Concurrent xanthogranulomatous orchiepididymitis and seminoma in the same testis

Abstract

Xanthogranulomatous orchiepididymitis (XGO) is a rare inflammatory and destructive disease of the testis that may simulate testicular malignancy. To the authors' knowledge only 19 cases of XGO have been previously reported. Herein is reported the case of a 52-year-old man with XGO who presented with a left testicular mass and pyogenic discharge from the scrotum. Ultrasound examination indicated heterogeneous testicular areas suggestive of neoplasia. Testicular tumor markers were normal. Orchidectomy was performed and histopathology showed XGO and a concurrent, occult typical seminoma. As far as the authors know the coincidence of these two lesions has not been documented previously. XGO may mimic testicular malignancy and may coexist with it. Pathologists should be aware of this concurrence of lesions to avoid potential misdiagnosis. Wide sampling of the orchidectomy specimens with XGO is mandatory to exclude an occult seminoma.

Xanthogranulomatous Orchitis Presenting as a Scrotal Mass in an Elderly Male: Malignancy or Mimicker?

“…Differential diagnosis of XGO includes testicular tumor, infectious epididymo-orchitis, malakoplakia, Rosai-Dorfman disease, lepromatous orchitis, and idiopathic granulomatous orchitis. 1 , 7 Malakoplakia is an uncommon granulomatous process of the testis, characterized by accumulation of macrophages with granular and eosinophilic cytoplasm. These macrophages contain characteristic intracytoplasmic inclusions known as Michaelis-Gutmann bodies.…”

“…Xanthogranulomatous orchitis may coexist with a testicular malignancy. Val-Bernal et al 7 reported a case of XGO and a concurrent, occult typical seminoma. Hence, histopathologic examination is important and is the only conclusive evidence to rule out malignancy and to diagnose xanthogranulomatous inflammation.…”

“…Orchidectomy is curative due to wide tissue destruction seen in XGO. 7 The role of antibiotic treatment is a matter of debate because most cases end up with loss of the affected organ. Transinguinal orchiectomy should be the operative procedure of choice if the scrotum is intact.…”

Identifying the deceiver: the non-neoplastic mimickers of genital system neoplasms

“…Imaging findings are mostly non-specific, and differential diagnoses include other infectious, inflammatory and neoplastic diseases of the testes. Moreover, XGO may coexist with testicular malignancies [ 25 ]. Radical orchiectomy can be performed for both definitive diagnosis and curative treatment [ 24 ].…”

Xanthogranulomatous orchitis: case report of a rare condition

“…Microscopic findings include yellowish nodules with "lipid-laden" macrophages associated to lymphocytes, giant cells and necrosis. However, such findings are not specific to the xanthogranulomatous process and could be concomitant to a tumor (7). The diagnosis is challenging, as the condition can resemble bacterial orchitis, which improves with antibiotic therapy, malakoplakia with typical Michaelis-Gutmann bodies (3) and neoplasm with differences in tumor and immunohistochemical markers (8).…”