前立腺結核の1例 : 経直腸的超音波断層法の診断的有用性

Abstract

症例は61歳男で, 尿閉を主訴とする.直腸疹では前立腺は硬く, 凹凸不整, 左右非対称であった.経直腸的超音波断層法では前立腺の直腸側にhypoechoic lesionを認めた.経直腸的超音波ガイド下systematic biopsyを行い, 全ての採取組織に慢性前立腺炎を認め, hypoechoic lesionに類上皮性肉芽腫, 乾酪壊死を認めた.前立腺マッサージ後尿道内に注入した生理食塩水を回収し, その中に結核菌を認めた.INH, RFPの化学療法により, 結核菌は陰性化し, hypoechoic lesionの経時的縮少を認めた

A case of prostatic tuberculosis is reported. A 61-year-old male visited our clinic complaining of urinary retention. On digital rectal examination, the prostate was found to be enlarged, hard, and uneven. Transrectal ultrasound revealed a large hypoechoic lesion in the posterior aspect of the prostate. Transrectal ultrasound guided systematic biopsies of the prostate were performed. The specimens obtained from the hypoechoic lesion, were diagnosed histopathologically as prostatitis with epithelioid granuloma, Langhans' type giant cells, and caseous necrosis. Mycobacterium tuberculosis was detected in the physiological saline solution injected into the urethra after prostatic massage. The patient was diagnosed as having prostatic tuberculosis and underwent antituberculotic therapy with INH and RFP. Transrectal ultrasound seemed to be useful in detecting histopathological changes associated with tuberculosis in the prostate.