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Val-Bernal JF, Garijo MF. Isolated Idiopathic Granulomatous (Giant Cell) Vasculitis of the Prostate. Int J Surg Pathol 2016. [DOI: 10.1177/106689699900700108] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Vasculitis involving the prostate is uncommon and usually reflects systemic disease. Isolated prostatic vasculitis is very rare. Most of these cases are morphologically categorized as polyarteritis nodosa. We describe a 72-year-old man with idiopathic granulomatous vasculitis limited to the prostate. The vasculitis was identified incidentally upon microscopic examination of the suprapubic prostatectomy specimen removed for nodular hyperplasia. The transmural inflammation was centered on muscular arteries and veins and it was accompanied by narrowing of the lumen. Vasculitis was not associated with any secondary changes such as infarct or postinfarct fibrosis. Immunophenotyping of the vascular inflammatory infiltrate disclosed abundant macrophages and T-lymphocytes and virtual absence of B-lymphocytes. The patient is alive and well on no treatment for a follow-up period of 14 months. To our knowledge this is the second case report of prostatic involvement in localized idiopathic granulomatous vasculitis. It is important to distinguish cases of isolated granulomatous vasculitis in the prostate from systemic disease, because the latter implies a poor prognosis and requires an aggressive treatment.
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Affiliation(s)
| | - M. Francisca Garijo
- Department of Anatomical Pathology, Marques de Valdecilla University Hospital, Medical Faculty, University of Cantabria, Santander, Spain
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2
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Val-Bernal JF, González-Vela C, Mayorga M, Garijo MF. Isolated Fibrinoid Arteritis of the Prostate. Int J Surg Pathol 2016. [DOI: 10.1177/106689699600400303] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Four cases of apparently asymptomatic isolated fibrinoid arteritis in the prostate are described. All four cases occurred in elderly men with nodular hyperplasia. In all of these cases isolated fibrinoid arteritis was an incidental finding unrelated to the presenting symptoms. The histopathological appearance of the vasculitis was not sufficiently specific to exclude the possibility of systemic polyarteritis nodosa. However, there were no signs of generalized disease. Follow-up studies showed no evidence of disseminated vasculitis. Immunophenotyping of the vascular cellular infiltrate revealed abundant T lymphocytes, significant numbers of histiocytes, and virtual absence of B lymphocytes. The diagnosis of isolated arteritis depends on the exclusion of systemic disease, its excellent prognosis differing dramatically from the more common form of systemic polyarteritis nodosa. Information that isolated arteritis may occur in the prostate is of importance both to avoid misdiagnosis and to prevent unnecessary treatment. Int J Surg Patltol 4(3):00-00, 1997
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Affiliation(s)
- J. Fernando Val-Bernal
- Anatomical Pathology Department, Marqués de Valdecilla University Hospital, University of Cantabria, Santander, Spain
| | - Carmen González-Vela
- Anatomical Pathology Department, Marqués de Valdecilla University Hospital, University of Cantabria, Santander, Spain
| | - Marta Mayorga
- Anatomical Pathology Department, Marqués de Valdecilla University Hospital, University of Cantabria, Santander, Spain
| | - M. Francisca Garijo
- Anatomical Pathology Department, Marqués de Valdecilla University Hospital, University of Cantabria, Santander, Spain
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3
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Travis WD. Common and uncommon manifestations of wegener's granulomatosis. Cardiovasc Pathol 2015; 3:217-25. [PMID: 25990999 DOI: 10.1016/1054-8807(94)90032-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/1994] [Accepted: 04/13/1994] [Indexed: 11/29/2022] Open
Affiliation(s)
- W D Travis
- Department of Pulmonary and Mediastinal Pathology, Armed Forces Institute of Pathology, Washington, D.C., USA
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Dufour JF, Le Gallou T, Cordier JF, Aumaître O, Pinède L, Aslangul E, Pagnoux C, Marie I, Puéchal X, Decaux O, Dubois A, Agard C, Mahr A, Comoz F, Boutemy J, Broussolle C, Guillevin L, Sève P, Bienvenu B. Urogenital manifestations in Wegener granulomatosis: a study of 11 cases and review of the literature. Medicine (Baltimore) 2012; 91:67-74. [PMID: 22391468 DOI: 10.1097/md.0b013e318239add6] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
We describe the main characteristics and treatment of urogenital manifestations in patients with Wegener granulomatosis (WG). We conducted a retrospective review of the charts of 11 patients with WG. All patients were men, and their median age at WG diagnosis was 53 years (range, 21-70 yr). Urogenital involvement was present at onset of WG in 9 cases (81%), it was the first clinical evidence of WG in 2 cases (18%), and was a symptom of WG relapse in 6 cases (54%). Symptomatic urogenital involvement included prostatitis (n = 4) (with suspicion of an abscess in 1 case), orchitis (n = 4), epididymitis (n = 1), a renal pseudotumor (n = 2), ureteral stenosis (n = 1), and penile ulceration (n = 1). Urogenital symptoms rapidly resolved after therapy with glucocorticoids and immunosuppressive agents. Several patients underwent a surgical procedure, either at the time of diagnosis (n = 3) (consisting of an open nephrectomy and radical prostatectomy for suspicion of carcinoma, suprapubic cystostomy for acute urinary retention), or during follow-up (n = 3) (consisting of ureteral double J stents for ureteral stenosis, and prostate transurethral resection because of dysuria). After a mean follow-up of 56 months, urogenital relapse occurred in 4 patients (36%). Urogenital involvement can be the first clinical evidence of WG. Some presentations, such as a renal or prostate mass that mimics cancer or an abscess, should be assessed to avoid unnecessary radical surgery. Urogenital symptoms can be promptly resolved with glucocorticoids and immunosuppressive agents. However, surgical procedures, such as prostatic transurethral resection, may be mandatory in patients with persistent symptoms.
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Affiliation(s)
- Jean-François Dufour
- From Hospices Civils de Lyon (JFD, CB, PS), Hôpital de la Croix-Rousse, Department of Internal Medicine, Lyon, and Université Claude Bernard Lyon 1, Lyon; CHU de Caen (TLG, JB, BB), Department of Internal Medicine, Caen, and Université de Caen Basse-Normandie, UFR de Médecine, Caen; Hospices Civils de Lyon (JFC), Department of Pneumology, Hôpital Louis Pradel, Lyon,and Université Claude Bernard Lyon 1, Lyon; CHU de Clermont-Ferrand (OA), Hôpital Gabriel-Montpied, Department of Internal Medicine, Clermont-Ferrand; Clinique Protestante (LP), Department of Internal Medicine, Lyon; Hôtel-Dieu (EA), Assistance publique-Hôpitaux de Paris, Department of Internal Medicine, Paris; Descartes University Medical School (EA), Paris; Hôpital Cochin (CP, AM, LG), Assistance publique-Hôpitaux de Paris, Department of Internal Medicine, Paris, and Université Paris V, Paris; CHU de Rouen (IM), Department of Internal Medicine, Rouen; CH Le Mans (XP), Centre de compétences Maladies systémiques et auto-immunes rares, LeMans; CHU de Rennes (OD), Hôpital Sud, Department of Internal Medicine, Rennes; Clinique Beau Soleil (AD), Montpellier; CHU de Nantes (CA), Hôtel-Dieu, Department of Internal Medicine, Nantes; and CHU de Caen (FC), Department of Pathology, Caen; France
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5
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Lamarche JA, Peguero AM, Rosario JO, Patel A, Courville C. Anti-MPO small-vessel vasculitis causing prostatis and nephritis. Clin Exp Nephrol 2007; 11:180-183. [PMID: 17593520 DOI: 10.1007/s10157-007-0473-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2006] [Accepted: 03/16/2007] [Indexed: 12/11/2022]
Abstract
Microscopic polyangiitis is a necrotizing angiitis involving capillaries, venules, and arterioles. The vascular beds of various organs may be involved, causing varying presentations. To our knowledge, this is the first case of anti-myeloperoxidase (anti-MPO) antibody small-vessel vasculitis causing prostatic vasculitis. A 79 year-old nonsmoker American man presented with symptoms of fevers, malaise, weight loss, and cough. Urine analysis revealed hematuria. Blood tests were remarkable for an elevated prostate-specific antigen (PSA) and a serum creatinine of 3.1 mg/dl (baseline, 1.2 mg/dl). Computed tomography (CT) scan of the thorax revealed a 4.7-cm mass in the left lower lobe of the lung. Metastatic prostate cancer was suspected. Therefore, prostatic biopsy was performed. The biopsy revealed fibrinoid degeneration with vasculitic changes involving the arterioles. When evaluated by nephrology, his serum creatinine was 9.9 mg/dl. A renal biopsy was performed, which revealed focal segmental necrotizing glomerulopathy with microscopic vasculitis. All the serologies were normal, with the exception of low C4, and positive perinuclear antineutrophil cytoplasmic antibodies (ANCA) associated with anti-MPO. The patient was started on intermittent hemodialysis, steroids, and oral cytoxan. Despite treatment, with improvement of the respiratory and constitutional symptoms, the patient remained dialysis-dependent. He later decided to discontinue dialysis and subsequently expired. Vasculitic involvement of the prostate is an uncommon manifestation of microscopic polyangiitis. This bedazzling entity is challenging to diagnose and thus makes it difficult to treat in a timely manner.
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Affiliation(s)
- Jorge A Lamarche
- James A. Haley Veterans Hospital, University of South Florida, 13000 Bruce B. Downs Blvd. Nephrology Department 7B West 105, Tampa, Fl33612, USA.
| | - Alfredo M Peguero
- James A. Haley Veterans Hospital, University of South Florida, 13000 Bruce B. Downs Blvd. Nephrology Department 7B West 105, Tampa, Fl33612, USA
| | - Joaquin O Rosario
- James A. Haley Veterans Hospital, University of South Florida, 13000 Bruce B. Downs Blvd. Nephrology Department 7B West 105, Tampa, Fl33612, USA
| | - Amit Patel
- James A. Haley Veterans Hospital, University of South Florida, 13000 Bruce B. Downs Blvd. Nephrology Department 7B West 105, Tampa, Fl33612, USA
| | - Craig Courville
- James A. Haley Veterans Hospital, University of South Florida, 13000 Bruce B. Downs Blvd. Nephrology Department 7B West 105, Tampa, Fl33612, USA
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Gunnarsson R, Omdal R, Kjellevold KH, Ellingsen CL. Wegener's granulomatosis of the prostate gland. Rheumatol Int 2004; 24:120-2. [PMID: 12879271 DOI: 10.1007/s00296-003-0343-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2003] [Accepted: 04/23/2003] [Indexed: 12/23/2022]
Abstract
Wegener's granulomatosis (WG) is a systemic granulomatous vasculitis affecting medium and small arteries, venules, and arterioles. The upper and lower respiratory tract and kidney are primarily involved. Patients with classic WG essentially present with upper airway and pulmonary involvement. Renal disease is common. Involvement of other organ systems is also relatively frequent, most often heart, joints, muscles, eyes, skin, and central and/or peripheral nervous system. We present a patient in whom WG was diagnosed primarily because of prostate involvement. This seems to be a rare manifestation.
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Affiliation(s)
- Ragnar Gunnarsson
- Department of Internal Medicine, Rogaland Central Hospital, PO Box 8100, 4068, Stavanger, Norway.
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Crawford BE, Daroca PJ, Davis R. Periprostatic subendothelial intravascular granulomatosis: a mimic of high-grade intravascular prostatic adenocarcinoma. Int J Surg Pathol 2004; 12:75-8. [PMID: 14765279 DOI: 10.1177/106689690401200114] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
A rare case of intravascular granulomatous inflammation mimicking intravascular prostatic adenocarcinoma is reported. To the author's knowledge, there have been no previous reports of prostatic or periprostatic intravascular granulomatous inflammation. A 67-year-old man presented with elevated serum prostate specific antigen (PSA) and was found to have a high-grade adenocarcinoma of the prostate. A radical prostatectomy revealed intravascular subendothelial granulomatous inflammation mimicking vascular invasion of a high-grade adenocarcinoma found elsewhere in the prostate. Immunoperoxidase stains confirmed that the subendothelial infiltrate was composed of histiocytes and not tumor cells. Periprostatic subendothelial intravascular granulomatosis is a rare event, which may mimic vascular involvement of high-grade prostatic adenocarcinoma and may result from a previous needle biopsy of the prostate. Possible mechanisms for this finding are discussed. It is important to distinguish this process from high-grade prostatic adenocarcinoma involving blood vessels for obvious clinical reasons.
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Affiliation(s)
- Byron E Crawford
- Department of Pathology and Laboratory Medicine, Tulane University Health Science Center, New Orleans, Louisiana 70112-2699, USA
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Ebo DG, Mertens AV, De Clerck LS, Gentens P, Daelemans R. Relapse of Wegener's granulomatosis presenting as a destructive urethritis and penile ulceration. Clin Rheumatol 1998; 17:239-41. [PMID: 9694061 DOI: 10.1007/bf01451056] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Non-renal urogenital Wegener's granulomatosis is considered to be rare. Generally it occurs in a setting of concurrent multisystem disease or in patients already diagnosed as having Wegener's granulomatosis. We present a patient with a penile ulceration related to a destructive urethritis, as presentation of a relapse of Wegener's granulomatosis.
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Affiliation(s)
- D G Ebo
- Department of Immunology, Allergy and Rheumatology, University of Antwerp (UIA), Antwerpen, Belgium
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10
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Huong DL, Papo T, Piette JC, Wechsler B, Bletry O, Richard F, Valcke JC, Godeau P. Urogenital manifestations of Wegener granulomatosis. Medicine (Baltimore) 1995; 74:152-61. [PMID: 7760722 DOI: 10.1097/00005792-199505000-00005] [Citation(s) in RCA: 60] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
We report 8 patients with Wegener granulomatosis (WG) who suffered from symptomatic urogenital involvement including acute urinary retention related to prostatitis, orchitis, ureteral stenosis, bladder pseudotumor, and penile ulceration. Urogenital manifestations occurred as an isolated manifestation of WG in 4 patients, at the onset of the disease in 1 patient, and as the only symptom of relapse in 3. Data used to distinguish specific WG involvement from infection or cyclophosphamide urothelial toxicity are discussed. Four patients needed a surgical procedure consisting of suprapubic cystostomy for acute urinary retention, bilateral ureteral double J stents for bilateral ureteral stenosis, and prostate transurethral resection. Urogenital symptoms promptly resolved with medical therapy. High-dose corticosteroids and immunosuppressive drugs should be used as first-line therapy to avoid unnecessary surgery.
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Affiliation(s)
- D L Huong
- Department of Internal Medicine, Groupe Hospitalier Pitié-Salpêtrière, Paris, France
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