Testicular Infarction with Associated Vasculitis: A Series of 19 Cases.
Fadi Brimo, Jonathan I Epstein. McGill University Health Center, Montreal, QC, Canada; Johns Hopkins Hospital, Baltimore, MD
Background: As a result of only very small series and case reports on testicular vasculitis, it is unknown how often they are a manifestation of isolated or systemic vasculitis.
Design: We herein report the clinical and pathological findings in a series of 19 cases (15 consultation and 4 in-house cases) of localized testicular infarction with associated vasculitis spanning 24 years.
Results: All cases were orchiectomy specimens and up to the time of abstract submission detailed clinical information was available in 14 cases. Mean age was 38 years. While the initial clinical presentation was testicular pain in 11 and testicular mass in three patients, the pre-operative impression was testicular cancer in 13 cases and in one case orchiectomy was performed for pain alleviation. In all cases, localized testicular infarction associated with vasculitis was present and in none was tumor identified. The majority of cases (n=14) showed polyarteritis nodosa (PAN)-like features with transmural necrotizing inflammation of medium to small arteries associated with fibrinoid necrosis and acute inflammatory reaction. In four cases, the vasculitis was granulomatous (two necrotizing and two non-necrotizing) and in one case it was lymphocytic. An infectious etiology was excluded clinically and by performing special stains. While seven patients did not show evidence of systemic vasculitis, two were confirmed with Wegener vasculitis, one with Churg-Strauss syndrome and one with subclinical systemic vasculitis. Two of those four patients had testicular PAN-like vasculitis and two had granulomatous vasculitis. Three patients had elevated serum inflammatory response proteins/abnormal urinalysis without definite evidence of systemic vasculitis.
Conclusions: Testicular vasculitis can cause localized infarction clinically mimicking cancer. While testicular vasculitis is an isolated finding in the majority of patients (10/14 or 71%), an associated systemic vasculitis is not a rare event (4/17 or 29%), especially if the vasculitis is granulomatous (50% in this series) and therefore all patients should be investigated for systemic disease clinically.
Category: Genitourinary (including renal tumors)
Monday, February 28, 2011 2:30 PM
Platform Session: Section A, Monday Afternoon