Prostatic paracoccidioidomycosis with a fatal outcome: a case report

Dealing with prostate cancer? Don’t let histiocytic lesions fool you!

Background

Prostate adenocarcinoma has well known benign mimickers. Histiocytic proliferations usually impose differential diagnosis with high-grade component of acinar adenocarcinoma (Gleason pattern 5).

Case presentation

We present herein three cases of histiocytic lesions of the prostate in which accurate recognition avoided inappropriate upgrading (malakoplakia associated with prostate adenocarcinoma, two cases) and false positive diagnosis at biopsy (xanthoma with signet ring morphology).

Conclusion

In needle biopsies, pathologists should have a low threshold to perform immunostains when considering a differential diagnosis between high-grade carcinoma and a histiocytic lesion. In prostatectomy specimens, abrupt transition to solid areas in low and intermediate grade tumors should raise concern to exclude malakoplakia. PAS and von Kossa stains are inexpensive and a valuable tool to highlight typical Michaelis–Gutmann bodies.

Fungal prostatitis due to endemic mycoses and Cryptococcus: A multicenter case series

BACKGROUND

Fungal prostatitis is exceedingly rare with mostly case reports.

METHODS

Electronic medical records at three medical centers were searched for cases of fungal prostatitis due to endemic mycoses and Cryptococcus over the preceding 10 years.

RESULTS

Seven cases were identified from 105 600 prostate biopsies within the Southern California Permanente Medical Group for an incidence of 0.0066%. An additional eight cases were identified from two other health care systems. Excluding four patients without available clinical data, 11 patients were reviewed, most of whom underwent biopsy due to elevated prostate-specific antigen. Four were asymptomatic and the remainder had nonspecific signs or symptoms. All biopsies revealed granulomatous inflammation and fungal organisms. Seven patients had coccidioidomycosis, three patients had cryptococcosis (confirmed in two cases and suspected by organism morphology in the other), and one patient had likely histoplasmosis based on organism morphology. Prolonged antifungal treatment was standard; outcomes were favorable.

CONCLUSION

Fungal prostatitis due to endemic mycoses and Cryptococcus is uncommon and associated with favorable outcomes but generally involves prolonged therapy.

Prostatic involvement in disseminated paracoccidioidomycosis: An unusual presentation mimicking malignant neoplasm

Paracoccidioidomycosis is a granulomatous fungal infection, endemic to Latin America, which has great economic impact. Prostatic involvement is rare and can simulate other conditions, which poses a diagnostic challenge for the clinician. This article describes the report of a case of disseminated paracoccidioidomycosis with prostatic involvement, initially confused with prostatic adenocarcinoma. We hope to contribute to the knowledge of this presentation as a differential diagnosis and reinforce the importance of thorough clinical investigation.