Stony testicle: case of calcific granulomatous orchitis

A thirty-three-year-old man presented with a hard testicular mass considered preoperatively to be a malignant testicular tumor. Frozen section revealed calcific granulomatous orchitis, which does not appear to have been previously described in man. Granulomatous orchitis is an important differential diagnosis of testicular lesions. The hard nature of this particular lesion contributed to the preoperative diagnosis of malignancy.     

Xanthogranulomatous orchitis with scrotal fistulas

Xanthogranulomatous orchitis is an extremely rare inflammatory change of testis which is difficult to distinguish from testicular tumor. We report on a 21-year-old man who presented with left testicular swelling and pyogenic discharge from the scrotum. Testicular tumor markers were normal. Scrotal ultrasonography showed a testicular tumor in the left testis. Because of severe adhesion between the scrotum and intrascrotal structures, radical orchiectomy combined with hemiscrotectomy was performed to exclude possible malignancy. Histopathological findings showed xanthogranulomatous orchitis.     

Granulomatous orchitis

Granulomatous orchitis is an inflammatory change of the testis. This is a rare lesion of unknown etiology. Usually are unilateral. The clinical appearance varies, and it is difficult to differentiate from testicular cancer. The diagnosis usually being made on histological examination after orchiectomy. Our paper report one case of granulomatous orchitis in a 27 year old patient. A review of the literature is made on the diagnosis and pathogenesis.     

Sonographic appearance of benign intratesticular lesions

58 patients with a purely intratesticular lesion were investigated with scrotal ultrasound. A pathognomonic echo pattern could be found for simple parenchymal cysts and hemangiomas only. The nature of all other lesions (chronic orchitis, hematoma, epidemoid cyst, testicular necrosis, abscess and tuberculosis) could not be defined solely on sonographic grounds.     

Role of interferon-alpha-2B in prevention of testicular atrophy with unilateral mumps orchitis

OBJECTIVES: To determine the effectiveness of intravenously administered interferon-alpha-2B for the prevention of testicular atrophy in postpubertal men with mumps orchitis. METHODS: Eighteen patients with mumps orchitis were evaluated. The patients were hospitalized, and 3 x 1,000,000 IU intravenous interferon-alpha-2B was administered daily for a total of 7 days. All patients were evaluated by testicular biopsy on the 12th month after interferon treatment. RESULTS: Biopsy results demonstrated total atrophy of the seminiferous tubules in seven (38.8%), 10% atrophy in three (16.6%), and no apparent histopathologic alterations except an arrest in spermatogenesis in eight (44.6%) testes. CONCLUSIONS: Systematic treatment with interferon-alpha-2B does not seem completely effective in preventing testicular atrophy after mumps orchitis. Further investigations involving larger populations are needed.     

Xanthogranulomatous orchitis in an adult Nigerian

Xanthogranulomatous orchitis (XGO) is a rare benign disease of the testis which has not been previously documented in tropical Africa. We report a case of a 24-year-old Nigerian man who presented with a painless left hemiscrotal swelling. Our clinical diagnosis was left testicular cancer. Testicular tumor markers were normal. At surgical exploration, we found a left testicular tumor. Histopathological examination of the specimen showed XGO of the left testis. He had left radical orchiectomy and left inguinal node dissection. He has remained stable 8 months after the treatment. Xanthogranulomatous orchitis cannot be distinguished clinically from testicular cancer unless by histopathological examination. Orchiectomy is the treatment of choice. However, in all patients and particularly young patients and those with a single testis, histopathological confirmation is suggested to avoid unnecessary radical orchiectomy, useless irradiation and ill-timed chemotherapy.     

Brucella orchitis: a rare cause of testicular mass: report of a case

Brucellosis is a multiorgan infectious disease. The genitourinary system is affected in 2–20% of the cases and the most common form is orchitis. Rarely, patients may present with a testicular mass and it must be distinguished from malignant processes. We report brucellar orchitis, a rare cause of testicular mass, in a 22-year-old man. We described the clinicopathological features of this rare entity and reviewed the literature.     

Systemic alpha-interferon therapy: a possible method for prevention of testicular atrophy and permanent sterility in patients with bilateral mumps orchitis

In postpubertal men orchitis is the most common complication of mumps infection, occurring in 5-37% of this population. A bilateral manifestation is observed in 16-65%. The most important danger is the risk of developing testicular atrophy, which results in sterility. Four patients with bilateral mumps orchitis received systemic treatment with interferon-alpha 2B (3 X 10(6) IU/day) for 7 days. All acute symptoms of mumps orchitis disappeared within 2 or 4 days of hospitalization. During 12-20 months of follow-up no incidence of testicular atrophy was observed. In three of the four patients pretreatment examination revealed subfertility (oligoasthenozoospermia), while 2-4 months after interferon treatment and throughout the entire follow-up period normozoospermia was found. No severe adverse effects occurred during treatment. The flu-like symptoms could be prevented by concomitant administration of paracetamol (3 X 500 mg/day). Systemic treatment with interferon-alpha 2B appears to be highly effective in preventing sterility and testicular atrophy after bilateral mumps orchitis. Further investigations involving larger populations should be performed to confirm the present promising results.     

Syphilitic orchitis: a case report]

Syphilitic orchitis is recently a rare disease in Japan. A 75-year-old man was referred to our hospital with the complaint of persistent swelling of the left scrotal contents in spite of prior antibiotic therapy. We suspected a testicular tumor because of lack of pain, and performed high orchiectomy. The specimen showed wide-ranged necrosis with a non-specific inflammatory change of the testis on hematoxylin-eosin stain. After performing analysis using a polymerase chain reaction method, we reached the final diagnosis of syphilitic orchitis.     

Systemic treatment with interferon-alpha 2B: an effective method to prevent sterility after bilateral mumps orchitis

In men orchitis represents the most common complication of mumps infection and occurs in 5 to 37% of this population. Bilateral manifestation is observed in 16 to 65% of the patients. The most important danger is the risk of testicular atrophy which results in sterility. Four patients with bilateral mumps orchitis received systemic treatment with interferon-alpha 2B (3 x 10(6) IU per day) for 7 days. All acute symptoms of mumps orchitis disappeared within 2 to 4 days of hospitalization. During 6 to 15 months of followup no incidence of testicular atrophy was observed. In 3 of 4 patients pre-treatment examination revealed subfertility (oligoasthenospermia), while 2 to 4 months after interferon treatment, as well as during the entire followup period normospermia was found. No severe adverse effects occurred during treatment. The flu-like symptoms could be prevented by concomitant administration of paracetamol (500 mg. 3 times a day). Systemic treatment with interferon-alpha 2B appears to be highly effective in preventing sterility and testicular atrophy after bilateral mumps orchitis. Further investigations involving larger populations should be performed to establish the present promising results.     

Bilateral idiopathic granulomatous orchitis

A rare case of asymtomatic synchronous bilateral granulomatous orchitis idiopathic is decribed. In the scrotal ultrasonography are multiple hypoecoic areas, differential diagnosis between testicular tumor and granulomatous orchitis is very difficult in any examination by histological findings.     

A case report of granulomatous orchitis--review of 20 cases in Japan

We report a case of granulomatous orchitis. A 31-year-old male complained of right lumbago and scrotal pain. The ultrasonographic finding was multiple hypo-echoic areas in the right testis as highly suggestive of testicular cancer. The diagnosis was made after orchiectomy. Granuromatous orchitis is a rare disease which true etiology remains obscure. Only 20 cases have been reported in Japan. The clinical, radiological and pathological features of 20 cases are presented and discussed. Patients' age ranged from 29 to 79 years, an average of 55 years. The left testis was involved in 7 patients, the right in 9 and 4 cases were bilateral. Ultrasonographic examination of the affected testis revealed hypoechoic mass, so little value in differentiating granulomatous orchitis from neoplasm. The correct diagnosis of granulomatous orchitis has never been made prior to surgery, because it clinically bears a lot of resemblance to testicular cancer. The diagnosis usually is made on histological examination. Orchiectomy is the main form of treatment to date, because antibiotics have little effect on the course of the disease and at the time of diagnosis, the testis is already destroyed and there is hardly any viable testicular tissue in the removed specimens.     

Mumps orchitis in the non‐immune postpubertal male: a resurgent threat to male fertility?

OBJECTIVE: To report clinical findings associated with an increased incidence of mumps orchitis in Liverpool, UK, as in the last 2 years there has been a four-fold increase in the number of notified viral mumps cases in the UK. PATIENTS AND METHODS: In the 8 months before April 2005, patients presenting to the Accident and Emergency/Urology Departments of the Royal Liverpool University Hospital with a diagnosis of epididymo-orchitis were identified from the emergency urological admission database. RESULTS: Of 195 males presenting with an acute history of testicular pain and swelling, 25 gave a history of mumps parotitis 4-11 days earlier. Three had bilateral orchitis and two needed scrotal exploration to exclude torsion. Scrotal ultrasonography findings varied from increased vascularity to abnormal testicular echo texture. Treatment included analgesia, scrotal support, re-hydration and broad-spectrum antibiotics. Of the 10 patients followed-up to date, four had testicular abnormalities; one had persistent testicular pain, one a change in testicular consistency, one a noticeably reduced size of one testis, and one significant testicular atrophy. CONCLUSION: As postpubertal mumps in males is associated with a 40% incidence of orchitis, parents should be made aware that failing to immunize their children threatens the future fertility of their sons. Young men not immunized as children should be counselled and offered urgent vaccination. Clinicians should be aware that epididymo-orchitis may be secondary to mumps infection even with no history or clinical evidence of parotitis.     

Clinical aspects of granulomatous orchitis

Granulomatous orchitis can presort in a variety of forms Varying from acute to chronic. Clinically, testicular neoplasm is usually diagnosed and radical orehieetomy is performed, with the correct diagnosis being made on microscopic examination. In this article 6 cases of granulontatous orchitis are presented, with a variety of clinical presentations varying front acute to the more chronic forms.     

雄性生殖道巨噬细胞研究进展

综述了近年来关于雄性生殖道内巨噬细胞的研究进展 ,及其在男性生殖生理及病理方面的作用 ,包括睾丸巨噬细胞与Leydig细胞、支持细胞、生精细胞及下丘脑 垂体 性腺轴的紧密联系和相互影响 ,巨噬细胞在免疫炎症中的形态和功能改变 ,以及对炎症进展的调节作用。从而进一步阐明了睾丸巨噬细胞在睾丸内复杂的免疫调节网络中起的重要作用及其在生精过程和睾丸生精微环境的稳定中所发挥的独特功能 ,为临床治疗提供理论依据     

Establishment of murine model of autoimmune male infertility]

BACKGROUND: Experimental autoimmune orchitis (EAO) has been studied as an animal model for human immunological male infertility. We have already reported the induction of contralateral EAO ("sympathetic orchitis") by unilateral testicular injury in mice. In this paper, we report the induction of autoimmune infertility in such mice as well as EAO. METHODS: Ten to 20 needle punctures were made to the unilateral testis of mice and it was crushed by a needle-holder. Such mice were mated in vivio with female mice. RESULTS: Fifty to 80% mice whose testis was injured unilaterally became infertile in 3 months. Delayed type hypersensitivity (DTH), one of the cell-mediated immunities, to autologous testicular cells (TC) as well as anti-TC antibodies, humoral immunity, were both detected in those mice. CONCLUSION: We have clearly shown that unilateral testicular injury could induce not only the contralateral EAO but also autoimmune infertility in mice. Our present injury model mimics clinical testicular trauma; therefore, this testicular injury model can be very useful in studying the immunological mechanism of EAO and of human immunological male infertility.     

Chronic orchitis: a neglected cause of male infertility?

Infection and inflammation of the male reproductive tract are accepted as important aetiological factors of infertility. With regard to their impact on male reproductive function, orchitis and epididymo-orchitis due to local or systemic infection as well as noninfectious aetiological factors are of particular concern. There is clinical and pathological evidence that chronic inflammatory conditions of the testes can disrupt spermatogenesis and irreversibly alter both sperm number and quality. In the majority of patients, however, diagnosis is hampered by an asymptomatic course of the disease and unspecific clinical signs. Hence, respective epidemiological data are scarce. On the other hand, systematic histopathological work-up of testicular biopsies from infertile men indicates a high prevalence of inflammatory reactions. A characteristic pattern of inflammatory lesions with focal or multifocal, predominantly peritubular lymphocyte infiltration and concomitant damage of seminiferous tubules is seen in chronic orchitis of various origins. This supports the concept that induction of testicular inflammation is associated with a T-cell-mediated autoimmune response, i.e. disruption of the immune privilege. Moreover, despite the patchy distribution of the lesions, testicular volume and score counts for spermatogenesis may be significantly reduced. In conclusion, asymptomatic inflammatory reactions in the testis should not be neglected as an underlying cause or co-factor of male infertility. However, definitive diagnosis of chronic asymptomatic orchitis still requires testicular biopsy and guidelines for the therapeutic management are not yet available.     

Granulomatous orchitis

An additional case of granulomatous orchitis is described. The pathogenesis of the disease is discussed. We believe that repeated minor injury, resulting in sperm extravasation, will cause small sperm granulomas. These granulomas initiate the sensitization process. Repeated minor injury can create altered testicular antigen which could result in the evolution of a granulomatous orchitis.     

Case of mumps orchitis after vaccination

We present a case of mumps orchitis after vaccination. A 35‐year‐old man visited the emergency unit of our hospital for fever and right testicular pain on 7 January 2012. Two weeks before the visit, he underwent vaccination for mumps. After 7 days of hospitalization, the patient recovered from fever and testicular pain. Scrotal magnetic resonance imaging suggested right orchitis, and an increased level of serum mumps immunoglobulin M and immunoglobulin G indicated an initial infection of mumps virus. The peak value of immunoglobulin G showed 106 enzyme immunoassay unit 5 weeks after vaccination, which was 10‐fold higher than the ordinary rise of a vaccinated individual. This fact leads to two possibilities. One is this happened as an adverse event of vaccination, and the other is that he actually had a wild‐type infection at the same time as vaccination. There are some reports regarding adverse events of mumps vaccine; however, they might include wild‐type infection.     

Testicular underlying pathology, especially mumps orchitis in patients developing testicular tumors (author's transl)

From 1966 to 1976, 502 patients with testicular tumors were treated in Hamburg. This represents a morbidity of 3 cases in 100,000 of the male population. Increase in morbidity was noticed. The average age for patients with seminomas was 37.7 years, for patients with teratoid carcinomas 28.3 years and with mixed tumors 29.2 years. Two patients had mumps orchitis in their history. Because of the long interval between mumps orchitis and development of tumor a causal realtionship was considered unlikely. 4.8% of the patients had a history of epididymitis on the side where the tumor developed later. Epididymitis may be the only symptom of mumps and mumps therefore still be of importance in the development of testicular tumors. Postorchitic testicular atrophy may form the basis for tumor development. The high incidence of undescended testicles, orchidopexy and inguinal hernia operations in the history of these patients is discussed.