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International braz j urol

On-line version ISSN 1677-6119

Int. braz j urol. vol.37 no.2 Rio de Janeiro Mar./Apr. 2011

http://dx.doi.org/10.1590/S1677-55382011000200022 

UROLOGICAL SURVEY
PATHOLOGY

 

Testicular vasculitis: a series of 19 cases

 

 

Brimo F; Lachapelle J; Epstein JI

Department of Pathology, McGill University Health Center, Montreal, Canada
Urology. 2011; 16. [Epub ahead of print]

 

 

OBJECTIVES: Because of limited reported cases, it is unknown how often testicular vasculitis represents isolated or systemic disease.
METHODS: We report 19 cases (15 consultation; 4 in-house cases) of localized testicular infarction with associated vasculitis spanning 24 years.
RESULTS: All were orchiectomy specimens; detailed clinical information was available in 16 cases. Mean age was 38 years. Clinical presentation was testicular pain in 13 and mass in 3 patients. Preoperative impression was testicular cancer in 13 cases. In all cases, localized testicular infarction associated with vasculitis was present and in none was tumor identified. Most cases (n = 14) showed polyarteritis nodosa (PAN)-like features with transmural necrotizing inflammation of small-medium arteries. In 4 cases, vasculitis was granulomatous (2 necrotizing; 2 non-necrotizing) and in 1 case was lymphocytic. An infectious etiology was excluded clinically and by special stains. Four patients were subsequently confirmed with systemic vaculitis: one with PAN, one with Wegener vasculitis, one with vasculitis not otherwise specified and one with subclinical systemic vasculitis. Two of those 4 patients had testicular PAN-like vasculitis and 2 had granulomatous vasculitis.
CONCLUSIONS: Testicular vasculitis can cause localized infarction that clinically mimics cancer. Although testicular vasculitis is an isolated finding in most patients an associated systemic vasculitis is not a rare event (4/16, or 25%), especially if the vasculitis is granulomatous (50% in this series). All patients should be clinically investigated for systemic disease.

 

Editorial Comment

This is a large series of a rare condition in the testis. Testicular vasculitis can cause localized infarction that clinically may mimic cancer (1). Testicular vasculitis may be an isolated finding, however, in most patients is associated with systemic vasculitis. All patients should be clinically investigated for systemic disease. In this series of 19 cases the mean age was 38 years and most cases (n = 14) showed polyarteritis nodosa-like features with transmural necrotizing inflammation of small-medium arteries (2). The pathologist must be aware of this condition and look for vasculitis whenever a patient with an infarcted testis has no history of torsion or trauma.

 

References

1. Atis G, Memis OF, Güngör HS, Arikan O, Saglican Y, Caskurlu T: Testicular polyarteritis nodosa mimicking testicular neoplasm. ScientificWorldJournal. 2010; 10: 1915-8.         [ Links ]

2. Meeuwissen J, Maertens J, Verbeken E, Blockmans D: Case reports: testicular pain as a manifestation of polyarteritis nodosa. Clin Rheumatol. 2008; 27: 1463-6.         [ Links ]

 

Dr. Athanase Billis
Full-Professor of Pathology
State University of Campinas, Unicamp
Campinas, São Paulo, Brazil
E-mail: athanase@fcm.unicamp.br

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