Page 733 - Textbook of Pathology, 6th Edition

inflammatory infiltrate. Oedema, hyperaemia and foci of of 50 years and its incidence approaches 75-80% in men above 717
necrosis frequently accompany acute inflammatory 80 years. However, symptomatic BEP producing urinary tract
involvement. obstruction and requiring surgical treatment occurs in 5-10%
of cases only.
Chronic Prostatitis ETIOLOGY. The cause of BEP has not been fully established.
Chronic prostatitis is more common and foci of chronic However, a few etiologic factors such as endocrinologic, racial,
inflammation are frequently present in the prostate of men inflammation and arteriosclerosis have been implicated but
above 40 years of age. Chronic prostatitis is usually endocrine basis for hyperplasia has been more fully
asymptomatic but may cause allergic reactions, iritis, neuritis investigated and considered a strong possibility in its genesis.
or arthritis. It has been found that both sexes elaborate androgen and
oestrogen, though the level of androgen is high in males and
Chronic prostatitis is of 2 types—bacterial and abacterial. that of oestrogen is high in females. With advancing age,
Chronic bacterial prostatitis is caused in much the same there is decline in the level of androgen and a corresponding
way and by the same organisms as the acute prostatitis. It is rise of oestrogen in the males. The periurethral inner prostate
generally a consequence of recurrent UTI. Diagnosis is made which is primarily involved in BEP is responsive to the rising
by detection of more than 10-12 leucocytes per high power level of oestrogen, whereas the outer prostate which is mainly
field in expressed prostatic secretions, and by positive culture involved in the carcinoma is responsive to androgen. A
of urine specimen and prostatic secretions. This condition is plausible hypothesis suggested is that there is synergistic
more difficult to treat since antibiotics penetrate the prostate stimulation of the prostate by both hormones—the oestrogen
poorly. acting to sensitise the prostatic tissue to the growth
Chronic abacterial prostatitis is more common. There is promoting effect of dihydroxy-testosterone derived from
no history of recurrent UTI and culture of urine and prostatic plasma testosterone.
secretions is always negative, though leucocytosis is
demonstrable in prostatic secretions. The pathogens MORPHOLOGIC FEATURES. Grossly, the enlarged pro-
implicated are Chlamydia trachomatis and Ureaplasma state is nodular, smooth and firm and weighs 2-4 times CHAPTER 23
urealyticum. its normal weight i.e. may weigh up to 40-80 gm. The
appearance on cut section varies depending upon whether
MORPHOLOGIC FEATURES. Pathologic changes in the hyperplasia is predominantly of the glandular or
both bacterial and abacterial prostatitis are similar. fibromuscular tissue (Fig. 23.13). In primarily glandular BEP
Grossly, the prostate may be enlarged, fibrosed and the tissue is yellow-pink, soft, honey-combed, and milky
shrunken. fluid exudes, whereas in mainly fibromuscular BEP the cut
Histologically, the diagnosis of chronic prostatitis is made surface is firm, homogeneous and does not exude milky
by foci of lymphocytes, plasma cells, macrophages and fluid. The hyperplastic nodule forms a mass mainly in
neutrophils within the prostatic substance. Corpora the inner periurethral prostatic gland so that the
amylacea, prostatic calculi and foci of squamous surrounding prostatic tissue forms a false capsule which
metaplasia in the prostatic acini may accompany enables the surgeon to enucleate the nodular masses. The
inflammatory changes. Seminal vesicles are invariably
involved.

Granulomatous Prostatitis
Granulomatous prostatitis is a variety of chronic prostatitis, The Male Reproductive System and Prostate
probably caused by leakage of prostatic secretions into the
tissue, or could be of autoimmune origin.

MORPHOLOGIC FEATURES. Grossly, the gland is firm
to hard, giving the clinical impression of prostatic
carcinoma on rectal examination.
Histologically, the inflammatory reaction consists of
macrophages, lymphocytes, plasma cells and some
multinucleate giant cells. The condition may be confused
with tuberculous prostatitis.

NODULAR HYPERPLASIA
Non-neoplastic tumour-like enlargement of the prostate,
commonly termed benign nodular hyperplasia (BNH) or
benign enlargement of prostate (BEP), is a very common Figure 23.13 Nodular enlargement of the prostate. Sectioned
condition in men and considered by some as normal ageing surface of enlarged prostate shows soft to firm, grey-white, nodularity
process. It becomes increasingly more frequent above the age with microcystic areas.