Imaging of Non-malignant Conditions of the Prostate and Seminal Vesicles: A Comprehensive Review

Abstract

Non-malignant conditions of the prostate and seminal vesicles are much more common in imaging practice than prostate cancer. They include benign prostatic hyperplasia, infective and inflammatory prostatitis, prostatic and periprostatic cysts, and benign tumors. The advances in magnetic resonance imaging (MRI) of the prostate gland have dramatically improved the ability to identify these entities, many of them being identified incidentally in patients evaluated for other indications. Good knowledge of these conditions can aid in precise diagnosis and avoid interpretation pitfalls. In this article, we present non-malignant conditions of the prostate gland using several imaging modalities, including transrectal ultrasound, MRI, and computed tomography. We also present the pathological correlation for benign tumors.

Keywords

benign - prostate - seminal vesicles - magnetic resonance imaging - MRI

Publication History

Article published online:
23 February 2024

• References

• 1 Borofsky S, George AK, Gaur S. et al. What are we missing? false-negative cancers at multiparametric MR imaging of the prostate. Radiology 2018; 286 (01) 186-195
• 2 Fütterer JJ, Briganti A, De Visschere P. et al. Can clinically significant prostate cancer be detected with multiparametric magnetic resonance imaging? A systematic review of the literature. Eur Urol 2015; 68 (06) 1045-1053
• 3 Panebianco V, Giganti F, Kitzing YX. et al. An update of pitfalls in prostate mpMRI: a practical approach through the lens of PI-RADS v. 2 guidelines. Insights Imaging 2018; 9 (01) 87-101
• 4 Rosenkrantz AB, Taneja SS. Radiologist, be aware: ten pitfalls that confound the interpretation of multiparametric prostate MRI. AJR Am J Roentgenol 2014; 202 (01) 109-120
• 5 Han EA, Nandalur KR, Morgan MA. et al. MRI of benign prostatic hyperplasia: important pre- and posttherapeutic considerations. Radiographics 2023; 43 (05) e220096
• 6 Turkbey B, Rosenkrantz AB, Haider MA. et al Prostate imaging reporting and data system version 2.1: 2019 update of prostate imaging reporting and data system version 2. Eur Urol 2019; Sep; 76 (03) 340-351
• 7 Banner MP. Imaging of benign prostatic hyperplasia. Semin Roentgenol 1999; 34 (04) 313-324
• 8 Diaz TA, Benson B, Clinkenbeard A, Long JR, Kawashima A, Yano M. MRI evaluation of patients before and after interventions for benign prostatic hyperplasia: an update. AJR Am J Roentgenol 2022; 218 (01) 88-99
• 9 Wasserman NF, Spilseth B, Golzarian J, Metzger GJ. Use of MRI for Lobar classification of benign prostatic hyperplasia: potential phenotypic biomarkers for research on treatment strategies. AJR Am J Roentgenol 2015; 205 (03) 564-571
• 10 Wasserman NF. Benign prostatic hyperplasia: a review and ultrasound classification. Radiol Clin North Am 2006; 44 (05) 689-710 , viii
• 11 Cheah PY, Liong ML, Yuen KH. et al. Chronic prostatitis: symptom survey with follow-up clinical evaluation. Urology 2003; 61 (01) 60-64
• 12 Krieger JN, Nyberg Jr L, Nickel JC. NIH consensus definition and classification of prostatitis. JAMA 1999; 282 (03) 236-237
• 13 Krieger JN, Dobrindt U, Riley DE, Oswald E. Acute Escherichia coli prostatitis in previously health young men: bacterial virulence factors, antimicrobial resistance, and clinical outcomes. Urology 2011; 77 (06) 1420-1425
• 14 Roberts RO, Lieber MM, Rhodes T, Girman CJ, Bostwick DG, Jacobsen SJ. Prevalence of a physician-assigned diagnosis of prostatitis: the Olmsted County Study of Urinary Symptoms and Health Status Among Men. Urology 1998; 51 (04) 578-584
• 15 Etienne M, Chavanet P, Sibert L. et al. Acute bacterial prostatitis: heterogeneity in diagnostic criteria and management. Retrospective multicentric analysis of 371 patients diagnosed with acute prostatitis. BMC Infect Dis 2008; 8: 12
• 16 Shigehara K, Miyagi T, Nakashima T, Shimamura M. Acute bacterial prostatitis after transrectal prostate needle biopsy: clinical analysis. J Infect Chemother 2008; 14 (01) 40-43
• 17 Shakur A, Hames K, O'Shea A, Harisinghani MG. Prostatitis: imaging appearances and diagnostic considerations. Clin Radiol 2021; 76 (06) 416-426
• 18 Ha US, Kim ME, Kim CS. et al. Acute bacterial prostatitis in Korea: clinical outcome, including symptoms, management, microbiology and course of disease. Int J Antimicrob Agents 2008; 31 (Suppl. 01) S96-S101
• 19 Inflammatory and Pain Conditions of the Male Genitourinary Tract: Prostatitis and Related Pain Conditions, Orchitis, and Epididymitis - ClinicalKey [Internet]. [cited 2023 Dec 11]. Accessed January 17, 2023 at: https://www.clinicalkey.com/#!/content/book/3-s2.0-B9780323546423000562?scrollTo=%23hl0000225
• 20 Haaga JR, Dogra VS, Forsting M, Gilkeson RC, Ha HK, , and Sundaram M. , eds. Mosby Elsevier; 2008
• 21 Shukla P, Gulwani HV, Kaur S. Granulomatous prostatitis: clinical and histomorphologic survey of the disease in a tertiary care hospital. Prostate Int 2017; 5 (01) 29-34
• 22 Naik KS, Carey BM. The transrectal ultrasound and MRI appearances of granulomatous prostatitis and its differentiation from carcinoma. Clin Radiol 1999; 54 (03) 173-175
• 23 Bour L, Schull A, Delongchamps NB. et al. Multiparametric MRI features of granulomatous prostatitis and tubercular prostate abscess. Diagn Interv Imaging 2013; 94 (01) 84-90
• 24 Nghiem HT, Kellman GM, Sandberg SA, Craig BM. Cystic lesions of the prostate. Radiographics 1990; 10 (04) 635-650
• 25 Shebel HM, Farg HM, Kolokythas O, El-Diasty T. Cysts of the lower male genitourinary tract: embryologic and anatomic considerations and differential diagnosis. Radiographics 2013; 33 (04) 1125-1143
• 26 Curran S, Akin O, Agildere AM, Zhang J, Hricak H, Rademaker J. Endorectal MRI of prostatic and periprostatic cystic lesions and their mimics. AJR Am J Roentgenol 2007; 188 (05) 1373-1379
• 27 Trivedi J, Sutherland T, Page M. Incidental findings in and around the prostate on prostate MRI: a pictorial review. Insights Imaging 2021; 12 (01) 37
• 28 Nakamura Y, Shida D, Shibayama T. et al. Giant multilocular prostatic cystadenoma. World J Surg Oncol 2019; 17 (01) 42
• 29 McDermott VG, Meakem III TJ, Stolpen AH, Schnall MD. Prostatic and periprostatic cysts: findings on MR imaging. AJR Am J Roentgenol 1995; 164 (01) 123-127
• 30 Takahashi H, Potretzke TA, Kawashima A, Cheville JC, Masuoka S, Kim B. Imaging of the Bulbourethral (Cowper) gland: abnormalities and differential diagnosis. Radiographics 2022; 42 (07) 2037-2053
• 31 Surana S, Elshazly M, Allam A, Jayappa S, AlRefai D. A case of giant Cowper's gland syringocele in an adult male patient. Case Rep Urol 2015; 2015: 682042
• 32 Wagemans MEHM, Tsachouridis G, Kuijper CF, de Mooij KL, Klijn AJ, de Jong TPVM. Cowper's syringocele in the pediatric population: a retrospective study of 122 patients. J Pediatr Urol 2019; 15 (05) 546-551
• 33 Melquist J, Sharma V, Sciullo D, McCaffrey H, Ali Khan S. Current diagnosis and management of syringocele: a review. Int Braz J Urol 2010; 36: 3-9
• 34 Moch H, Humphrey PA, Ulbright TM, Reuter V. WHO Classification of Tumours of the Urinary System and Male Genital Organs. Lyon, France: International Agency for Research on Cancer; 2016
• 35 Grignon DJ. Unusual subtypes of prostate cancer. Mod Pathol 2004; 17 (03) 316-327
• 36 Marcal LP, Surabhi VR, Ramani NS, Katabathina VS, Paspulati RM, Prasad SR. Mesenchymal neoplasms of the prostate and seminal vesicles: spectrum of disease with radiologic-pathologic correlation. Radiographics 2022; 42 (02) 417-432
• 37 Johnson MH, Carter HB. Stromal tumor of uncertain malignant potential (STUMP) with PSA >500 ng/ml: a case report. Urol Case Rep 2015; 3 (05) 175-177
• 38 Hansel DE, Herawi M, Montgomery E, Epstein JI. Spindle cell lesions of the adult prostate | Modern Pathology [Internet]. Accessed January 17, 2023 at: https://www.nature.com/articles/3800676
• 39 Virarkar M, de Castro Faria S, Patnana M, Zhang M, Sagebiel T. Leiomyoma of the prostate: case report and review of the literature. Clin Genitourin Cancer 2018; 16 (04) e771-e776
• 40 Zhang Y, Zhao J, Xu P, Qi Q. Multiple schwannoma of the seminal vesicle: a case report. Medicine (Baltimore) 2020; 99 (33) e21603
• 41 Rha SE, Byun JY, Jung SE, Chun HJ, Lee HG, Lee JM. Neurogenic tumors in the abdomen: tumor types and imaging characteristics. Radiographics 2003; 23 (01) 29-43
• 42 Seminal vesicle schwannoma presenting with left hydroureteronephrosis - PMC [Internet]. [cited 2023 Dec 11]. Accessed January 17, 2023 at:: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4216547/
• 43 Solitary Fibrous Tumor of the Prostate. A Case Report and Literature Review - PMC [Internet]. [cited 2023 Dec 11]. Accessed January 17, 2023 at:: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8621876/
• 44 Herawi M, Epstein JI. Solitary fibrous tumor on needle biopsy and transurethral resection of the prostate: a clinicopathologic study of 13 cases. Am J Surg Pathol 2007; 31 (06) 870-876
• 45 Ronchi A, La Mantia E, Gigantino V. et al. A rare case of malignant solitary fibrous tumor in prostate with review of the literature. Diagn Pathol 2017; 12 (01) 50
• 46 Tanaka Y, Nakamoto A, Inada Y, Narumi Y, Hirose Y, Azuma H. A case of malignant solitary fibrous tumor of the prostatic urethra. BJR Case Rep 2018; 4 (04) 20180034
• 47 McKenney JK. Mesenchymal tumors of the prostate. Mod Pathol 2018; 31 (S1): S133-S142
• 48 Pernick N. Adrenal gland and paraganglia. In: Yang XJ, Zhou M. eds. Practical Genitourinary Pathology. Cham, Switzerland: Springer; 2021: 273-287
• 49 Padilla-Fernández B, Antúnez-Plaza P, Lorenzo-Gómez MF, Rodríguez-González M, Martín-Rodríguez A, Silva-Abuín JM. Paraganglioma of prostatic origin. Clin Med Insights Case Rep 2012; 5: 69-75
• 50 Halat S, Eble JN, Grignon DJ. et al. Ectopic prostatic tissue: histogenesis and histopathological characteristics. Histopathology 2011; 58 (05) 750-758
• 51 Yeager TS, Stroh BC, Youssef RE, Michaels PJ. Ectopic prostatic tissue involving the omentum and presenting with intussusception and small intestinal obstruction: a report of a rare case with a review of the literature. Human Pathology Reports 2022; 30: 300679
• 52 Dai S, Huang X, Mao W. A novel submucosa nodule of the rectum: A case of the ectopic prostatic tissue outside the urinary tract. Pak J Med Sci 2013; 29 (06) 1453-1455
• 53 Roy C, Guth S, Gasser B. et al. Benign hyperplasia in ectopic prostatic tissue: a rare cause of pelvic mass. Eur Radiol 1997; 7 (01) 35-37
• 54 Fulton RS, Rouse RV, Ranheim EA. Ectopic prostate: case report of a presacral mass presenting with obstructive symptoms. Arch Pathol Lab Med 2001; 125 (02) 286-288
• 55 Vogel U, Negri G, Bültmann B. Ectopic prostatic tissue in the spleen. Virchows Arch 1996; 427 (05) 543-545
• 56 Han C, Zhu L, Liu X, Ma S, Liu Y, Wang X. Differential diagnosis of uncommon prostate diseases: combining mpMRI and clinical information. Insights Imaging 2021; 12 (01) 79