Butel Ryan, Ball Richard
Department of Histopathology, Norfolk and Waveney Cellular Pathology Service, The Cotman Centre, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, Norfolk, UK.
Prostate. 2018 Nov;78(15):1134-1139. doi: 10.1002/pros.23688. Epub 2018 Jul 10.
We observed in cystoprostatectomy specimens that Bacillus Calmette-Guérin (BCG) granulomatous prostatitis tended preferentially to affect the peripheral zone (PZ) and aimed to study the matter, postulating that assessment of its distribution might contribute to understanding pathogenetic processes.
Entire prostate glands from 27 men (47-83 years; mean = 69 years), who had previously received intravesical BCG therapy for non-muscle-invasive urothelial carcinoma of the bladder, were studied as whole-mount sections to determine the anatomical distribution and histopathological characteristics of BCG prostatitis.
Twenty-two (81.5%) showed BCG-type granulomatous inflammation. It often radiated from close to the prostatic urethra toward to the gland periphery as a wedge-shaped area related to one or more duct systems. Twenty-one of these prostate glands (95.5%) showed predominantly or exclusively PZ involvement. Eighteen (81.8%) involved only the PZ, while three cases (13.6%) also showed involvement of the transitional zone (TZ). One case (4.5%) involved only the TZ. No granulomas were seen in the central zone or anterior fibromuscular septum.
Our observations imply the microanatomical arrangement of prostatic ducts is a factor in the pathogenesis of BCG prostatitis. PZ ducts enter the urethra at less obtuse angles than those from other zones and are likely to be more prone to urine reflux and damage from suspended BCG. We speculate that prostatic duct microanatomy could also play a role in the pathogenesis of other prostatic diseases, including conventional prostatitis and adenocarcinoma.
我们在膀胱前列腺切除标本中观察到，卡介苗（BCG）肉芽肿性前列腺炎倾向于优先累及外周带（PZ），并旨在研究这一问题，推测对其分布的评估可能有助于理解发病机制。
对27名男性（47 - 83岁；平均年龄 = 69岁）的整个前列腺进行研究，这些男性此前因非肌肉浸润性膀胱尿路上皮癌接受了膀胱内卡介苗治疗，将前列腺作为整体切片来确定卡介苗前列腺炎的解剖分布和组织病理学特征。
22例（81.5%）显示出卡介苗型肉芽肿性炎症。炎症常从靠近前列腺尿道处呈楔形区域向腺体周边放射，与一个或多个导管系统相关。其中21例前列腺（95.5%）主要或仅累及外周带。18例（81.8%）仅累及外周带，而3例（13.6%）也显示移行带（TZ）受累。1例（4.5%）仅累及移行带。在中央带或前纤维肌性间隔未见肉芽肿。
我们的观察结果表明前列腺导管的微观解剖结构是卡介苗前列腺炎发病机制中的一个因素。外周带导管进入尿道的角度比其他区域的导管更平缓，可能更容易发生尿液反流以及受到悬浮卡介苗的损伤。我们推测前列腺导管微观解剖结构在包括传统前列腺炎和腺癌在内的其他前列腺疾病的发病机制中也可能起作用。
