Indian Journal of Radiology and Imaging Indian Journal of Radiology and Imaging

LETTER TO EDITOR
Year
: 1999  |  Volume : 9  |  Issue : 3  |  Page : 154--155

Granulomatous orchitis : An unusual presentation


Ravi Kapoor, Sunita Kapoor 
 City X-ray Lab, New Delhi, India

Correspondence Address:
Ravi Kapoor
City X-ray Lab, New Delhi
India




How to cite this article:
Kapoor R, Kapoor S. Granulomatous orchitis : An unusual presentation.Indian J Radiol Imaging 1999;9:154-155


How to cite this URL:
Kapoor R, Kapoor S. Granulomatous orchitis : An unusual presentation. Indian J Radiol Imaging [serial online] 1999 [cited 2020 Aug 9 ];9:154-155
Available from: http://www.ijri.org/text.asp?1999/9/3/154/28328


Full Text

Sir,

Painless benign testicular masses due to non-tuberculous granulomatous orchitis are very unusual in elderly patients. We present one such rare case.

A 70-years old man presented with a painless enlargement of the right testis over three months. No history of fever, cough, weight loss, anorexia or recent trauma could be elicited. Local examination showed an enlarged, firm, non-tender right testis. A grey scale scan with a 7.5 Mhz linear transducer showed a heterogeneous echopattern in the right testis [Figure 1]. No calcification was seen. The left testis and both epididymis were normal. No free fluid was seen on either side. Color Doppler US showed marked increased vascularity in the right testis with normal left testicular and epididymal vascularity. Right sided orchidectomy was performed, in view of the possibility of malignancy. On histopathology, the testis was infiltrated with distinctly uniform and well-rounded non-caseating granulomas. The granulomas consisted of epithelioid cells and Langhan's type giant cells with minimal lymphocytic infiltration. A diagnosis of granulomatous orchitis was made [Figure 3]. The epididymis was found to be uninvolved. To exclude a diagnosis of tuberculosis, a chest radiograph, Mantoux test and Elisa test for tuberculosis were performed and were found to be within normal limits.

The differential diagnosis of a heterogeneous echopattern in the testes includes primary and secondary neoplasm, infarction, fibrosis and orchitis [1]. The patient's history is often helpful in arriving at a specific diagnosis. Testicular size is another important clue because diffuse neoplasms tend to enlarge the testis whereas an infarcted testis tends to be smaller than normal. Testicular hypervascularity without associated epididymal hyperemia is more suggestive of a neoplastic process than of orchitis [2]. Variable sonographic findings in tuberculous orchitis include diffuse enlargement of a hypoechoic testis, ill-defined or well-demarcated hypoechoic lesions and multiple small hypoechoic nodules. Tuberculous orchitis with no epididymal involvement is very rare [3].

References

1Tessler FN, Tublin ME, Rifkin MD, Ultrasound assessment of testicular and paratesticular masses. JCU 1996; 24: 423-436.
2Agarwal S, Bhargava SK, Mehrotra G, Rathour DPS. Role of Color Doppler Sonography in evaluation of scrotal pathologies. Ind J Radiol Imag 1997; 7:261-265.
3Churg JJ, Kim MJ, Lee T, Yoo HS, Lee J. Sonographic findings in tubercular epididymitis and epididymo-orchitis. J Clin Ultrasound 1997; 25: 390-394.