泌尿生殖道结核(GUTB),流行地区第二常见的肺外结核(TB)类型,最初由Wildbolz于1973年描述。前列腺和附睾是男性生殖器结核的第一个部位,其次是精囊和睾丸.这里,我们描述了一例65岁男性在过去6周内出现阻塞性下尿路症状(LUTS)的病例.直肠指检显示前列腺增大,表面坚硬且呈结节状。在血清分析中发现高前列腺特异性抗原水平(88ng/ml)。根据临床怀疑前列腺癌,放射学,和血清学检查。鉴于怀疑癌症,进行了前列腺活检,揭示了前列腺腺体和基质元素的增殖与散布的肉芽肿,坏死,和成熟淋巴细胞的聚集体。组织病理学结果提示良性前列腺增生伴肉芽肿性前列腺炎。Ziehl-Neelsen(ZN)染色对耐酸杆菌呈阴性。在前列腺活检组织位上订购了结核分枝杆菌的基于盒的核酸扩增测试(CBNAAT),显示出积极的结果。在组织病理学和核酸扩增试验的基础上,考虑了前列腺结核的诊断。没有与前列腺结核相关的特定临床和放射学发现;因此,只有在组织病理学检查和基于组织的盒式核酸扩增试验后才能确定诊断。临床医生应该对结核病有很高的怀疑指数,特别是在来自流行国家的患者中出现下尿路症状,特别是如果有肉芽肿性炎症和坏死。
Genitourinary tuberculosis (GUTB), the second most frequent type of extrapulmonary tuberculosis (TB) in endemic regions, was initially described by Wildbolz in 1973. The prostate and epididymis are the first sites of male genital tuberculosis, followed by the seminal vesicles and the testicles. Here, we describe a case of a 65-year-old male who presented with obstructive lower urinary tract symptoms (LUTS) for the previous six weeks. The digital rectal examination revealed prostatic enlargement with a firm and nodular surface. A high prostate-specific antigen level (88 ng/ml) was found in serum analysis. There was a suspicion of prostate cancer on the basis of clinical, radiological, and serological examination. In view of the suspicion of carcinoma, a prostate biopsy was performed, which revealed the proliferation of prostatic glandular and stromal elements with interspersed granulomas, necrosis, and aggregates of mature lymphoid cells. The histopathology findings were indicative of benign prostatic hyperplasia with granulomatous prostatitis. Ziehl-Neelsen (ZN) stain was negative for acid-fast bacilli. The cartridge-based nucleic acid amplification test (CBNAAT) for Mycobacterium tuberculosis was ordered on the prostate biopsy tissue bits, which showed positive results. On the basis of histopathology and nucleic acid amplification test, the diagnosis of prostate tuberculosis was considered. There are no specific clinical and radiological findings related to prostate tuberculosis; hence, the diagnosis can be established only after histopathological examination and tissue-based cartridge-based nucleic acid amplification test. Clinicians should have a high index of suspicion for tuberculosis, especially in patients from endemic countries who present with symptoms of the lower urinary tract, especially if there is granulomatous inflammation coupled with necrosis.