Oppenheimer J R, Kahane H, Epstein J I
Department of Pathology, The Johns Hopkins Medical Institutions, Baltimore, Md 21287, USA.
Arch Pathol Lab Med. 1997 Jul;121(7):724-9.
To assess pathologic findings of granulomatous prostatitis (GP) on needle biopsy.
Ninety-four cases of granulomatous prostatitis were culled from 25,852 (incidence 0.36%) consecutive men who underwent needle biopsy; clinical correlations were obtained for 75. Cases were categorized as nonspecific (NSGP, 77.7%), infectious (IGP, 18.1%), or indeterminate (4.3%) granulomatous prostatitis based on histologic and clinical criteria.
Consecutive cases from a large commercial laboratory and consultation cases.
All cases of IGP had a history of prior bacillus Calmette-Guerin therapy for transitional cell carcinoma. Histologically, 57% of NSGP cases mimicked infection and 4% mimicked cancer. Caseating necrosis was identified in 76% of cases of IGP. Significant numbers of eosinophils were found in 68% of NSGP cases, but in only 12% of IGP cases. In no case was eosinophilia documented in peripheral blood. Multinucleated giant cells were absent or rare in 69% of NSGP cases. Significant numbers of neutrophils were found in 53% of NSGP cases, but in only 29% of IGP cases. At the time of biopsy, cancer was clinically suspected in 55% of cases categorized as NSGP and 73% categorized as IGP. Serum prostate-specific antigen ranged from less than 0.5 ng/mL to 114 ng/mL (mean 12.7 ng/mL) in NSGP and from 0.9 ng/mL to 9.7 ng/mL (mean 4.2 ng/mL) in IGP. Digital rectal exam was abnormal in 69% and 91% of NSGP and IGP cases, respectively. Transrectal ultrasound was abnormal in 77% and 100% of NSGP and IGP cases, respectively. There was no correlation between the extent of core involvement with either clinical impression, prostate-specific antigen levels, transrectal ultrasound, or digital rectal exam. Thirty additional granulomatous prostatitis cases on needle biopsy were obtained from the consultation files of one of the authors. The major difference in this group was a higher percentage of cases histologically mimicking cancer (20%); two cases were misdiagnosed by the referring pathologist as high-grade cancer.
While NSGP is the most common granulomatous prostatitis seen on needle biopsy, bacillus Calmette-Guerin granulomas are not seen infrequently. Lesser known histologic features of NSGP were the frequent finding of neutrophils and eosinophils and infrequent multinucleated giant cells. Granulomatous prostatitis may be clinically indistinguishable from cancer, and NSGP may also histologically mimic carcinoma.
评估经针吸活检得到的肉芽肿性前列腺炎（GP）的病理表现。
从25852例连续接受针吸活检的男性中筛选出94例肉芽肿性前列腺炎患者（发病率0.36%）；获得了75例患者的临床相关信息。根据组织学和临床标准，病例被分为非特异性（NSGP，77.7%）、感染性（IGP，18.1%）或不确定性（4.3%）肉芽肿性前列腺炎。
来自一家大型商业实验室的连续病例及会诊病例。
所有IGP病例均有既往卡介苗治疗移行细胞癌的病史。组织学上，57%的NSGP病例类似感染，4%类似癌症。76%的IGP病例出现干酪样坏死。68%的NSGP病例中发现大量嗜酸性粒细胞，但IGP病例中仅12%有此发现。外周血中均未记录到嗜酸性粒细胞增多。69%的NSGP病例中多核巨细胞缺失或罕见。53%的NSGP病例中发现大量中性粒细胞，但IGP病例中仅29%有此发现。在活检时，55%分类为NSGP的病例和73%分类为IGP的病例临床上怀疑有癌症。NSGP患者血清前列腺特异性抗原范围为小于0.5 ng/mL至114 ng/mL（平均12.7 ng/mL），IGP患者为0.9 ng/mL至9.7 ng/mL（平均4.2 ng/mL）。NSGP和IGP病例中分别有69%和91%的直肠指检异常。NSGP和IGP病例中分别有77%和100%的经直肠超声检查异常。活检核心组织受累程度与临床印象、前列腺特异性抗原水平、经直肠超声或直肠指检之间均无相关性。从一位作者的会诊档案中又获得了30例针吸活检的肉芽肿性前列腺炎病例。该组的主要差异在于组织学上类似癌症的病例百分比更高（20%）；两名病例被转诊病理学家误诊为高级别癌症。
虽然NSGP是针吸活检中最常见的肉芽肿性前列腺炎，但卡介苗肉芽肿也并不少见。NSGP鲜为人知的组织学特征是经常发现中性粒细胞和嗜酸性粒细胞，且多核巨细胞少见。肉芽肿性前列腺炎在临床上可能与癌症难以区分，NSGP在组织学上也可能类似癌。
