Indian Journal of Urology
CASE REPORT
Year
: 2001  |  Volume : 18  |  Issue : 1  |  Page : 92--94

Granulomatous orchitis - a case report


Nitin M Gadgil, Nilima U Ranadive, Monika Sachdeva 
 Department of Pathology, Lokmanya Tilak Municipal Hospital, Sion, Mumbai., India

Correspondence Address:
Nitin M Gadgil
6, Malhar, Anushakti Nagar, Mumbai - 400 095
India

Abstract

Clinically seminoma and granulomatous orchitis are difficult to separate. The present case highlights this aspect. 50-year-old male presented with mass & pain in right testis since 6 to 8 months. Right testis was enlarged, hard & tender: Laboratory investigations were within normal limits. Orchiectomy specimen revealed homogenous appearance with yellow grey colour Sections studied showed multiple non-caseating granulomas mainly within seminiferous tubules. Differential diagnosis of non-caseating granulomas mainly includes sarcoidosis & granulomatous orchitis. Restriction of granulomas to seminiferous tubules as in our case is a characteristic feature of granulomatous orchitis.



How to cite this article:
Gadgil NM, Ranadive NU, Sachdeva M. Granulomatous orchitis - a case report.Indian J Urol 2001;18:92-94


How to cite this URL:
Gadgil NM, Ranadive NU, Sachdeva M. Granulomatous orchitis - a case report. Indian J Urol [serial online] 2001 [cited 2020 Oct 22 ];18:92-94
Available from: https://www.indianjurol.com/text.asp?2001/18/1/92/37470


Full Text

 Introduction



Granulomatous orchitis was first described by Grunberg in 1925, since then about 70 cases have been reported in literature.[1] The etiology of this condition remains obscure. Clinically this condition may resemble epididymo-orchitis, tuberculosis or malignancy. As testicular biopsy is contraindicated in a suspected case of malignancy, the diagnosis of granulomatous orchitis can be achieved only on histopathology of resected testis and many a time it comes as a surprise. The following case is presented for its close clinical resemblance to malignancy.

 Case Report



A 50-year-old male presented with history of mass in right side of scrotum since 6-8 months. He had history of pain on right side of scrotum for past 2 years, which was increasing gradually. On local examination, right testis was enlarged measuring 6x5x5 cms, tender and hard in consistency. The routine laboratory investigations were unremarkable. On ultrasound examination of right scrotum, testis measured 5x4x5 cms. CT scan of the abdomen was unremarkable. Levels of carcinoembryonic antigen (CEA) and alpha feto protein were within normal limits. Placental alkaline phosphatase level was not done. The patient underwent rightsided high orchiectomy, as testicular malignancy-? Seminoma was suspected. The testis measured 5x4x3 cms and weighed 50 gms. Tunica albuginea was thickened. The cut surface had uniform homogenous appearance with yellowish grey colour [Figure 1]. The epididymis was unremarkable. The microscopy revealed multiple non-caseating granulomas practically involving every seminiferous tubule, yet its outline was preserved. The granulomas consisted of epithelioid cells, lymphocytes. plasma cells [Figure 2]. The germinal epithelial cells were totally lacking. Granulomas were not seen in the interstitium.

The interstitium showed lymphoplasmocytic infiltration.

 Discussion



Granulomatous orchitis is a rare condition, the precise etiology of which is unknown. Trauma, autoimmune reaction to sperms and urinary tract infection[2] has been postulated.

The differential diagnosis of non-caseating granulomas mainly includes sarcoidosis and granulomatous orchitis. But granulomas in sarcoidosis are seen in the interstitium. The restriction of granulomas to seminiferous tubules is a characteristic feature of granulomatous orchitis. The tuberculous infections always involve the epididymis and secondarily involve the testis... Seminoma and granulomatous orchitis occur in same age group with similar clinical presentation. Clinically seminoma and granulomatous orchitis can not be differentiated, as sensitive serological marker for seminoma is not available.

According to Dr. C.P. Chiton3 steroids may be given if the symptoms appear in contralateral testis.

This case highlights clinical simulation of granulomatous orchitis to testicular malignancy especially seminoma. [3]

References

1Lynch VP, Eakins D, Moirison E. Granulomatous orchitis. Br J Urol 1968; 40: 451-458.
2Cruikshank B, Stuart Smith DA. Orchitis associated with sperm agglutinating auto antibodies. Lancet 1959; 1: 708-709.
3Chilton CP, Smith PJB. Steroid therapy in the treatment of Granulomatous orchitis. Br J Urol 1979; 51: 404-405.