Prostatic Involvement in Wegener’s Granulomatosis

Abstract

Wegener's granulomatosis involving the prostate gland is unusual. We report 3 cases of this condition in which typical necrotizing granulomas with vasculitis were seen histologically. These lesions may cause gross hematuria or obstructive voiding, including urinary retention. Management includes prostatectomy when the symptoms are severe but an initial trial of aggressive medical therapy may be successful. Treatment requires a knowledge of the natural history of Wegener's granulomatosis and its usual response to medical therapy.

Triple Wegener’s Granulomatosis in the Urogenital Tract

“…Extrarenal uro genital manifestations of WG have been re ported infrequently. Prostatic involvement in WG has been estimated to amount to 2-7% [1], and involvement of seminal vesicles, testes, urethra and bladder wall has been reported sporadically [2][3][4][5][6][7][8]. Four cases have been de scribed with ureteric obstruction due to an inflammatory infiltration associated with a generalized WG [9][10][11][12][13].…”

‘Prostate Abscess' as the Initial Manifestation of Granulomatosis with Polyangiitis (Wegener's Granulomatosis)

“…Prostatic involvement in GWP is rare, amounting to 2.3-5% of cases [6,7]. It mostly arises in the context of systemic involvement [4].…”

Wegener?s granulomatosis presenting with gross hematuria due to prostatitis

“…Sir, Wegener's granulomatosis (WG) represents a systemic vasculitis usually affecting the upper respiratory tract (74%), lungs (70%) and kidneys (46%) and affecting men and women equally, with a peak occurrence during the fifth and sixth decades of life [4,5]. The etiology is unknown, but generation of anti-neutrophil cytoplasmic antibodies (c-ANCA) and activation of cellular response probably triggered by a preceding infection are discussed [1].…”

“…The diagnosis of WG should be made considering clinical presentation, histological findings in biopsy specimens and measurement of c-ANCA, which are highly specific [4]. Histologically, "dirty" liquefactive and/or coagulative necroses with a large number of eosinophilic granulocytes, scanty lymphocytes, plasma cells and multinucleated giant cells associated with a destructive leukocytoclastic vasculitis of arteries and veins are usually found in the lesions of the upper airways and lungs [5]. Renal disease includes focal necrotizing glomerulonephritis or interstitial nephritis [2,5].…”

“…Histologically, "dirty" liquefactive and/or coagulative necroses with a large number of eosinophilic granulocytes, scanty lymphocytes, plasma cells and multinucleated giant cells associated with a destructive leukocytoclastic vasculitis of arteries and veins are usually found in the lesions of the upper airways and lungs [5]. Renal disease includes focal necrotizing glomerulonephritis or interstitial nephritis [2,5]. Clinically, WG presents with symptoms of the upper and lower respiratory tract, including nasal obstruction, discharge, ulcers, sinusitis or otitis, cough, hemoptysis and dyspnea, often associated with a progressive loss of renal function with microhematuria, nephritic urine sediment, moderate proteinuria up to rapidly progressive renal failure and systemic symptoms such as fever, weight loss and sweats [5].…”