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Multiparametric MRI characterization of giant benign prostatic hyperplasia with an intraprostatic calculus: Operative and histopathologic correlation in a case report

Year: 2026

Type: article

Abstract: Multiparametric MRI can characterize extreme prostatic enlargement, assess cancer suspicion, and define obstructive urinary tract changes. We describe radiologic and operative correlation in giant benign prostatic hyperplasia. MRI demonstrated a prostate measuring 12.0 × 8.5 × 10.1 cm, with an ellipsoid volume of 539.4 mL and grade III intravesical prostatic protrusion measuring 2.5 cm. The transition zone was replaced by well-circumscribed heterogeneous nodules, some with a nodule-in-nodule appearance. No focal suspicious diffusion abnormality or early enhancement was identified; the highest reported assessment category was PI-RADS v2.1 category 2. Findings also included bladder-wall thickening and trabeculation, a left anterolateral bladder diverticulum, mild bilateral upper urinary tract dilatation, and a solitary 2.07 × 2.11 × 1.99 cm right anterior transition-zone focus. The focus was markedly T2 hypointense, intermediate on T1-weighted and STIR images, hypointense on b = 1400 s/mm² DWI, hyperintense on the ADC map, and nonenhancing, indicating facilitated diffusion. The 60-year-old patient had catheter-dependent urinary retention and prostate-specific antigen of 98 ng/mL. Systematic biopsy showed benign prostatic hyperplasia with chronic inflammation. Open transvesical prostatectomy with diverticulectomy yielded a 510 g adenoma and an approximately 2 × 2 × 2 cm calculus at the corresponding location. Representative prostatectomy sections showed nodular glandular and stromal hyperplasia without identified carcinoma. At 18 months, symptoms, postvoid residual urine, and prostate-specific antigen improved, with preserved continence and resolved upper urinary tract dilatation. MRI localized and characterized the focus but could not prospectively determine its composition; operative correlation established the diagnosis.

Source: Radiology Case Reports

DOI: 10.1016/j.radcr.2026.10.020