Pathology case study 2 ~ Education

A 54-year-old male presents with a PSA of 16.2 and a firm slightly enlarged prostate.

Xanthogranulomatous prostatitis

The low power architecture is just maintained but the glands are partly destroyed and filled with inflammatory cellss.

Xanthogranulomatous prostatitis

The high power view shows atrophic glands surrounded by a mixed inflammatory cell infiltrate including epithelioid histiocytes (granulomata)

Diagnosis: Xanthogranulomatous inflammation of the prostate

Discussion: This is a relatively unusual condition but is important to recognize.  Clinically it often presents with a firm prostate associated with a high PSA.  This may reach above 20.

Prostatitis is a contentious area. There is no correlation between clinical symptoms and the pathological findings of inflammation.  The causes of prostatitis are uncertain.  It has been associated with infections but most probably is related to chemical irritation.  Prostatic fluid is full of proteases and complex proteins that are very antigenic.  In xanthogranulomatous prostatitis the glands are ruptured and release the contents into the surrounding stroma. The more common pattern of prostatitis is associated with acute inflammatory cells within the glandular lumina with no rupture.  This results in atrophy. Both these patterns are more common in the peripheral zone.

Chronic inflammation in the prostate has been associated with the development of malignancy but this remains contentious.

This case is de-identified and intended for education purposes only.

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