Heah Nathaniel H, Tan Teck Wei, Tan Yung Khan
Department of Urology, Tan Tock Seng Hospital, Singapore, Singapore.
J Endourol Case Rep. 2017 Jun 1;3(1):74-77. doi: 10.1089/cren.2017.0030. eCollection 2017.
Isolated malakoplakia of the prostate is a rare inflammatory condition that has been clinically mistaken for prostatic malignancies. The development of Prostate Imaging Reporting and Data System (PI-RADS) classifications, and Prostate Health Index (PHI) has led to more accurate diagnosis of clinically significant disease and stratification of patients that may be at risk of prostate cancer. We present a case of a 75-year-old male who was on follow-up with our hospital for elevated prostate specific antigen (PSA). He was admitted for an episode of urosepsis, which was treated with antibiotics and subsequently underwent further workup and was found to have a raised PHI, as well as a high PI-RADS classification and was later found to have malakoplakia based on histology of prostate tissue obtained during targeted magnetic resonance imaging (MRI)-guided fusion prostate biopsy. To our understanding, this is the first case where a prostate lesion has been labeled as a PI-RADS 5 lesion, with elevated PHI that has subsequently been proven histologically to be malakoplakia. An important possible confounder is the interval between the MRI and the episode of urosepsis and it is well known that urosepsis can affect the PSA and MRI result. We present this case to highlight the potential for a false diagnosis of prostate cancer, in spite of laboratory and radiological findings.
孤立性前列腺软斑病是一种罕见的炎症性疾病，临床上曾被误诊为前列腺恶性肿瘤。前列腺影像报告和数据系统（PI-RADS）分类以及前列腺健康指数（PHI）的发展，使得对具有临床意义的疾病诊断更加准确，对可能有前列腺癌风险的患者分层也更加准确。我们报告一例75岁男性患者，因前列腺特异性抗原（PSA）升高在我院接受随访。他因泌尿道感染发作入院，接受抗生素治疗，随后接受进一步检查，发现PHI升高，PI-RADS分类也较高，后来在靶向磁共振成像（MRI）引导下的融合前列腺活检获取的前列腺组织病理学检查中发现患有软斑病。据我们所知，这是首例前列腺病变被标记为PI-RADS 5类病变、PHI升高且随后经组织学证实为软斑病的病例。一个重要的可能混淆因素是MRI检查与泌尿道感染发作之间的时间间隔，而且众所周知，泌尿道感染会影响PSA和MRI结果。我们展示此病例以强调尽管有实验室和影像学检查结果，但仍有可能误诊前列腺癌。
