Testicular Hemorrhage, Necrosis and Vasculopathy: Likely Manifestations of Intermittent Torsion That Clinically Mimic a Neoplasm
Chia-Sui Kao, Chen Zhang, Thomas M Ulbright. Indiana University School of Medicine, Indianapolis, IN; University of Michigan Medical School, Ann Arbor, MI
Background: The finding of vascular damage in the testis with associated hemorrhage and necrosis cause concern for systemic vasculitis, despite that the latter only rarely manifests at this site. We investigated 29 cases to determine the possible etiology and the relationship to systemic vasculitis.
Design: We reviewed H&E slides from 29 testes with intraparenchymal hemorrhage and/or necrosis and associated vascular damage, including thrombi, intimal and medial fibrosis, fibrinoid necrosis and vasculitis. Other assessed features were location and size of the involved vessels, their venous or arterial nature and interstitial inflammation. The findings were compared with those in 11 orchiectomies resected for clinical acute torsion.
Results: The patients were 12 to 66 years old (median, 33) and most (24) had orchiectomy for a clinical concern of neoplasm. All cases showed damaged blood vessels with either associated hemorrhage/hematoma (24) and/or areas of parenchymal necrosis (22). In 8, the damage occurred only in veins, and in the remainder, both arteries and veins were involved or the vessels were of indeterminate type. 27 had organizing and/or remote, recanalized thrombi, and 7 also had recent thrombi; none had only recent thrombi. Intimal and/or medial fibrosis (usually both) occurred in 27 and interstitial inflammation in 29. Fibrinoid vascular necrosis was seen in 15 and vasculitis in 19. The latter was mostly lymphohistiocytic and light but occasionally prominent (3). Follow-up in 16 (1-96 mos, mean 27) showed no evidence of recurrence in the contralateral testis or development of systemic vasculitis. All cases of clinical acute torsion showed both parenchymal and fibrinoid vascular necrosis, and 10 had hemorrhage/hematoma; they lacked vasculitis, chronic vascular changes and interstitial inflammation.
Conclusions: Testicular vasculopathy, characterized by acute and chronic vascular injury that may include vascular inflammation, is frequent in patients with parenchymal hemorrhage and necrosis who clinically present with features concerning for a neoplasm. Acute torsion shares several features including fibrinoid vascular necrosis, but lacks more chronic features including interstitial inflammation and vasculitis. These results support that testicular vasculopathy associated with hemorrhage and necrosis is secondary to chronic intermittent torsion, and that vascular inflammation is part of the chronic inflammatory response. It does not appear to be related to systemic vasculitis.
Category: Genitourinary (including renal tumors)
Wednesday, March 6, 2013 9:30 AM
Poster Session V # 152, Wednesday Morning