PMC7649586_01
(A) Huge prostate with central avascular necrotic area that demonstrates moving internal echoes within suggestive of prostatic abscess.. (B) Decreasing prostatic volume to approximately 53.5 mm3.
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Transrectal ultrasonography being unavailable, transabdominal ultrasonography (USG) revealed massive enlargement of prostate with central avascular necrotic area showing moving internal echoes (Fig. 1A). Magnetic Resonance Imaging (MRI). (Fig. 5) Repeat transabdominal USG showed 53.5 g of prostate (Fig. 1B). Mantoux tuberculin skin test was normal along with serum adenosine deaminase (ADA).
(A) The axial section of the abdomen and pelvis with a black arrow head that demonstrates massively enlarged prostate measuring about 230 g with central liquefaction of approximately 101 mm3.. (B) The coronal section with white arrow head showing the prostatic abscess.
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Cefoperazone-sulbactum was started in the view of prostatic abscess. Contrast Enhanced Computed Tomography (CECT) abdomen showed massively enlarged prostate measuring about 230 g with central liquefaction of approximately 101 mm3 along with significant adjacent inflammatory changes (Fig. 2A and B).
(A) The bilobar enlargement of the prostate.. (B) The efflux of pus from the abscess cavity.. (C) The deroofing of the abscess cavity.
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Intraoperatively, bi-lobar enlargement of prostate along with high bladder neck was appreciated (Fig. 3A). Meanwhile, intraoperative per-rectal manipulation of prostate visualized the pus point and puncture of the prostate was done into it along with gentle transrectal massage of the prostate which provided the counter force to expel the pus from the cavity (Fig. 3B and C).
(A) and (B) The H&E stained sections which show discrete as well as confluent well-formed epithelioid granulomas with caseation and Langhan's type of giant cells. Dense multifocal necrotic areas are evident along with increased proliferation of stromal and glandular components that show double layered epithelium- inner columnar and outer cuboidal to flattened epithelium suggestive of benign prostatic hyperplasia.
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Histopathology examination of prostatic specimen showed well-formed epithelioid granulomas with caseation and Langhan's type of giant cell suggestive of necrotizing granulomatous prostatitis highly suggestive of prostatic tuberculosis (Fig. 4A and B).
The Micturition Cystourethrogram (MCUG) with normal opacification of urinary bladder with irregular wall and ill-defined prostatic urethra with loss of normal outline and no evidence of peritoneal spillage.
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Magnetic Resonance Imaging (MRI). (Fig. 5) Repeat transabdominal USG showed 53.5 g of prostate (Fig. 1B). Mantoux tuberculin skin test was normal along with serum adenosine deaminase (ADA).