Unusual Case of Prostatic Malacoplakia: Etiopathogenetic,Anatomo-clinical Considerations and Therapeutical Approach

Abstract

— Malacoplakia is a granulomatous disease that is histologically characterized by the presence of Michaelis-Gutmann bodies in the macrophages. A 59-year-old man was referred to our attention for retention of urine. On digital rectal examination the left prostatic lobe was found to be increased in consistency. The PSA value was 14 ng/ml; transrectal sonography revealed a lesion of dishomogeneous pattern with hyperechoic spots at the confluence of the peripheral and transitional left zone. The smears obtained by transrectal fine needle aspiration biopsy of the lesion showed a large amount of histiocytes with the characteristic Michaelis-Gutmann bodies. The patient was treated by both surgical therapy: trans-urethral resection of the prostate (TURP-P) and pharmacological therapy: bethanechol, ascorbic acid and rifampicin. Check-ups at 3 and 6 months and subsequent transrectal sonography re-examination of the prostate revealed no evidence of relapse of the disease. The PSA value after 6 months was 3.4 ng/ml. The patient is actually in good health without recurrence of the disease. Prostatic malacoplakia must be considered as part of the differential diagnosis of prostatic nodules. Only histologic or cytologic examination leads to the proper diagnosis.