Original Article Granulomatous prostatitis: clinical and histomorphologic survey of the disease in a tertiary care hospital Prakriti Shukla, Hanni V. Gulwani * , Sukhpreet Kaur Department of Pathology, Bhopal Memorial Hospital and Research Centre, Bhopal, India article info Article history: Received 7 December 2016 Received in revised form 3 January 2017 Accepted 4 January 2017 Available online 12 January 2017 Keywords: Granulomatous prostatitis Histomorphology Nonspecific Specific abstract Background: Granulomatous prostatitis is an uncommon entity that is diagnosed incidentally on his- topathology and is broadly classified as nonspecific, specific, postsurgical (post-transurethral resection), or secondary to other rare systemic granulomatous diseases. Only very few studies are available in the literature that describe the clinical and histomorphological spectrum of the disease. Methods: A retrospective analysis of histopathological records of 1,181 prostatic specimens received in the pathology department was done over a period of 13 years (January 2003 to January 2016). All his- tologically proven cases of granulomatous prostatitis were retrieved, and relevant clinical data were collected from patients’ records. Epstein and Hutchins classification was used to categorize these cases. Results: Twenty-two cases of granulomatous prostatitis were identified, accounting for an incidence of 1.86%. Among these, nonspecific granulomatous prostatitis (n ¼ 10) was the most common followed by tubercular prostatitis (n ¼ 5), posttransurethral resection of the prostate (n ¼ 3), allergic (n ¼ 2), and xanthogranulomatous prostatitis (n ¼ 2). The age range of these patients was between 41 and 75 years, with the majority of patients in their 7 th decade. Serum prostate-specific antigen levels ranged between 0.88 ng/mL and 19.22 ng/mL. Hard and fixed nodules were observed on digital rectal examination in 14 cases. Transrectal ultrasound revealed hypoechoic shadows in five cases. Conclusion: Despite present-day advances in imaging modalities and serological investigations, it is virtually impossible to identify granulomatous prostatitis clinically. Histopathology remains the gold standard in diagnosing the disease. However, assigning an etiologic cause to the wide spectrum of granulomas in granulomatous prostatitis requires a pathologist’s expertise and proper clinical correlation for appropriate patient management. © 2017 Asian Pacific Prostate Society, Published by Elsevier Korea LLC. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/). 1. Introduction Granulomatous prostatitis is a group of morphologically distinct forms of chronic prostatitis that is often detected incidentally on histopathology. Although the incidence is low, it is currently diag- nosed more frequently because of increased transurethral resection of the prostate (TURP), needle biopsy procedures, and extensive use of intravesical Bacillus CalmetteeGuerin (BCG) instillation in non- muscle invasive bladder cancer (NMIBC). 1 The major concern lies in the fact that it simulates prostate malignancy on clinical as well as radiological fronts leading to overtreatment. Thus, the diagnosis of granulomatous prostatitis is based on histological detection of epitheloid granulomas with or without other inflammatory cells. A literature search revealed only a few reports on the incidence and clinicopathological series of granulomatous prostatitis. Considering the importance of granulomatous prostatitis in urology clinics, it is pivotal to histologically differentiate this entity from other lesions of the prostate. In the present study, the inci- dence of granulomatous prostatitis, its clinical and histomorpho- logic spectrum, was studied, emphasizing the distinction between the various types observed in a tertiary care multispecialty hospital. 2. Material and methods All the resected prostatic specimens including prostatic bi- opsies, TURP chips, and radical prostatectomies sent to the * Corresponding author. Department of Pathology, Bhopal Memorial Hospital and Research Centre, Bhopal 462038, India. E-mail addresses: hannigulwani@yahoo.com, hannigulwani@gmail.com (HV Gulwani). Contents lists available at ScienceDirect Prostate International journal homepage: https://www.journals.elsevier.com/prostate-international http://dx.doi.org/10.1016/j.prnil.2017.01.003 p2287-8882 e2287-903X/© 2017 Asian Pacific Prostate Society, Published by Elsevier Korea LLC. This is an open access article under the CC BY-NC-ND license (http:// creativecommons.org/licenses/by-nc-nd/4.0/). Prostate Int 5 (2017) 29e34