Tuberculous Epididymo-orchitis Research Articles

Tuberculosis of the testis and its appendages

Tuberculosis of the genitourinary system has not lost its relevance. During the years of the pandemic of a new coronavirus infection, the number of newly diagnosed cases of tuberculosis of all localizations has decreased, but their structure has become more severe and mortality has increased. There is a wide variation in the statistics of urogenital tuberculosis (UGT) in the literature. The true incidence of scrotal tuberculosis is not known; at the end of the last century, it was believed that it was 7% of all cases of tuberculosis. It is believed that the share of isolated tuberculosis of the genital organs of men accounts for no more than 30% of all localizations of UGT, and most often tuberculosis develops in the epididymis. The spread of M. tuberculosis to the organs of the scrotum, as a rule, occurs by the hematogenous route from the primary focus in the lungs or kidney. However, the infection can also spread retrogradely from the prostate and seminal vesicles to the epididymis and testicles. Tuberculosis of the testis and its epididymis is often complicated by infertility and the formation of fistulas. This disease has no pathognomonic symptoms. Differential diagnosis is carried out between tuberculous epididymo-orchitis, testicular tumor, testicular torsion, bacterial epididymo-orchitis. Ultrasound examination is of great diagnostic value in tuberculosis of the scrotal organs. The ultrasound picture in tuberculosis of the testis and its epididymis is divided into 4 types: diffuse enlargement, heterogeneous hypoechogenicity; diffuse increase, uniform hypoechogenicity; nodular enlargement, heterogeneous hypoechogenicity; miliary dissemination. The world literature does not describe an example of tuberculosis of the scrotal organs, when the disease would be diagnosed during the patient’s initial visit to the doctor. As a result of late diagnosis or low suspicion for TB, up to 70% of patients undergo unnecessary surgery, although TB orchiepididymitis can be treated medically. The lecture also analyzed a number of clinical observations.

Unilateral Tb Epididymo-Orchitis with Scrotal Fistula- A Case Report

Tuberculosis is one of the most common worldwide diseases that remain almost unaltered in prevalence for the past few years. Genitourinary tract tuberculosis is common, but when associated with scrotal fistula it is a rare presentation. A 50 years old male came to the hospital with the complaints of pricking pain and swelling in the left side of scrotum for the past 2 months. He had history of smoking for past 40 years, on examination swelling of size approximately 6x5 cm present in left side of scrotum, globular in shape; penis pushed to right side was present, lower part of the swelling was firm to hard in consistency, left cord thickness was present and fixity to skin was also present. There was a small fistulous opening present in the left side of scrotum with no active discharge. Bilateral inguinal lymph nodes were palpable. This is a rare case presentation of tuberculous epididymo-orchitis with scrotal fistula leading to testis removal. Initially emperical treatment was started for TB epididymoorchitis which turned unresponsive, so he was then proceeded for surgery to avoid further disease progression. This case was managed radiologically, clinically and pathologically. This case report shows how the case was managed and followed up.Since symptoms of TB epididymo-orchitis are milder when compared to the symptoms of pyogenic epididymo-orchitis, they appear to physicians in later advanced stages. Tuberculosis should be considered in Patients with mild symptoms of epididymo-orchitis, mainly in those with HIV, immunosuppressive conditions and endemic areas.

Management of tuberculous epididymal-orchitis: a literature review

Extrapulmonary tuberculosis can develop in a large number of sites; the 3 common sites are the skeleton, genitourinary tract, and central nervous system. Involvement of these organs due to hematogenous spread of bacilli. Tuberculous (TB) epididymal-orchitis is the most common male genital tuberculosis, followed by prostate tuberculosis and tuberculosis of seminal vesicles. Infections of TB epididymal-orchitis usually start from globus major due to its rich blood supply. Based on clinical findings, tuberculous infection of the epididymal-orchitis is hardly distinguishable from tumor and infarction. In chronic stage, painless or painful swelling is seen. Several laboratory tests such as Urine Acid Fast Bacilli (AFB) Stains, Culture, and Interferon-? release Assay (IGRA) can be performed to diagnose the disease. Radiology and Histopathology findings with fine-needle aspiration cytology (FNAC) also play an important role. Until now, TB epididymo-orchitis has been difficult to diagnose due to non-specific presentation. Therefore, this paper was created to provide an understanding based on current literature studies on the management of TB epididymal orchitis. This paper will discuss the clinical manifestations of tuberculous epididymo-orchitis, methods for diagnosis, and treatment concepts. This paper is also expected to be a guidance for primary healthcare doctors to be aware with the clinical findings of the TB epididymal-orchitis.

Surgical management of tuberculous epididymo-orchitis: a retrospective study of 81 cases with long-term follow-up

BackgroundNowadays, most studies of tuberculous epididymo-orchitis (TBEO) are case reports or small sample cohort series. Our study is aimed to present the largest series of TBEO with our management experiences and long-term follow-up outcomes.MethodsPatients diagnosed with TBEO after surgical procedures at Department of Urology, West China Hospital from 2008 to 2019 were included. All clinical features, auxiliary examination results, treatment and histopathological findings were extracted if available.ResultsEighty-one patients (mean age 50.77 ± 16.1 years) were included. Scrotal swelling (N = 47, 58.0%) and pain (N = 29, 35.8%) were the most common presenting complaint. Pyuria and microscopic hematuria were observed in twenty-two (27.2%) and eight patients (9.9%), respectively. Urine acid fast bacilli cultures were available in 16 patients and all were negative. The mean duration between the onset of symptoms and the definite diagnosis was 6.42 ± 7.0 months. TBEO was considered in 30 (37.0%), tumors in 28 (34.6%) and nonspecific bacterial epididymo-orchitis in 23 (28.4%) patients. All patients received triple therapy of chemotherapy-surgery-pharmacotherapy and definite diagnosis was confirmed through histopathology of surgical specimens. Fifty-five patients were followed up regularly (mean follow-up 82.35 ± 36.6 months). One patient (1.2%) died from liver cirrhosis and no recurrence was observed. Postoperative complications included erectile dysfunction in 4 patients (4.9%), premature ejaculation in 5 patients (6.2%) and sterility in 7 patients (8.6%).ConclusionsWe recommend patients with advanced TBEO to receive triple therapy of chemotherapy-surgery-pharmacotherapy. Physicians should pay more attention to patients’ sexual function and fertility during follow up after treatment completed.

English

BACKGROUND The incidence of testicular malignancy has been increasing in men, orchidectomy is necessary for the removal of neoplastic lesions or in patients with chronic inflammatory conditions resistant to treatment. We wanted to evaluate the various histopathological patterns of lesions in testis. METHODS A retrospective study of 86 orchidectomy specimens over a period of three years with age wise distribution from March 2017 to February 2020 was done in the Department of Pathology, Guntur Medical College, Guntur. Histopathological slides stained with haematoxylin and eosin were retrieved and reviewed. Immunohistochemistry was done in two cases. RESULTS Of the 86 cases, 78 (90.7 %) cases were non neoplastic and 8 (9.3 %) cases were neoplastic. Youngest age in non-neoplastic group was four days and in neoplastic group was 18 years. The oldest age was 82 years in the non-neoplastic lesions and 60 years in the neoplastic lesions. Non neoplastic lesions were common in the 3 rd decade. In malignant lesions, highest number of cases was seen in the 6 th decade and equal distribution was observed in 3rd and 5th decade. Unilateral involvement was common than bilateral involvement. Out of all non-neoplastic lesions, undescended testis 20 (25.64 %) cases was the common finding followed by non-specific epididymo orchitis 19 (24.36 %) cases, abscess 14 (17.95 %) cases, torsion infarction 13 (16.67 %) cases, Leydig cell hyperplasia 4 (5.13 %) cases, 3 (3.85 %) cases each of tuberculous epididymo orchitis and granulomatous epididymo orchitis. 1 (1.28 %) case each of rare entities like vanishing testis and splenogonadal fusion were also found. Among the neoplastic lesions, all 8 cases were malignant tumours. Out of these malignant tumours, mixed germ cell tumours were seen in 3 (37.5 %) cases followed by seminomas 2 (25 %) cases, post pubertal teratoma 1 (12.5 %) case, non-Hodgkin’s lymphoma (NHL) 1 (12.5 %) case and primitive neuroectodermal tumour (PNET) 1 (12.5 %) case. CONCLUSIONS Histopathological examination on routine haematoxylin and eosin (H&E) stained sections primarily differentiate non neoplastic lesions from neoplastic group and benign tumours from malignant tumours as the treatment modality varies. Immunohistochemistry (IHC) is useful in the diagnosis of poorly differentiated small round cell tumours. KEYWORDS Orchidectomy Specimens, Neoplastic and Non-Neoplastic Lesions

DIFFERENT PRESENTATION OF TUBERCULOUS ORCHITIS: CASE SERIES

SESSION TITLE: Medical Student/Resident Chest Infections Posters SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: October 18-21, 2020 INTRODUCTION: Extrapulmonary tuberculosis (TB) still presents a diagnostic and therapeutic challenge. Genitourinary TB constitutes about 20% of the extrapulmonary cases in regions where TB is endemic. Where TB is found in unexpected sites, its positive diagnosis remains important. Tuberculous infection of epididymis and testis is difficult to differentiate clinically from pyogenic infection, tumour or infarction. The clinical presentation of genitourinary tuberculosis (TB) may be variable and a high index of suspicion is required for a timely diagnosis, especially in endemic areas. Scrotal ulcers associated with epididymo-orchitis should alert the clinician of a possible diagnosis of TB. Isolated tuberculous epididymo-orchitis may closely mimic testicular tumour particularly in patients with no history of systemic TB thereby presenting a diagnostic and treatment challenges. CASE PRESENTATION: Case1: 49 years old immunocompetent male smoker came with swelling and pus discharging ulcer in right testis for 3 months. Genital examination showed ulcer over posterior aspect and sinus over anterior aspect of the enlarged scrotum. His chest x ray was normal. USG scrotum echogenic collection with specks of calcification in TV sac. Sinus tract was excised and CBNAAT shows rifa sensitive MTB. Case2: 55 years old immunocompetent male, never smoker came with dry cough, right sided scrotal pain with pus discharging ulcer of 20 days duration. He denied prior ATT, and had no contact with tuberculosis. USG scrotum showed anechoeic collection in right TV sac. CXR showed air space opacity on right upper zone. Sputum: AFB 1+ , CBNAAT: rifa sensitive, MTB detected low. Discharge from ulcer in CBNAAT showed rifa sensitive MTB. Case3: 28 years old immunocompetent male had scrotal swelling of 6 months duration. No constitutional symptoms. Had prior ATT taken only 3 months for HPE proved TB right cervical adenitis. Genital examination showed sinus tract in posterior aspect of right scrotum. USG scrotum shows scrotal wall abscess suggestive of tuberculosis. Sinus tract excision has epitheloid granuloma without caseous necrosis and CBNAAT had rifa sensitive MTB. All 3 cases showed free from symptoms and partial resolution of ulcer after 2 months of ATT. DISCUSSION: Tuberculous epididymitis may be the presenting symptom of genitourinary TB. It usually presents as a painful, inflamed scrotal swelling but occasionally can present as a draining sinus on the posterior surface of the scrotum. TB orchitis without epididymal involvement is very rare. It is most common in young (20-40 years), sexually active males but here in middle age group also involved. CONCLUSIONS: The clinical presentation of genitourinary tuberculosis (TB) may be variable and a high index of suspicion is required for a timely diagnosis, especially in endemic areas. Sebaceous cyst is the commonest swelling that occurs in the scrotal skin. Reference #1: AlZayyani, N. R., Wani, A. M., Al Miamini, W. & Al Harbi, Z. S. Chronic epididymo-orchitis and scrotal ulcers. BMJ Case Rep. (2011) doi:10.1136/bcr.03.2010.2825. Reference #2: Shenoy, V. P., Viswanath, S., D’Souza, A., Bairy, I. & Thomas, J. Isolated tuberculous epididymo-orchitis: An unusual presentation of tuberculosis. J. Infect. Dev. Ctries. (2012) doi:10.3855/jidc.2145. Reference #3: Khan, A., Singaraddi, R., Shetty, D. & Rodrigues, G. Primary cutaneous ‘ulcerative’ tuberculosis of the scrotum: A rare occurrence. BMJ Case Rep. (2018) doi:10.1136/bcr-2018-227177. DISCLOSURES: No relevant relationships by UMAPATHI SIVASUBRAMANIAM, source=Web Response

Ultrasonographic findings of various diseases involving male genitalia: clinical and pathological correlations

Purpose With review of anatomy and vascular supplies in male genitalia, we will present the ultrasonographic findings of various cases involving testis, epididymis and penis. Materials and Methods All of eleven cases were confirmed either pathologically or clinically. We present 3 cases of scrotal neoplasms (immature teratoma, rapid growing and large seminoma, mixed germ cell tumor), 2 cases of infectious diseases (tuberculous epididymo-orchitis, mumps epididymo-orchitis, 3 cases of other scrotal diseases (testicular torsion, testicular rupture, epididymal rupture), and 3 cases of penile diseases (penile fracture, paraffinoma, leiomyosarcoma). Results Eleven cases of various diseases involving the male genitalia showed the variable ultrasonographic findings on grey scale and color Doppler ultrasonography. Clinical history is helpful in the diagnosis of some cases, such as mumps epididymitis, post-traumatic rupture of testis or epididymis, penile fracture or penile paraffinoma. Conclusion We have to know the clinical history and specific ultrasonographic findings of various diseases of male genitalia for the exact diagnosis and differentiation.

REPORTING AN UNUSUAL CASE OF INFERTILITY; ISOLATED BILATERAL TUBERCULOUS EPIDIDYMO-ORCHITIS

Tuberculosis may infect any part of the body. Tuberculous orchitis is a rare disease that usually occurs as a result of direct extension from the epididymis. Only a paucity of cases regarding epididymo-orchitis and scrotal involvement without renal or pulmonary involvement has been reported until today. Isolated tuberculous epididymo-orchitis presents with a clinical picture and radiographic illustrations mimicking a scrotal neoplasm; therefore, diagnosis can be challenging for physicians. We are presenting a case of isolated bilateral tuberculous epidymo-orchitis resulting in infertility and discharging scrotal sinuses which responded to 6 months anti – tuberculous therapy.

Vulval Tuberculosis Mimicking Malignancy – A Diagnostic Dilemma

Abstract Extrapulmonary tuberculosis can occur in conjunction with pulmonary focus or in isolation. Tuberculosis of vulva and vagina is rare and is seen in only 1% of genital TB that usually occurs in women of reproductive age. We report a case of postmenopausal woman with isolated vulval tuberculous lesion that clinically mimicked malignancy. Keywords Vulval tuberculosis; Vulval malignancy; Cauliflower growth. Case presentation A 72 years old postmenopausal woman was referred with the diagnosis of vulval malignancy, she presented with 4x3 cms irregular friable cauliflower growth that bleeds on touch, present on lower one third of labia majora and minora (Figure 1). Although clinically it mimicked vulval malignancy but punch biopsy histopathological examination showed granuloma consisting of clusters of epitheloid and langhans cells, suggestive of tuberculosis. She was started on antitubercular drugs and after 2 months the lesion regressed by 50% and after 4 months of completion of ATT normal anatomy of vulva was restored. Discussion Tuberculosis of vulva and vagina is rare, seen in only 1% of genital TB and usually occurs in women of reproductive age [1]. Vulval TB usually is the extrapulmonay manifestation of primary focus at lungs but venereal transmission also can occur from infected male partner, harbouring tuberculous epididymo-orchitis [2]. It begins as a nodule which breaks down and forms irregular ragged ulcer. It may have varied presentation and mimics sexually transmitted diseases or malignancy [3]. Antitubercular drugs causes full regression of ulcer and histopathological confirmation is a necessity before radical surgery

Classical case of tuberculous Epididymo-orchitis and how to rule out differentials on sonography

Tuberculous infection of the scrotum is rare and occurs in approximately 7% of patients with tuberculosis. With the rise in the human immunodeficiency virus pandemic, the incidence of opportunistic extrapulmonary tuberculosis has correspondingly increased, the genitourinary system being the most common affected site. We present a classical case of tuberculous epididymo-orchitis with clinical, sonographic and histopathological (macro and microscopic) findings as well as the precise management plan incorporated. The sonographic imaging overlap with bacterial epididymo-orchitis, malignant testicular lesions and testicular torsion is discussed. Adequate knowledge of this entity is of utmost importance to ensure a meticulous diagnosis and treatment.

Tuberculous epididymo-orchitis mimicking a testicular tumour: a case report

Isolated tuberculous epididymo-orchitis may closely mimic testicular tumour particularly in patients with no history of systemic TB thereby presenting a diagnostic and treatment challenges. A 44-year old man presented with 4 months history of left scrotal mass and had left orchidectomy following a presumptive diagnosis of testicular tumour. Histopathological diagnosis of testicular tuberculosis was subsequently made. Although the patient was thereafter referred for antituberculosis treatment at the local tuberculosis treatment centre, he defaulted after commencing treatment. Adequate evaluation of patients with testicular mass by means of abdominal and scrotal ultrasound coupled with fine needle aspiration cytology is critical to diagnostic accuracy, optimal treatment and possibility of avoiding surgery in those with testicular tuberculosis.

"BCGitis": A rare case of tuberculous epididymo-orchitis following intravesical Bacillus Calmette-Guérin therapy

Tuberculous epididymo-orchitis is a rare complication of intravesical Bacillus Calmette-Guérin (BCG) therapy for urothelial cancer of the bladder. We present such a case, describe its sonographic appearance and review the literature. The difficulties in diagnosing this condition based on imaging alone, given the extensive overlap with the appearance of bacterial epididymo-orchitis, malignant testicular disease and testicular torsion, are discussed. Adequate knowledge of tuberculous epididymo-orchitis is of capital importance in order to ensure a proper diagnosis and treatment.

Granulomatous epididymo-orchitis, a rare complication of intravesical bacillus Calmette-Guérin therapy for urothelial cancer

Only a few cases of tuberculous epididymo-orchitis after bacillus Calmette-Guérin (BCG) therapy have been published. This report presents a case of granulomatous epididymo-orchitis after intravesical BCG therapy in a patient presenting with pain and unilateral swelling of the scrotal content. This complication should always be considered when a patient presents with these symptoms after BCG therapy. Isoniazid may be used as a first choice of treatment.

Role of ultrasonography in diagnosis of scrotal disorders: a review of 110 cases

ObjectiveTo determine the role of ultrasonography in diagnosis of scrotal disorders.Materials and methodsThis study was carried out after institutional review board approval was granted, and informed consent was waived. Between January 2005 and January 2007, 144 patients aged 12 years and older with scrotal symptoms, who underwent scrotal ultrasonography (US), were retrospectively reviewed. The clinical presentation, outcome, and US results were analysed. The presentation symptoms were divided into three groups including scrotal pain, painless scrotal mass or swelling, and others. Surgery was performed in 32 patients.ResultsOf 144 patients, 110 had clinical follow-up and constituted the material of this study. The patients ranged in age from 13 to 82 years (mean 38.6 years). Of 110 patients, 84 (76.4%) presented with scrotal pain, 21 (19%) had painless scrotal mass or swelling and 5 (4.5%) had other symptoms. Of the 84 patients with scrotal pain, 52 had infection, 4 had testicular torsion, 7 had testicular trauma, 10 had varicocele, 4 had hydrocele, 1 had epididymal cyst, 1 had scrotal sac and groin metastases, and 5 had unremarkable results. Of the 21 patients who presented with painless scrotal mass or swelling, 18 had extratesticular lesions and 3 had intratesticular lesions. All the extratesticular lesions were benign. Of the 3 intratesticular lesions, one was due to tuberculous epididymo-orchitis, one was non-Hodgkin’s lymphoma, and one was metastasis from liposarcoma. Of the 5 patients who presented with other symptoms, 4 had undescended testes, and 1 had gynaecomastia. US gave incorrect diagnosis in only one patient with scrotal pain.ConclusionThe most common cause of scrotal pain was infection. The most common cause of scrotal mass or swelling was extratesticular lesion. US plays an important role in the diagnosis of scrotal disorders and in planning for proper management.

Chronic Tuberculous Epididymo-orchitis Manifesting as a Non-Tender Scrotal Swelling: Magnetic Resonance Imaging–Histological Correlation

Clinically, chronic tuberculous epididymo-orchitis often is nonspecific and subsequently is indistinguishable from other various scrotal lesions. Gray-scale and color Doppler ultrasound is most commonly used for distinguishing these conditions. However, there are few reports on the magnetic resonance imaging (MRI) features of chronic tuberculous epididymo-orchitis. We describe MRI features of this lesion clinically manifesting as non-tender scrotal swelling with a correlation of the histological findings.

Sterility as Unique Symptom of Tuberculous Epididymo-orchitis

Objective: To study the rare tuberculous epididymo-orchitis causing infertility. Design: Surgical specimens received at a Reference Laboratory serving the Igbo ethnic group in Nigeria were analyzed as regards tuberculosis during a period of 30 years. Results: One hundred cases involving peripheral lymph nodes, 30 cases of peritoneal disease and 24 cases affecting the genitalia were accessed during the 1970s. Thereafter, only one case was found to be due to sterility. Conclusion: In all probability, if the sexual history can be included routinely as part of the complete medical evaluation, this symptom may be found to be commoner in Nigeria and other areas of the world where TB is a health problem. Keywords : Tuberculosis, epididymis, testis, sterility, epidemiology. Journal of College of Medicine Vol. 13 (2) 2008: pp. 126-127

Case report: USG of bilateral tuberculous epididymo-orchitis

The genitourinary tract is the most common extrapulmonary site affected by tuberculosis.[1] The male genital organs are involved in more than 50% of patients.[2] The epididymis is the commonest structure to be involved, followed by the seminal vesicles, prostate, testis, and the vas deferens.[3] Bilateral involvement of scrotal structures is not rare. Bilateral epididymal involvement has been reported in 25% of patients with scrotal tuberculosis.[4] We would like to report a patient with bilateral tuberculous epididymo-orchitis.

Tuberculous Epididymo-orchitis After Intravesical BCG Therapy for Superficial Bladder Carcinoma

Intravesical instillation of BCG vaccine for superficial bladder carcinoma has been well established, and several reports have suggested superior effectiveness over other chemotherapy options. Complications after intravesical BCG therapy are rare, with local complications in the bladder being far more frequent than systemic complications. Few cases of tuberculous epididymo-orchitis after intravesical BCG therapy can be found in the literature, and sonographic findings, if described, are variable and nonspecific. We report a case of granulomatous epididymo-orchitis diagnosed after resection of sonographically suspected testicular cancer in a patient with a history of superficial bladder carcinoma treated with intravesical BCG instillation. To our knowledge, the presence of punctate calcifications within a nodular lesion has not been described before and mimics the sonographic findings expected in common tuberculous epididymo-orchitis.

Tuberculous epididymo-orchitis masquerading as paratesticular sarcoma in childhood- A case report

Testicular involvement is a rare complication of tuberculosis. Among children the disease is often misdiagnosed and confusedwith paratesticular sarcoma. A six-year old boy presented with painful testicular mass. The histology showed a granulomatous inflammation and acid fast bacilli consistent with tuberculosis. Tuberculous epididymo-orchitis should be considered in the differential diagnosis of any testicular enlargement in children living in tuberculosis endemic areas. Keywords : testis; histology; childhood African Journal of Paediatric Surgery Vol. 4 (2) 2007: pp. 106-107

Tuberculids as sentinel lesions of tuberculous epididymo‐orchitis

Tuberculids are rarely associated with male genital tract tuberculosis (TB). Tuberculous epididymo-orchitis (TBEO) has been associated rarely with papulonecrotic tuberculid (PNT) but not with erythema induratum (EI) or the simultaneous occurrence of different tuberculids. A retrospective assessment of tuberculids that occurred with underlying TBEO was carried out. Five patients, four with one and one with two skin biopsies, with clinical diagnoses of PNT (two), EI (one), impetigo (two) and calf ulcer (one), formed the study cohort. Histopathological evaluation confirmed PNT and EI in four and two skin biopsies, respectively. Two patients who returned for follow-up were commenced on anti-tuberculous therapy. All patients sought medical attention 3-34 months later for tender right-sided (two) and left-sided (three) testicular masses. Orchidectomy was undertaken following a poor clinical response to empirical treatment with trimethoprim sulfamethoxazole. Pathological examination of the testis and epididymis confirmed TBEO. The patients were initiated on anti-tuberculous therapy. There was dramatic healing of the skin lesions. Tuberculids are a sentinel cutaneous manifestation of visceral TB and a valuable external audit of treatment compliance and response. Heightened recognition of and more rigorous genitourinary tract investigation are necessary to identify occult or asymptomatic TBEO as the underlying cause of tuberculids.