MORBID ANATOMY - CHRONIC DIFFUSE PROSTATITIS.
Some thirty years ago the elder Gross said that the morbid anat omy of chronic prostatitis was something which did not exist. If we were to accept many of the so-called cases of prostatorrhcea as chronic inflammation of the prostate the opinion of this distinguished surgeon might still be accepted as authoritative. As already indi cated, however, a large proportion of these cases are not entitled to the term chronic prostatitis, consisting as they do merely of hyper aemia of the prostate with attendant hypersecretion. Inasmuch as chronic prostatitis is not essentially a fatal disease, opportunities for the post-mortem study of the disease are relatively rare. A sufficient number of observations have been made, however, to show not only that chronic prostatitis exists as a pathological entity, but that its morbid anatomy presents well-marked features.
In the follicular or parenchymatous form of chronic inflammation of the prostate there may be little or no alteration in the prostate body, as shown on clinical examination, yet post-mortem section of the tissue shows an increase of consistency of the prostatic tissue in cidental to a greater or less degree of periglandular thickening, i.e., interstitial connective-tissue hyperplasia. This interstitial change is more marked in patients toward middle age. It would seem that long continuance of the glandular inflammation eventually determines a greater or less degree of chronic inflammation of a diffuse charac ter. Diffuse inflammation with considerable enlargement of the prostate in men of middle age is in all probability often due to long continued glandular inflammation, or to chronic hyperaemia. Hyper plasia of the epithelium lining the ducts and glands of the prostate is a constant condition. The lymphatics of the organ may be thick ened and hyperplastic. These conditions of thickening and hyper plasia of the glands are likely to lead to an irregularity of contour of the prostate which may be mistaken for tuberculosis. The follicular and racemose glands and their ducts are often dilated, usually irreg ularly so. Complete or partial occlusion may occur at certain points, as a consequence of which retention cysts of muco-pus and epithe lium may form. The urethral orifices of the prostatic ducts are
dilated and thickened as a rule, although in some instances their lumen is more or less contracted. Pressure upon the gland causes the exudation of a muco-purulent fluid mixed with epithelial debris. The mucous membrane of the prostatic urethra may be compara tively normal, but it is likely to be thickened, hyperaemic, and possi bly granular. This condition of the urethra exists in cases in which chronic prostato-urethritis has been the chief feature of the case. The changes above described are to be expected in practically all in dividuals who have experienced an acute inflammation of the prostate at some period more or less remote. That such changes are fre quent the author has demonstrated by a large number of post mortem examinations.
Le Dentu has given an excellent description of chronic diffuse prostatitis in a patient thirty-tWo years of age who died of some in tercurrent disease. The prostate was greatly enlarged, the right lobe being especially so. The normal tissue of both lobes was replaced by connective tissue presenting lacume varying in dimension from the size of a hemp-seed to that of a large pea. The larger cavities were filled with muco-pus and were evidently formed by the fusion of smaller cavities.
The author's diSsections show that in well-marked diffuse inflam mation of the prostate, the morbid process involves not only the prostate body proper, but the prostatic urethra, the prostatic glands and ducts, the seminal vesicles, yasa defereutia, and the peri-prostatic tissues which invest the prostate, neck of the bladder, seminal vesi cles, and vas deferens. Thickening and induration of the involved tis sues are a marked feature. Desnos and Kirmesson have directed especial attention to the thickening of the submucous rectal tissue contiguous to the prostate and to the cellular tissue lying between the latter organ and the rectum. Adenitis with resulting enlarge ment of the lymphatic glands and a nodular condition of the prostate which may be felt from the rectum is more likely to occur in the dif fuse than in the follicular or parenchymatous form. This condition is probably the one which is most often mistaken for prostatic tuberculosis.