黄色肉芽肿性前列腺炎的诊治体会(附1例报告并文献复习)

Diagnosis and treatment of xanthogranulomatous prostatitis:A case report and review of the literature

目的:提高黄色肉芽肿性前列腺炎(XP)的诊治水平。方法:报告1例XP患者,男,75岁,尿频、排尿困难3个月,加重2 d。DRE:前列腺Ⅱ度增大,质硬,无压痛。血清PSA:172.5μg/L。B超:残余尿量200 ml,膀胱粘膜增厚,呈梗阻性改变,前列腺4.3 cm×3.8 cm×5.0 cm,内部回声欠均匀。MRI:前列腺体积明显增大,信号不均,双侧外周带信号减低,边缘欠光滑,部分前列腺组织略凸向膀胱,与膀胱分界欠清晰。初步诊断:前列腺癌,为明确诊断行经直肠超声引导下前列腺穿刺活检术。结果:活检穿刺组织病理报告:镜下可见大量泡沫细胞,混有少量多核巨细胞、淋巴细胞、浆细胞,伴纤维组织增生,形成瘤样结节。免疫组化:CD68(+),PSA(-)。给予间断导尿,并予坦索罗辛、糖皮质激素口服。随访20个月。4个月后排尿症状改善,血清PSA呈下降趋势,13个月后降至9.2μg/L,17个月后下降并稳定于3.6μg/L。结论:XP属临床罕见病,确诊依赖于病理及免疫组化诊断,应警惕合并前列腺恶性肿瘤的可能,治疗以对症支持治疗为主,下尿路梗阻症状严重者可行TURP术。XP患者治疗后需密切复查血清PSA,必要时进行重复前列腺穿刺活检。

Objective： To explore the diagnosis and treatment of xanthogranulomatous prostatitis.Methods： A 75-year-old man presented with a 3-month history of difficult urination and frequent micturition,which was exacerbated for 2 days.Digital rectal examination indicated an enlarged prostate size of Ⅱ° with hard texture but no tenderness.Serum total PSA was 172.5 μg/L.TRUS revealed 200 ml of post-micturition residual urine,thickened bladder wall,prostate size of 4.3 cm×3.8 cm×5.0 cm and no isoechoes.MRI showed an enlarged prostate gland,with marked enlargement of the central zones and low-signal intensity of the peripheral gland,part of the prostate gland protruding to the bladder with no clear dividing line.It was diagnosed as prostate cancer initially,and confirmed by needle biopsy.Results： Histopathological examination revealed large numbers of ＂foamy macrophages＂ in the lesion,with a few multinucleated giant cells,leukomonocytes,plasmocytes and fibroplasia.Immunohistochemistry showed CD68（＋） and PSA（-）.The patient was treated with oral Tamsulosin and glucocorticoid and by temporary catheterization,and followed up for 20 months.Urination symptoms began to alleviate and serum PSA to decrease at 4 months.The PSA level was 9.2 μg/L at 13 months and 3.6 μg/L at 17 months.Conclusion： Xanthogranulomatous prostatitis is a rare clinically,which can be confirmed by histopathological examination.It is treated mainly by supportive therapy and,for the cases with severe lower urinary tract obstruction,TURP can be employed.Follow-up must be performed by possible examination of PSA and necessary needle biopsy of the prostate.