstructed ducts . Recently one study has linked this condition to an autoimmune disease . The typical lesion in granulomatous prostatitis consists of a large nodular infiltrate of epitheliod histiocytes, lymphocytes and plasma cells occupying many prostatic lobules. "
[Show abstract][Hide abstract] ABSTRACT: Xanthogranulomatous prostatitis is an unusual benign inflammatory process of prostate. Clinically it mimics prostatic carcinoma, requiring pathological examination for diagnosis.
A 60-year-old patient presented with 6 months history of increasing difficulty in micturition. On digital rectal examination prostate was hard and nodular and estimated weight was 50-gram. His serum prostate specific antigen (PSA) was 150 ng/ml. Clinically a locally advanced carcinoma of prostate was suspected. In view of severe obstructive urinary symptoms and significant post-micturition residual urine, transurethral resection of prostate was carried out. Histopathological examination of resected prostatic tissue revealed xanthogranulomatous prostatitis with no evidence of malignancy. Patient remains symptom free at 16 months follow-up and serum PSA has decreased to 6 ng/ml.
Xanthogranulomatous prostatitis is a benign inflammatory disorder of prostate that can clinically and even biochemically mimic prostatic carcinoma. A high degree of suspicion and close co-operation with pathologist is necessary for the diagnosis of xanthogranulomatous prostatitis.
World Journal of Surgical Oncology 02/2006; 4(1):30. DOI:10.1186/1477-7819-4-30 · 1.41 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: 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.
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