Inflammatory Pseudo Tumour of Prostate--论文代写范文精选

51Due论文代写网精选essay代写范文：“ Inflammatory Pseudo Tumour of Prostate”  前列腺的炎症假瘤是非常罕见的。他们通常遵循良性过程,不需要激进的外科治疗。因此明确诊断是必要的,防止不必要的激进治疗。这篇医学essay代写范文研究了一种前列腺的炎症假瘤症状。炎症假瘤(IPT)是一种罕见的良性病因不明的条件。它的特点是模仿恶性肿瘤,因此世卫组织继续将炎症假瘤作为一种独特的临界病变症。发病机理仍不清楚。它可能出现手术后炎症反应,创伤,炎症或恶性肿瘤，在上述的例子中,没有证据表明病人历史病例，大多数情况下是无症状。

Abstract

A 60 year old man presented with history of overflow incontinence, requiring catherization. Digital rectal examination revealed non tender grade II prostatomegaly. Patient underwent transurethral resection of prostate and specimen was sent for histopathological examination. The specimen revealed spindle cell proliferation interspersed with chronic inflammation. Immunohistochemical staining was positive for smooth muscle actin and desmin. A final diagnosis of inflammatory pseudotumour of prostate was made. The patient was later discharged and advised for regular follow up. Inflammatory pseudotumour is very rare condition of prostate. They usually follow benign course and does not require radical surgical treatment. So a definitive diagnosis is essential to prevent unnecessary radical procedures. Key Words: Benign; Histopathology; Prostate; Pseudotumour; Spindle cell

 Introduction

Inflammatory Pseudotumour (IPT) is a rare benign condition of unknown etiology. It is characterized by presence of a mass that may mimic malignancy, hence WHO continues to classify inflammatory pseudotumour as a distinct borderline lesion of uncertainty. The tumour is composed of proliferating myofibroblasts, extracellular collagen, histiocytes and occasionally plasma cells and lymphocytes.1 IPT has been reported in nearly every site of the body. The common sites of occurrence are lungs and orbit and very rarely in genitourinary tract especially prostate. Till date very few cases of inflammatory pseudo tumour of prostate have been reported in literature.2 So here we present a rare case of inflammatory pseudotumor of prostate which has an impact on the management of the patient.

Discussion

Inflammatory pseudotumour of prostate is relatively very rare lesion. So etiopathogenesis is still not well understood. It may arise as an inflammatory reaction following surgery, trauma, inflammation or malignancy or as a denovo lesion without any previous insult3 . In our case there was no evidence of the above causes from the history given by the patient. The tumour has various modes of presentation. Most cases are asymptomatic and have been reported in men aged from 40-67 years4 . 

Clinical examination and radiological investigations are often inconclusive. Ultrasonography shows variable pattern of echogenecity with ill or well defined margins. Image guided biopsy may prove useful to make a definitive histological diagnosis5 . Morphologically inflammatory pseudotumour is small in size and identical to lesions occurring at other sites. These tumour show variable histologic characteristics and hence has been described by different names such as inflammatory myofibrotumour, plasma cell granuloma or pseudotumour and myofibroblastoma. Studies suggest that spindle cells may have fibroblastic or myofibroblastic origin. Histologically IPT shows typical reactive spindle cells within collagenous matrix and prominent vascularity with variable inflammatory cells of acute or chronic origin like plasma cells, lymphocytes and histiocytes. Generally tend to lack severe cytologic atypia though mitotic rate may be elevated but no abnormal mitosis seen, ruling out malignancy. The key histological finding in establishing the diagnosis of IPT are the co-existence of variable numbers of inflammatory cells and spindle cells with varying degrees of fibrosis. Genetic studies have found aberrant forms of anaplastic lymphoma kinase (ALK) in these tumours. 

Other than ALK the spindle cells of inflammatory pseudotumour also commonly express pancytokeratin, actin, desmin and p53and are negative for S100, CD 34, CD117, CD 21 and CD23 6.In our case the tumour cells were positive for smooth muscle actin, desmin and negative for ALK, S100 And CD 34. Most IPTs are benign with few very rare exceptions of the tumour that have been reported to metastasize. Generally the tumour follows innocuous course and prognosis is good. The differential diagnosis of the IPT remains difficult and challenging. So a definitive diagnosis and appropriate treatment play a crucial role in minimizing the morbidity. Hence preoperative recognition of this lesion to rule out malignancy is important.

Conclusion

 Inflammatory pseudotumour of prostate is of special clinical significance because the growth mimics malignancy and due to rarity of the tumour, the lesion may be misdiagnosed or overdiagnosed. As a result patient is subjected to radical surgical procedures leading to considerable morbidity. Also the financial burden is huge to the patient and community in general. Hence the definitive diagnosis of inflammatory pseudotumour is important as it will alter the management of the patient and prevent unnecessary radical treatment.

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