Bidot Samuel, Lay Aaron H, Harri Peter A, Harik Lara R
Department of Pathology, Emory University School of Medicine, Atlanta, Georgia, USA.
Department of Urology, Emory University School of Medicine, Atlanta, Georgia, USA.
J Endourol Case Rep. 2020 Sep 17;6(3):231-234. doi: 10.1089/cren.2020.0050. eCollection 2020.
Malakoplakia is a rare benign lesion, usually associated with deficient intralysosomal degradation of microorganisms, more commonly, . Malakoplakia occurs in various organ systems, the most frequently affected site being the urinary bladder. We report a rare case of isolated extensive malakoplakia involving the prostate, diagnosed on transurethral resection performed for radiologically suspected prostatic abscesses. A 61-year-old African American male presented with symptoms of urinary obstruction for the past 2 months. His medical history was significant for immunosuppression (liver transplantation 3 months prior and diabetes mellitus). He reported four episodes of -associated urinary tract infection after his liver transplantation. Serum prostate specific antigen was 1.83 ng/cc (normal inferior to 4 ng/cc), and urine culture was positive for sensitive to ceftriaxone. Pelvic magnetic resonance imaging was suggestive of prostatitis with prostatic abscesses; cystoscopy was unremarkable. The patient was started on intravenous ceftriaxone therapy. A standard bipolar transurethral resection of the prostate was performed, and purulent-like material was encountered in the resected tissue. Histologic examination demonstrated extensive infiltration and replacement of the prostatic tissue by sheets of pink histiocytes with targetoid inclusions consistent with Michaelis-Gutmann bodies, ultimately confirming malakoplakia of the prostate. Prostatic malakoplakia is an unexpected diagnosis in patients suspected of having malignancy or prostatitis. Its exact pathogenesis is unknown, but it involves defective bacterial degradation after phagocytosis. is often cultured from the patients' urine. Immunosuppression, present in our patient, is a well-known associated factor. Prostatic malakoplakia can radiologically masquerade as prostatic adenocarcinoma, despite the use of cutting-edge imaging technology. With the growing use of multiparametric 3T prostate magnetic resonance imaging to screen for prostate cancer, it is possible that urologists, radiologists, and pathologists will encounter prostatic malakoplakia more frequently in the future.
软斑病是一种罕见的良性病变，通常与溶酶体内微生物降解不足有关，更常见于……软斑病发生于各种器官系统，最常受累的部位是膀胱。我们报告一例罕见的孤立性广泛性前列腺软斑病，通过经尿道切除术诊断，该患者因放射学怀疑前列腺脓肿而接受手术。一名61岁的非裔美国男性在过去2个月出现尿路梗阻症状。他的病史中有免疫抑制（3个月前接受肝移植和糖尿病）。他报告在肝移植后发生了4次与……相关的尿路感染。血清前列腺特异性抗原为1.83 ng/cc（正常低于4 ng/cc），尿培养对头孢曲松敏感呈阳性。盆腔磁共振成像提示前列腺炎伴前列腺脓肿；膀胱镜检查无异常。患者开始接受静脉注射头孢曲松治疗。进行了标准的经尿道双极前列腺切除术，在切除组织中发现了脓性物质。组织学检查显示前列腺组织被成片的粉红色组织细胞广泛浸润和替代，这些组织细胞含有与迈克尔is -古特曼小体一致的靶样包涵体，最终确诊为前列腺软斑病。前列腺软斑病在疑似患有恶性肿瘤或前列腺炎的患者中是一种意外诊断。其确切发病机制尚不清楚，但涉及吞噬后细菌降解缺陷。……常从患者尿液中培养出来。我们的患者存在免疫抑制，这是一个众所周知的相关因素。尽管使用了先进的成像技术，但前列腺软斑病在放射学上可能会伪装成前列腺腺癌。随着多参数3T前列腺磁共振成像越来越多地用于筛查前列腺癌，未来泌尿外科医生、放射科医生和病理科医生可能会更频繁地遇到前列腺软斑病。
