Coccidioidomycosis of the Epididymis and Testis

Abstract

Dykes TM, Stone A, Canby-Hagino E= 78-year-old man with a history of benign prostate hypertrophy presented with a painless, firm right scrotal mass on routine physical examination. Scrotal sonography (Figs. 1A and 1B) with a linear 10-MHz transducer showed a focally enlarged lower pole of the epididymis with heterogeneous echotexture compared with the rest of the epididymis and a moderate-sized right hydrocele. Directly contiguous with the lower pole epididymal mass was a 1.8-cm hypoechoic mass in the lower pole of the right testicle. There was also a subtle, striated echotexture pattern in the right testicle compared with the left. The left testicle and epididymis were normal except for small epididymal head cysts and a small hydrocele. Because of the concern for a primary testicular neoplasm, abdominal and pelvic CT was performed and showed no retroperitoneal lymphadenopathy. Right orchiectomy was performed. The result of gross pathologic examination was a 1.3cm, yellow-tan cerebriform mass within the inferior medial pole of the right testis arising at the junction of the distal epididymis and the lower pole testis. The tumor appeared to involve the epididymis but did not extend through the tunica vaginalis. There was also a 2.0-cm pale area in the upper right testicular pole. Representative sections from the distal