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 Table of Contents  
CASE REPORT
Year : 2017  |  Volume : 4  |  Issue : 3  |  Page : 214-215

Xanthogranulomatous prostatitis with benign prostatic hyperplasia: A rare combination


1 Student, Department of Urology, Christian Medical College and Hospital, Ludhiana, Punjab, India
2 Department of Urology, Christian Medical College and Hospital, Ludhiana, Punjab, India

Date of Web Publication13-Jul-2017

Correspondence Address:
Navjot Grewal
35, Defence Colony, BRS Nagar, Ludhiana, Punjab
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/cjhr.cjhr_7_17

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  Abstract 

Xanthogranulomatous prostatitis is a rare benign granulomatous inflammation of the prostate. Only ten cases of such pathology have been reported in literature. Patients usually present with symptoms of lower urinary tract symptoms. It occasionally resembles other prostatic diseases such as prostatic carcinoma and abscess. Imaging techniques are not useful in the diagnosis of xanthogranulomatous prostatitis; hence, it is diagnosed only on the basis of histopathological examination of prostate.

Keywords: Histopathological examination, lower urinary tract infection, xanthogranulomatous prostatitis


How to cite this article:
Grewal N, Tuli A, Sridhar FK, Mammen KJ. Xanthogranulomatous prostatitis with benign prostatic hyperplasia: A rare combination. CHRISMED J Health Res 2017;4:214-5

How to cite this URL:
Grewal N, Tuli A, Sridhar FK, Mammen KJ. Xanthogranulomatous prostatitis with benign prostatic hyperplasia: A rare combination. CHRISMED J Health Res [serial online] 2017 [cited 2019 Oct 21];4:214-5. Available from: http://www.cjhr.org/text.asp?2017/4/3/214/210490


  Introduction Top


Xanthogranulomatous prostatitis is a rare benign granulomatous inflammation of prostate.[1] Prostate is a rare and infrequent site for xanthogranulomatous changes, and only ten cases of such pathology have been reported in literature.[2] The etiology and pathogenesis of xanthogranulomatous prostatitis remain unknown. Xanthogranulomatous prostatitis may be confused with other prostatic diseases such as prostatic carcinoma and prostatic abscess.[1] Hence, it is important for the pathologist to have a high index of suspicion for this rare pathology.


  Case Report Top


A 54-year-old gentleman with systemic hypertension and chronic obstructive lung disease presented with a history of acute urinary retention. He had obstructive and irritative lower urinary tract symptoms (LUTS) for the past 1 year. Three months back, he had a similar episode of acute urinary retention for which he was catheterized and started on alpha blockers. On examination, he had a tender palpable bladder. Digital rectal examination revealed a firm and nontender Grade III prostate. He was catheterized and approximately 650 ml of urine was drained. Urine microscopy revealed 70–80 pus cells, and urine culture had grown enterobacter. His routine biochemical parameters were normal, and prostate-specific antigen (PSA) was 0.013 ng/ml. Ultrasonography was suggestive of prostatomegaly (50cc). He underwent transurethral resection of prostate (TURP) for bothersome LUTS with recurrent urinary retention on alpha-blocker. Postoperatively, he had an uneventful recovery period. Histopathological examination [Figure 1] and [Figure 2] of the resected prostate tissue revealed adenofibromatous hyperplasia with xanthogranulomatous prostatitis. The patient is currently on regular follow-up.
Figure 1: Photomicrograph showing sheets of xanthomatous cells (arrows) infiltrating prostatic stroma (H and E, ×200)

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Figure 2: Xanthogranulomatous inflammation with infiltration into prostatic glands (arrows) (H and E, ×400)

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  Discussion Top


The characteristic feature of xanthogranulomatous prostatitis is the presence of foamy macrophages in inflammatory cell infiltrate. It usually manifests in the early 60s with symptoms of LUTS. It occasionally resembles other prostatic diseases such as prostatic carcinoma and abscess, wherein serum PSA level is elevated.[3],[4] Transrectal ultrasonography and other imaging techniques are not useful in the diagnosis of xanthogranulomatous prostatitis; hence, it is diagnosed on the basis of histopathological examination of prostate.

Our patient in his mid-50s was a diagnosed case of benign prostatic hyperplasia presented with bothersome LUTS and recurrent urinary retention. Subsequently, TURP was performed. Histopathological examination [Figure 1] and [Figure 2] of the resected prostate tissue revealed sheets of foamy histiocytes, also known as xanthomatous cells, mixed with a few lymphocytes infiltrating the stroma of prostatic gland whose epithelium has denuded from its basement membrane, thus revealing xanthogranulomatis prostatitis. Hence, it becomes essential for the pathologist to keep in mind the possibility of this rare entity.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Valsangkar RS, Singh DP, Gaur DD. Xanthogranulomatous prostatitis: Rare presentation of rare disease. Indian J Urol 2012;28:204-5.  Back to cited text no. 1
  [Full text]  
2.
Patil N, Kundargi VS, Patil SB, Biradar AK, Desai AS. Xanthogranulomatous prostatitis: A rare case report. Med Surg Urol 2014;3:1-2.  Back to cited text no. 2
    
3.
Bryan RL, Newman J, Campbell A, Fitzgerald G, Kadow C, O'Brien JM. Granulomatous prostatitis: A clinicopathological study. Histopathology 1991;19:453-7.  Back to cited text no. 3
    
4.
Rafique M, Yaqoob N. Xanthogranulomatous prostatitis: A mimic of carcinoma of prostate. World J Surg Oncol 2006;4:30.  Back to cited text no. 4
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