Localized/Segmental Testicular Infarction: A Potential Clinical and Radiologic Mimic of Testicular Cancer. Clinicopathologic Study of 10 Cases.
John D Schwartz, William R Porter, Rajwant K Malhotra, Michael Aquino, Syed Zafar H Jafri, Mitual B Amin. William Beaumont Hospital, Royal Oak, MI
Background: Localized or segmental testicular infarction is a rare entity, with less than 50 reported cases. Most reports have been published in the urology and radiology literature. Literature search revealed only one published case report of this entity in the pathology literature. We present the first pathology case series consisting of 10 cases with their clinical, radiologic, and pathologic findings.
Design: 10 cases of segmental testicular infarction were retrieved from the pathology records of one institution. We excluded patients that had clinical or pathologic evidence of torsion. Also excluded were cases that showed diffuse testicular infarction. Clinical signs and symptoms, as well as pertinent radiologic and pathologic findings were noted. An extensive review of the published literature was performed.
Results: The patients ranged in age from 18 to 79 years. Presenting clinical features included pain (n=8) or evidence of a mass lesion (n=2). Ultrasound performed in all cases showed hypoechoic and hypovascular testicular lesions with inability to completely exclude malignancy. All these patients underwent orchiectomy. Gross pathology showed well demarcated lesions that were either hemorrhagic (n=3) or pale-fibrotic (n=7) depending on the age of the infarct. The size of these infarcts varied from 0.6 cm to 3 cm (mean 1.7 cm). Etiologic factors identified included cholesterol embolism (n=1), giant cell vasculitis (n=1), familial hypercoaguable state (n=1), and organizing thrombi (n=4); with these etiologies being clinically unknown at the time of diagnosis.
Conclusions: Segmental testicular infarcts are being increasingly recognized due to a ready availability of radiologic testing modalities such as ultrasound in out-patient clinical offices. This clinical mimic of cancer is, however, easliy diagnosed under the microscope. Both localized and systemic diseases can be causative factors in segmental testicular infarction. Careful pathologic examination of these specimens is warranted, as testicular infarction may be the first presenting sign of a systemic vasculopathy or constitutional coagulopathy. Literature review showed that although most cases are deemed idiopathic, many such patients were noted to have etiologic risk factors that include coronary and peripheral vascular disease, vasculitis, sickle cell disease, and surgical manipulation of the inguinal region.
Category: Genitourinary (including renal tumors)
Tuesday, March 1, 2011 1:00 PM
Poster Session IV # 76, Tuesday Afternoon