Granulomatous epididymo-orchitis: diagnosis by fine needle aspiration

Handa, Uma; Kundu, Reetu; Raghubanshi, Gunjan; Bhalla, Vidur

doi:10.1177/0049475517711017

Cited by 6 publications

(8 citation statements)

References 19 publications

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“…Besides looking for bacteriological evidence, another de nitive examination of epididymitis TB is FNAB cytology or surgical resection of the epididymis. 22 FNAB has an essential role in excluding the differential diagnosis of epididymal nodules, such as malignancy, or other benign tumors, both acute and chronic. 12,21,22 FNAB can provide an accurate and rapid diagnosis and prevent aggressive and potentially inappropriate surgical procedures.…”

Section: Discussionmentioning

confidence: 99%

“…22 FNAB has an essential role in excluding the differential diagnosis of epididymal nodules, such as malignancy, or other benign tumors, both acute and chronic. 12,21,22 FNAB can provide an accurate and rapid diagnosis and prevent aggressive and potentially inappropriate surgical procedures. 12,22 However, invasive biopsy is often not feasible to perform, so radiological examination can help establish the diagnosis of epididymitis TB.…”

Section: Discussionmentioning

confidence: 99%

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Isolated Epididymitis Tuberculosis in an Adolescent Male: When Foresight Clinical Decisions Determine the Right Diagnosis

Cesilia,

Nugraha,

Siregar

et al. 2023

Preprint

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Background: Urogenital tuberculosis (UGTB) is one of the common extrapulmonary TB in children. One form of UGTB is epididymitis TB, which is reported rarely in children. Epididymitis TB presented with unspecific chronic clinical manifestation and definitive diagnosis made by bacteriological confirmation due to paucibacillary and histopathology findings. Case presentation: A 16-year-old boy had been admitted to the hospital due to painful swelling of the left scrotum in the last three month. Persistent coughing for 2 months was reported. Physical examination of the left scrotum showed swelling accompanied by cardinal signs. Palpable hard mass on the left scrotum, firm borders, pain, measuring 7x4 cm. Laboratory examination was within normal limits, tumor markers (AFP, CEA, LDH) within normal limits, and routine urinalysis showed leukocyturia. Genital ultrasound showed epididymitis sinistra with septal hydrocele. Genital MRI showed left epididymitis with bilateral inguinal lymph node enlargement. TB evaluation examination showed a PPD test of 0 mm and a negative bacteriologic examination, but CXR showed perihilar lymphadenopathy. The patient was diagnosed as isolated TB lymphadenitis and received quadruple ATT for two months, followed by RH for four months. After treatment, the size of the left testicle decreased and was equal to that of the right; no signs of inflammation were found, weight increased by 5 kg, and cough disappeared. However, sperm analysis at the end of treatment showed teratozoospermia. The patient is currently being treated for teratozoospermia by urologic surgery colleagues. Conclusions: Biopsy and culture testing for TB epididymitis confirmation are difficult to perform in the clinical setting. TB epididymitis should be considered in adolescent boys with complaints of chronic scrotal swelling and pain. Clinical judgment based on history taking, physical examination, and radiologic features supporting the picture of tuberculosis is helpful to diagnose correctly and quickly for a favorable outcome.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Isolated Epididymitis Tuberculosis in an Adolescent Male: When Foresight Clinical Decisions Determine the Right Diagnosis

Cesilia,

Nugraha,

Siregar

et al. 2023

Preprint

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“…Handa et al and Gupta et al, in their retrospective analysis of a combined more than 250 patients, found FNAC useful in 90% cases for a diagnosis of tuberculous orchitis [14][15]. Viswaroop et al reported a case series of 40 patients with epididymal tuberculosis in which 26 patients diagnosed with FNAC, nine patients required tissue biopsy, and five patients underwent orchiectomy for the suspicion of a testicular tumor and diagnosed with histopathology specimen [16].…”

Section: Discussionmentioning

confidence: 99%

A Review of the Diagnostic Use of Fine-needle Aspiration Cytology for Tuberculosis Epididymo-orchitis: To Do or Not to Do

Sharma¹,

Nagalli²,

Varughese³

et al. 2020

Cureus

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Isolated tuberculous epididymo-orchitis is a rare manifestation of the vast extrapulmonary tuberculosis (EPTB) disease spectrum, especially in developed nations, making it prone to delayed diagnosis or misdiagnosis and inadvertent orchiectomy. Several observational studies and case reports have been reported with the successful use of fine-needle aspiration cytology (FNAC) in diagnosing tuberculosis orchitis, thus avoiding inadvertent orchiectomy. Because tuberculous epididymo-orchitis can mimic testicular neoplasm, the use of FNAC is not prevalent in developed countries for fear of the seeding of tumor cells and there is a lack of consensus on the use of FNAC for diagnostic purposes in such patients. We report a case of a 27-year-old man with an atypical presentation of genitourinary tuberculosis (TB) and its management. The case report also reviews the literature to discuss the available evidence and tries to answer the long-standing question on the role of FNAC in the diagnosis of tuberculous epididymo-orchitis.The currently available literature has demonstrated the safety and efficacy of FNAC in diagnosing TB epididymo-orchitis and, based on our review, the benefits of differentiating TB epididymo-orchitis from testicular malignancy using FNAC exceeds its minimal risk and must be considered to minimize clinical diagnosis error and unnecessary orchiectomy in low-risk patients.

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“…С целью гистологической верификации диагноза некоторые авторы (N. Gupta et al, U. Handa et al) считают полезным выполнять тонкоигольную биопсию, однако эта процедура потенциально опасна, т. к. может вызвать у нелеченого больного молниеносную генерализацию туберкулеза [55,56]. Кроме того, в дифференциально-диагностическом ряду на первом месте стоит злокачественная опухоль яичка, поэтому ряд авторов предпочитают выполнить расширенную орхэктомию без предварительной биопсии, чтобы избежать диссеминации не только инфекции, но и опухолевых клеток [57].…”

Section: диагностика туберкулеза яичка и его придаткаunclassified

Tuberculosis of the testis and its appendages

Kulchavenya

2022

Medicinskij sovet

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Tuberculosis of the genitourinary system has not lost its relevance. During the years of the pandemic of a new coronavirus infection, the number of newly diagnosed cases of tuberculosis of all localizations has decreased, but their structure has become more severe and mortality has increased. There is a wide variation in the statistics of urogenital tuberculosis (UGT) in the literature. The true incidence of scrotal tuberculosis is not known; at the end of the last century, it was believed that it was 7% of all cases of tuberculosis. It is believed that the share of isolated tuberculosis of the genital organs of men accounts for no more than 30% of all localizations of UGT, and most often tuberculosis develops in the epididymis. The spread of M. tuberculosis to the organs of the scrotum, as a rule, occurs by the hematogenous route from the primary focus in the lungs or kidney. However, the infection can also spread retrogradely from the prostate and seminal vesicles to the epididymis and testicles. Tuberculosis of the testis and its epididymis is often complicated by infertility and the formation of fistulas. This disease has no pathognomonic symptoms. Differential diagnosis is carried out between tuberculous epididymo-orchitis, testicular tumor, testicular torsion, bacterial epididymo-orchitis. Ultrasound examination is of great diagnostic value in tuberculosis of the scrotal organs. The ultrasound picture in tuberculosis of the testis and its epididymis is divided into 4 types: diffuse enlargement, heterogeneous hypoechogenicity; diffuse increase, uniform hypoechogenicity; nodular enlargement, heterogeneous hypoechogenicity; miliary dissemination. The world literature does not describe an example of tuberculosis of the scrotal organs, when the disease would be diagnosed during the patient’s initial visit to the doctor. As a result of late diagnosis or low suspicion for TB, up to 70% of patients undergo unnecessary surgery, although TB orchiepididymitis can be treated medically. The lecture also analyzed a number of clinical observations.

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Granulomatous epididymo-orchitis: diagnosis by fine needle aspiration

Cited by 6 publications

References 19 publications

Isolated Epididymitis Tuberculosis in an Adolescent Male: When Foresight Clinical Decisions Determine the Right Diagnosis

Isolated Epididymitis Tuberculosis in an Adolescent Male: When Foresight Clinical Decisions Determine the Right Diagnosis

A Review of the Diagnostic Use of Fine-needle Aspiration Cytology for Tuberculosis Epididymo-orchitis: To Do or Not to Do

Tuberculosis of the testis and its appendages

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