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OJHAS Vol. 9, Issue 4:
Oct-Dec, 2010) |
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Inflammatory
Pseudo Tumour of Prostate |
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Siddappa Sujatha, Department of
Pathology,
Kowsalya R, Department of
Biochemistry,
Mythri KM, Department of Microbiology,
Venkatesh GK, Director and Head, Urology
Unit I,
Gajanana Bhat, Department of
Urology,
Institute of Nephrourology, Victoria Hospital
Campus, Bangalore – 560002, Karnataka, India
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Address For Correspondence |
Laboratory-In charge
Assistant professor, Dept of Pathology,
Institute of Nephrourology,
Victoria Hospital
Campus,
Bangalore – 560002,
Karnataka, India.
E-mail:
sujathasiddappa@gmail.com |
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Siddappa S, Kowsalya R, Mythri KM, Venkatesh GK, Bhat G.
Inflammatory Pseudo Tumour of Prostate. Online J Health Allied Scs.
2010;9(4):20 |
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Submitted: Nov 27,
2010; Accepted: Dec 28, 2010; Published: Jan 20, 2011 |
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| Abstract: |
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A 60 year old man presented with history
of overflow incontinence, requiring catherization. Digital rectal examination
revealed non tender grade II prostatomegaly. Patient underwent transurethral
resection of prostate and specimen was sent for histopathological examination.
The specimen revealed spindle cell proliferation interspersed with chronic
inflammation. Immunohistochemical staining was positive for smooth muscle
actin and desmin. A final diagnosis of inflammatory pseudotumour of
prostate was made. The patient was later discharged and advised for
regular follow up. Inflammatory pseudotumour is very rare condition
of prostate. They usually follow benign course and does not require
radical surgical treatment. So a definitive diagnosis is essential to
prevent unnecessary radical procedures.
Key Words: Benign; Histopathology;
Prostate; Pseudotumour; Spindle cell
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Inflammatory Pseudotumour (IPT) is a
rare benign condition of unknown etiology. It is characterized by presence
of a mass that may mimic malignancy, hence WHO continues to classify
inflammatory pseudotumour as a distinct borderline lesion of uncertainty.
The tumour is composed of proliferating myofibroblasts, extracellular
collagen, histiocytes and occasionally plasma cells and lymphocytes.1 IPT
has been reported in nearly every site of the body. The common sites
of occurrence are lungs and orbit and very rarely in genitourinary tract
especially prostate. Till date very few cases of inflammatory pseudo
tumour of prostate have been reported in literature.2 So
here we present a rare case of inflammatory pseudotumor of prostate
which has an impact on the management of the patient.
A non diabetic 60-year old man presented
with history of overflow incontinence for past six months presented
to our centre which is a tertiary care centre catering exclusively to
needs of nephrourology patients. Digital rectal examination revealed
non tender, enlarged prostate (grade II) without nodules. PSA level
was 2.01ng/ml. Ultrasonogram of abdomen and pelvis showed enlarged prostate
with thickened bladder wall. There was no evidence of any lymph node
enlargement or any form of lesion. Patient underwent transurethral resection
of prostate and the specimen was sent for histopathological evaluation.
The tissue was processed and stained
with hematoxylin and eosin stains. Histological examination showed mild
adenomatous hyperplasia with few prostatic glands (Fig-1) lying in a
hyperplastic stroma composed of numerous areas of elongated cells with
central elongated nuclei characteristic of spindle cells interspersed
with foamy histiocytes, blood vessels and chronic inflammation. Spindle cells
were bland with only an occasional mitosis (Fig-2)
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Figure 1: 10 X showing mild adenomatous
hyperplasia with few prostatic glands (arrow head) |
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Figure 2: 40 X showing
spindle cells with mitosis (arrow head) |
Immunohistochemical staining of
the spindle cells was positive for smooth muscle actin and desmin and
negative for ALK, S100 and CD34. A review opinion of the case was obtained
from an oncopathologist of the state run cancer institute and the final
diagnosis concurred with ours as inflammatory pseudotumour of prostate.
Post operatively, the patient voided normally and was discharged with
advice for regular follow up.
Inflammatory pseudotumour
of prostate is relatively very rare lesion. So etiopathogenesis is
still not well understood. It may arise as an inflammatory reaction
following surgery, trauma, inflammation or malignancy or as a denovo
lesion without any previous insult3. In our case there was
no evidence of the above causes from the history given by the patient.
The tumour has various modes of presentation. Most cases are asymptomatic
and have been reported in men aged from 40-67 years4. Clinical
examination and radiological investigations are often inconclusive.
Ultrasonography shows variable pattern of echogenecity with ill or well
defined margins. Image guided biopsy may prove useful to make a definitive
histological diagnosis5.
Morphologically inflammatory pseudotumour
is small in size and identical to lesions occurring at other sites.
These tumour show variable histologic characteristics and hence has
been described by different names such as inflammatory myofibrotumour,
plasma cell granuloma or pseudotumour and myofibroblastoma. Studies
suggest that spindle cells may have fibroblastic or myofibroblastic
origin. Histologically IPT shows typical reactive spindle cells within
collagenous matrix and prominent vascularity with variable inflammatory
cells of acute or chronic origin like plasma cells, lymphocytes and
histiocytes. Generally tend to lack severe cytologic atypia though mitotic
rate may be elevated but no abnormal mitosis seen, ruling out malignancy.
The key histological finding in establishing the diagnosis of IPT are
the co-existence of variable numbers of inflammatory cells and spindle
cells with varying degrees of fibrosis. Genetic studies have found aberrant
forms of anaplastic lymphoma kinase (ALK) in these tumours. Other than
ALK the spindle cells of inflammatory pseudotumour also commonly express
pancytokeratin, actin, desmin and p53and are negative for S100, CD 34,
CD117, CD 21 and CD23 6.In our case the tumour cells were
positive for smooth muscle actin, desmin and negative for ALK, S100
And CD 34.
Most IPTs are benign with few very rare
exceptions of the tumour that have been reported to metastasize. Generally
the tumour follows innocuous course and prognosis is good. The differential
diagnosis of the IPT remains difficult and challenging. So a definitive
diagnosis and appropriate treatment play a crucial role in minimizing
the morbidity. Hence preoperative recognition of this lesion to rule
out malignancy is important.
Inflammatory pseudotumour
of prostate is of special clinical significance because the growth mimics
malignancy and due to rarity of the tumour, the lesion may be misdiagnosed
or overdiagnosed. As a result patient is subjected to radical surgical
procedures leading to considerable morbidity. Also the financial burden
is huge to the patient and community in general. Hence the definitive
diagnosis of inflammatory pseudotumour is important as it will alter
the management of the patient and prevent unnecessary radical treatment.
We acknowledge the Department of histochemistry,
Kidwai Institute of Oncology, Bangalore for their help provided for
immunohistochemical stains.
- Horiuchi
R, Uchida T, Kojima T et al . Inflammatory pseudo tumour of the liver.
Clinicopathologic study and review of the literature. Cancer 1990;65:1583-1590.
- Kuramoto T, Kohjimoto Y, Mori T et al. Inflammatory pseudotumour of the
prostate: a case report. Hinyokika kiyo 2005;51:767-770.
- Young RH, Scully RE. Pseudosarcomatous lesions of urinary bladder, prostate
gland and urethra: A report of 3 cases and review of the literature. Arch Pathol Lab Med 1987;111:354-358.
- Pérez García FJ, Pinto Blázquez J, Gutiérrez García R, et al. Inflammatory
prostatic pseudotumor (fibromyxoid pseudosarcomatous tumor). Arch Esp Urol
2004;57:657–660.
- Park SB, Cho KS, Kim JK et al. Inflammatory pseudotumor (myoblastic tumor)
of the genitourinary tract. Am J Roentgenol. 2008;191:1255-1262.
- Hansel DE, Herawi M, Montgomery E et al.
Spindle cell lesion of the adult Prostate. Mod Pathol 2007;20:148-158.
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