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Table of Contents
CASE REPORT
Year : 2019  |  Volume : 16  |  Issue : 3  |  Page : 174-176

An unusual case of xanthogranulomatous orchitis: A tumor mimic


Department of Pathology, Apollomedics Superspeciality Hospital, Lucknow, Uttar Pradesh, India

Date of Submission15-Jun-2019
Date of Acceptance17-Aug-2019
Date of Web Publication11-Sep-2019

Correspondence Address:
Pretty Singh
J-7/28, Sushant Golf City, Lucknow - 226 030, Uttar Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/am.am_37_19

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  Abstract 


Xanthogranulomatous inflammatory reaction is an uncommon nonneoplastic disease process, which is an even rarer entity in testicles. We present a similar case report of a 20-year-old male with a testicular swelling and a provisional clinical diagnosis of a testicular neoplasm. We hence present this case in view of its rarity and its nature to deceptively mimic a neoplasm.

Keywords: Nonneoplastic disease, testicles, xanthogranulomatous inflammation


How to cite this article:
Somani K, Singh P, Verma S, Tandon T. An unusual case of xanthogranulomatous orchitis: A tumor mimic. Apollo Med 2019;16:174-6

How to cite this URL:
Somani K, Singh P, Verma S, Tandon T. An unusual case of xanthogranulomatous orchitis: A tumor mimic. Apollo Med [serial online] 2019 [cited 2019 Nov 18];16:174-6. Available from: http://www.apollomedicine.org/text.asp?2019/16/3/174/266777




  Introduction Top


Xanthogranulomatous inflammation (XGI) is an uncommon pathological diagnosis. It is distinctive type of chronic inflammation characterized by destruction of the affected tissue by a cellular infiltrate of foamy histiocytes with variable admixture of other inflammatory cells. It is a well-known disease entity of the kidney and gallbladder.[1] However, XGI of the testis has been rarely reported. We present a similar case of a 20-year-old male.


  Case Report Top


A 20-year-old male presented with a left scrotal swelling, gradually progressive in size for the last 3 months. There was no associated fever and urinary complaint. On examination, the testicular mass was firm and nontender. The right-sided scrotal examination was within normal limits. He underwent ultrasonography, which revealed a heterogeneously enhancing mass, measuring 4 cm × 3.5 cm × 3 cm, with central hypoechoic areas. The testicular tumor markers were within normal limits. However, the possibility of testicular neoplasm could not be completely excluded and the patient underwent inguinal orchiectomy.

Pathological examination

We received an orchiectomy specimen measuring 5.5 cm × 5 cm × 3.5 cm, with outer surface being smooth. The cut surface revealed a grayish-white solid mass with central area of necrosis [Figure 4]. Part of the spermatic cord was also identified. The specimen was thoroughly grossed. Sections showed extensive replacement of testicular parenchyma with sheets of foamy histiocytes along with groups of plasma cells and lymphocytes [Figure 1] and [Figure 2]. Areas of neutrophilic abscesses were also seen. Sections from the central friable areas showed necrosis along with neutrophilic debris. There was no evidence of malignancy, in any of the sections. The inflammatory cells were extending up to the adventitia. The spermatic cord section showed infiltration with inflammatory cells along with multiple thrombozed blood vessels [Figure 3].
Figure 4: Macroscopic examination revealed a solid whitish testicular mass with central areas of necrosis

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Figure 1: Testicular parenchyma displaying dense inflammatory infiltrate (HPE, ×200)

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Figure 2: Diffuse sheets of foamy histiocytes along with other inflammatory cells, destroying the normal testicular parenchyma (HPE, ×400)

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Figure 3: Sections from the spermatic cord showing partially thrombosed blood vessels (HPE, ×100)

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  Discussion Top


Xanthogranulomatous orchitis is a rare entity; it is associated with effacement of the testicular tissue with sheets of foamy histiocytes and other inflammatory cells. Before rendering this diagnosis, we should completely exclude testicular neoplasm by thorough grossing. The exact etiopathogenesis of this disease condition has yet not been established.

The likely causes may include immunologic defects, chronic infection, and abnormal phagocytosis of necrotic tissues. Obstruction of the epididymis and/or an ischemic process of the testis and genital tract associated with the chronic infective inflammation may also be considered few of the causes. This hypothesis is consistent with the obstructive mechanism known to be responsible for xanthogranulomatous pyelonephritis, xanthogranulomatous cholecystitis, and xanthogranulomatous appendicitis. Testicular ischemia secondary to arteriosclerosis may be present in older patients with xanthogranulomatous orchiepididymitis. However, in younger patients, the possible pathogenic role related to testicular ischemia may be an endarteritis or endophlebitis that is frequently associated with nonspecific chronic inflammation of the male genital tract, including xanthogranulomatous orchiepididymitis.[2],[3]

Localized XGI often mimics neoplasia, precluding radiologic diagnosis in most instances. In such cases, serological testicular tumor markers are also seen. The differential diagnosis includes malacoplakia and Rosai–Dorfman disease, distinguished by the presence of the characteristic Michaelis–Gutmann bodies in malacoplakia (emperipolesis) in Rosai–Dorfman disease. Both were absent in the present case.


  Conclusion Top


The present case serves as a reminder that xanthogranulomatous orchitis is a rare pseudoneoplastic condition and is seldom diagnosed preoperatively as physical and radiologic findings are indistinguishable from those of testicular tumors.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Wen YK, Chen ML. Xanthogranulomatous pyelonephritis complicated by emphysematous pyelonephritis in a hemodialysis patient. Clin Nephrol 2007;68:422-7.  Back to cited text no. 1
    
2.
Nistal M, Gonzalez-Peramato P, Serrano A, Regadera J. Xanthogranulomatous funiculitis and orchiepididymitis: Report of 2 cases with immunohistochemical study and literature review. Arch Pathol Lab Med 2004;128:911-4.  Back to cited text no. 2
    
3.
Syed AA, Mannan R, Kahvic M, Sara YA, Bharati C. An unusual case of extensive xanthogranulomatous orchitis in a diabetic patient. Med Princ Pract 2009;18:418-21.  Back to cited text no. 3
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4]



 

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