Intratubular Granulomatous Reactions within Seminiferous Tubules: A Spectrum of Diseases
Sarah Karram, Chia-Sui Kao, Adeboye Osunkoya, Thomas M Ulbright, Jonathan I Epstein. Johns Hopkins Hospital, Baltimore, MD; Indiana University School of Medicine, Indianapolis, IN; Emory University School of Medicine, Atlanta, GA
Background: Idiopathic granulomatous orchitis (IGO) is a rare disease thought to result from an autoimmune reaction to spermatogenic elements. Its relationship to IgG4-related disease (IgG4-RD) has not been evaluated.
Design: 16 orchiectomy specimens (1984-2012) with a prominent intratubular granulomatous reaction were reviewed: IGO diagnosed in consultation at 2 institutions (n=6); intratubular germ cell neoplasia unclassified (IGCNU) with a granulomatous reaction and associated seminoma (GS, n=6); & miscellaneous granulomatous orchitis involving tubules (GO, n=4). Necrotizing GO without an intratubular component were controls (n=2).
Results: Men with IGO aged 32-86 yrs. presented with a mass suspicious for malignancy. 1 had a history of rheumatoid arthritis (RA), the rest had no history of inflammatory diseases. IGO results are summarized in Table.
|% tubules||IgG4+/IgG+ (%)||IgG4+/HPF||Intratubular Inf.||Intratubular MGC||PT sclerosis||Interstitial Inf.||Interstitial fibrosis|
|100%||>40%||96 †||1+L, 1+P, 1+AI||1+||1+||3+L, 3+P||0|
|100%||>40%||88||1+L, 1+P, ∗||0||0||2+L, 2+P∗||3+|
|70%||>40%||51||2+L, 2+P||1+||0||3+ L, 3+P||2+|
|80%||6%||5||2+L, 1+P, 2+AI||0||2+||2+L, 2+P, 1+AI ∧||2+|
|100%||0||0||1+L, 1+P||0||0||3+L, 1+P∗||0|
|30%||0||0||1+L, 1+P, 1+AI||0||1+||3+L, 1+P||0|