软斑病是一种罕见的肉芽肿性炎症反应,特征为显微镜下呈嗜碱性同心层状Michaelis-Gutmann小体,其发生可能与大肠杆菌感染导致的巨噬细胞功能障碍有关。前列腺软斑病极为罕见,主要临床症状包括尿潴留、尿频、尿急、排尿困难、发热及夜尿增多,且还可能出现血尿,直肠检查和影像学检查结果与前列腺癌相似。前列腺穿刺活检是诊断的主要手段,治疗主要采用抗生素,必要时需进行手术。本文报告1例前列腺软斑病病例,根据其临床表现和磁共振成像结果,最初认为极有可能为前列腺癌,然而,前列腺活检发现为前列腺软斑病。患者反复出现发热、尿频、尿急、排尿困难、右侧睾丸肿胀等症状,经过常规抗生素治疗后,再次行前列腺穿刺活检术证实软斑病消失,达到痊愈。因此,建议此类患者进行尿液和血液培养检查,并根据药敏试验结果使用敏感抗生素治疗前列腺软斑病。
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[1] GOLDMAN RL. A case of malacoplakia with involvementof the prostate gland [J]. J Urol, 1965, 93: 407-410.
[2] HOFFMANN E, GARRIDO M. Malakoplakia of the prostate:report of a case [J]. J Urol, 1964, 92: 311-313.
[3] SHIN MS, COOPER JA, HO KJ. Pulmonary malacoplakiaassociated with rhodococcus equi infection in a patient withAIDS [J]. Chest, 1999, 115(3): 889-892.
[4] CARRUTHERS NC. Malakoplakia: report of a case [J].Can J Surg, 1959, 2(2): 213-214.
[5] STERRETT GF, HEENAN PJ, WYCHE P, et al.Malakoplakia of the prostate: a morphological and biochemicalstudy [J]. Pathology, 1975, 7(2): 139-147.
[6] MARÓTI M, ROHONYI B, VECSEY D. Malacoplakiaoriginating in the prostate gland [J]. Orv Hetil, 1975, 116(1):23-24.
[7] COUP AJ. Malakoplakia of the prostate [J]. J Pathol,1976, 119(2): 119-121.
[8] KONNAK JW, HART WR. Malacoplakia of the prostatein an immunosuppressed patient [J]. J Urol, 1976, 116(6):830-832.
[9] FERREIRA AA, ALVARENGA M. Malacoplakia of theprostate confused with clear cell carcinoma [J]. J Urol,1976, 116(6): 828-829.
[10] RHODES RH, WITTMANN AL. Malacoplakia of theprostate following chronic urinary tract infection [J]. J Urol,1977, 117(6): 808-810.
[11] DOURY JC, BERRUTI A, GARRON A, et al. A caseof prostatic malacoplakia [J]. Sem Hop, 1977, 53(40):2273-2275.
[12] RUBENSTE IN M, BUCY JG. M alacoplakia of theprostate [J]. South Med J, 1977, 70(3): 351-352.
[13] MCCLURE J. Malakoplakia of the prostate: a report oftwo cases and a review of the literature [J]. J Clin Pathol,1979, 32(6): 629-632.
[14] Haroske G, Kemmer C, Zotter S, et al. A case ofmalacoplakia of the prostate (author's transl) [J]. ZentralblAllg Patho, 1979, 123(4): 365-371.
[15] SHIMIZU S, TAKIMOTO Y, NIIMURA T, et al. A caseof prostatic malacoplakia [J]. J Urol, 1981, 126(2): 277-279.
[16] KUMON H, FURUKAWA M, TSUGAWA M, et al.Prostatic malacoplakia: a case report with a review of 49cases of malacoplakia of various sites in Japan [J]. ActaMed Okayama, 1983, 37(6): 493-501.
[17] KAWAMURA N, MURAKAMI Y, OKADA K. Threecases of malakoplakia of prostate [J]. Urology, 1980, 15(1):77-80.
[18] MAKEK M, LAGLER U. Malacoplakia of the prostate [J].Urologe A, 1980, 19(2): 89-92.
[19] ALTAFFER LF 3RD, ENGHARDT M. Malakoplakia ofprostate gland [J]. Urology, 1984, 24(2): 196-198.
[20] MATSUMOTO T, IH H, YAMADA Y, et al. Prostaticmalacoplakia [J]. Urol Int, 1985, 40(1): 10-12.
[21] KLAABORG KE, BENNEDBAEK J, STARKLINT H.Two cases of malakoplakia of the prostate [J]. Eur Urol,1985, 11(2): 137-138.
[22] ANDERSEN T, KRISTIANSEN W, RUGE S, et al.Malakoplakia of the prostate causing fatal fistula to rectum.A case report [J]. Scand J Urol Nephrol, 1986, 20(2):153-157.
[23] SUJKA SK, MALIN BT, ASIRWATHAM JE. Prostaticmalakoplakia associated with prostatic adenocarcinoma andm ultiple prostatic abscesses [J]. U rology, 1989, 34(3):159-161.
[24] ALPERN HD. Malakoplakia of the prostate [J]. Int UrolNephrol, 1991, 23(3): 257-259.
[25] SARMA HN, RAMESH K, AL FITURI O, et al.Malakoplakia of the prostate gland-report of two cases andreview of the literature [J]. Scand J Urol Nephrol, 1996,30(2): 155-157.
[26] 亓宝明,刘广庆,孙喜波.前列腺软斑病一例报告[J].中华泌尿外科杂志, 1998(5): 267.
[27] 杨勇,卢锦山,洪宝发.前列腺软斑病[J].中华外科杂志,1998, 36(11): 677.
[28] 孙晓文,许纯孝,郭玲玲.前列腺软斑病二例报告[J].中华泌尿外科杂志, 1999, 20(10): 627.
[29] WAGNER D, JOSEPH J, HUANG J, et al. Malakoplakiaof the prostate on needle core biopsy: a case report and reviewof the literature [J]. Int J Surg Pathol, 2007, 15(1): 86-89.
[30] 刘祥松.前列腺软斑病一例误诊[J].临床误诊误治, 2007,20(11): 95.
[31] 谢广静,郑妮,吴明贵.前列腺软斑病1例[J].疑难病杂志,2009, 8(4): 245,封3.
[32] GÖRGEL SN, BALCI U, SARI AA, et al. Malakoplakiaof the prostate diagnosed by elevated PSA level and transrectalprostate biopsy [J]. Kaohsiung J Med Sci, 2011, 27(4):163-165.
[33] GUNER G, AKDOGAN B, BAYDAR DE. Malakoplakiaof prostate as a complication of transrectal needle biopsy [J].Can J Urol, 2012, 19(1): 6124-6127.
[34] 徐国萍,李正金,苗杰,等.前列腺软斑病1例[J].大理学院学报, 2011, 10(12): 92.
[35] 高仁康,张春影,初茂林.前列腺软斑病1例报告[J].中华男科学杂志, 2021, 27(12): 1150-1151.
[36] 张洪宪,马潞林,杨邵敏,等.前列腺软斑病1例报告[J].北京大学学报(医学版), 2011, 43(4): 620-622.
[37] MEDLICOTT S, MAGI-GALLUZZI C, JIMENEZ RE,et al. Malakoplakia associated with prostatic adenocarcinoma:report of 4 cases and literature review [J]. Ann Diagn Pathol,2016, 22: 33-37.
[38] 陈波,卓育敏.前列腺软斑病2例[J].临床泌尿外科杂志, 2014,29(8): 751-752.
[39] RAPOSO G, FEVRIER B, STOORVOGEL W, MARKSMS. Lysosome-related organelles: a view from immunity andpigmentation [J]. Cell Struct Funct. 2002; 27(6): 443-56.
[40] LOU TY, TEPLITZ C. Malakoplakia: pathogenesis andultrastructural m orphogenesis. A problem of alteredmacrophage (phagolysosomal) response [J]. Hum Pathol,1974, 5(2): 191-207.
[41] SRIGLEY JR. Benign mimickers of prostatic adenocarcinoma [J].Mod Pathol, 2004, 17(3): 328-348.
[42] KOGULAN PK, SMITH M, SEIDMAN J, et al.Malakoplakia involving the abdominal wall, urinary bladder,vagina, and vulva: case report and discussion of malakoplakiaassociated bacteria [J]. Int J Gynecol Pathol, 2001, 20(4):403-406.
[43] CÓZAR OLMO JM, CÁRCAMO P, GASTÓN DEIRIARTE E, et al. Genitourinary malakoplakia [J]. Br JUrol, 1993, 72(1): 6-12.
[44] BIGGAR WD, CRAWFORD L, CARDELLA C, et al.Malakoplakia and immunosuppressive therapy. Reversal ofclinical and leukocyte abnormalities after withdrawal of prednisoneand azathioprine [J]. Am J Pathol, 1985, 119(1): 5-11.
[45] KAYEMBE B, SOHAWON S, DUTTMANN R, et al.Coexistence of renal malakoplakia and myelodysplastic syndrome [J].Intern Med J, 2012, 42(4): e27-e29.
[46] CURRAN FT. Malakoplakia of the bladder [J]. Br J Urol,1987, 59(6): 559-563.
[47] ABDOU NI, NAPOMBEJARA C, SAGAWA A, et al.Malakoplakia: evidence for monocyte lysosomal abnormalitycorrectable by cholinergic agonist in vitro and in vivo [J].N Engl J Med, 1977, 297(26): 1413-1419.
[48] ZURIER RB, WEISSMAN G. Anti-immunologic and antiinflammatory effects of steroid therapy [J]. Med Clin NorthAm, 1973, 57(5): 1295-1307.
张颖,许然,李思,等.前列腺软斑病 1 例报告并文献复习[J].泌尿外科杂志(电子版),2024,16(03):72-78.DOI:10.20020/j.CNKI.1674-7410.2024.03.16
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软斑病是一种罕见的慢性肉芽肿性炎症反应,与大肠杆菌感染相关,常累及泌尿生殖系统,尤其是膀胱,也可累及睾丸、输尿管、肾脏和前列腺[1-2]。软斑病还可出现在其他器官,如皮肤、子宫、肺、骨骼、结肠、肝脏、胃等[3]。前列腺软斑病是一种较罕见的疾病,对其临床诊断及治疗描述较少,发病后长期困扰患者,且其难与前列腺癌相鉴别,1959年CARRUTHERS[4]首次报道。因此,需深入了解软斑病发病机制以寻找合适的治疗方式,现报告前列腺软斑病1例,并回顾相关文献。
1 病历摘要
2 文献复习
3 讨论
软斑病发病机制可能与大肠杆菌感染引起的巨 噬细胞功能异常有关[39- 40]。在显微镜下可见von Hansemann组织细胞,其内外可见呈同心层状的Michaelis-Gutmann小体,其可作为软斑病诊断依据[5,41]。前列腺软斑病症状包括尿潴留、尿频、尿急、尿痛、血尿、发热和夜尿增多等,在文献复习中,有27例出现了以上症状。软斑病可继发于其他严重疾病,在文献复习中,15例同时患有肺癌、肺结核、败血症等疾病[29]。尿培养中最常见的为大肠杆菌,其次有克雷白杆菌、金黄色葡萄球菌、铜绿假单胞菌和奇异变形杆菌,在文献复习中,除表皮葡萄球菌1例、变形杆菌2例、铜绿假单胞菌1例、沙雷氏菌和肠球菌1例,以及阴性6例外,其余均为大肠杆菌[37]。前列腺软斑病仅通过直肠指诊及影像学易与前列腺癌混淆[9]。在直肠指诊中,前列腺软斑病可能表现与前列腺癌类似的硬结节。前列腺穿刺活检是确诊主要手段,细胞角蛋白和前列腺上皮标记缺失,以及CD68染色阳性也有助于鉴别是否为前列腺癌[41]。该疾病还需与肉芽肿性前列腺炎鉴别,其常与导管扩张或破裂有关,且无典型MG小体[25]。前列腺软斑病可能作为独立疾病,也可合并膀胱或睾丸软斑病、前列腺癌,回顾病例中有8例合并前列腺癌[42]。前列腺软斑病可为穿刺活检术并发症,当行经直肠前列腺穿刺活检术后几个月前列腺特异性抗原突然升高或直肠指诊异常时,应考虑前列腺软斑病[33]。抗生素治疗、手术切除联合增强免疫治疗可取得良好效果[43-44]。在文献复习中,大多数病例在抗生素或手术治疗后可被治愈,环丙沙星和复方新诺明是前列腺软斑病的首选抗生素治疗方案[45]。此外,环磷鸟苷酸水平的降低是软斑病患者溶酶体和微管功能障碍的原因[46]。因此,使用胆碱能药物或抗坏血酸可取得良好效果[47]。皮质类固醇药物可干扰巨噬细胞吞噬作用及抗原处理作用,停用或减量也有助于治疗软斑病[48]。本病例接受抗生素规律治疗后被治愈。建议根据药敏结果选择合适抗生素治疗。综上所述,前列腺软斑病是一种罕见的炎症过程,可通过病理活检发现典型的Michaelis-Gutmann小体进行诊断。由于前列腺软斑病在直肠指诊和影像学上与前列腺癌表现相似,因此,要注意进行鉴别。虽然有其他治疗方式被发掘,抗生素治疗仍然是主要治疗方法,且有达到完全治愈的可能。因此,建议进行尿培养,并根据药敏结果选择敏感抗生素治疗前列腺软斑病。
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