Tuberculous epididymo-orchitis mimicking a testicular tumour: a case report

Abstract

Introduction: Isolated tuberculous epididymo-orchitis may closely mimic testicular tumour particularly in patients with no history of systemic TB thereby presenting a diagnostic and treatment challenges.

A Rare Case of Primary Tuberculous Epididymo-Orchitis in a Young Patient.

“…The most common site of genital tuberculosis in males is the epididymis, followed by prostate, seminal vesicles and testis [4]. The mechanism of dissemination is from retrograde spread of tubercle bacilli from the affected urinary tract into the prostate via reflux, followed by canalicular spread to the other parts [1].It may spread via hematogenous or lymphatic spread. [2].…”

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“…Characteristic FNAC picture includes epithelioid granuloma with a necrotic background and presence of variable lymphocytes. Ziehl-Neelsen (ZN) stain performed on the slides confirms the presence of numerous acid-fast bacilli 4 . Sonographic patterns of tuberculosis in the scrotum are varied and dependent on the stage of the disease 6 .…”

“…The epididymis being the commonest structure to be involved, followed by the seminal vesicles, prostate, testis, and the vas deferens 2 .Tuberculous orchitis usually occurs as a result of direct extension from the epididymis 3 .Present HIV Pandemic has resulted in a global surge in the TB prevalence which in turn resulted in the surge of extra pulmonary TB in endemic areas 4 Most of the cases are coexist with pulmonary TB or tuberculosis of other parts of lower genitourinary system including bladder, ureter and prostate. Isolated tuberculous epididymitis (TBE) or epididymo-orchitis(TBE-O) is rare 4 Clinically, TBE-O may mimicthe other testicular conditions like bacterial epididymitis, viral orchitis, infected hydrocele, spermatocele, testicular torsion, scrotal trauma, or neoplasm in healthy patients with no clinical symptoms and signs. This diagnostic dilemma may result in aninappropriate surgical procedure for a potentially curable medical illness, which could have been avoided with anti-TB management 5 hence accurate differentiation is important for appropriate treatment.…”

Isolated Tuberculous Epididymoorchitis Developing After Allogeneic Haematopoietic Stem Cell Transplantation: A Case Report

“…Olgumuzda ilk atakta skrotal Doppler USG yapılarak torsiyon dışlandı. Tüberküloz epididimoorşiti genellikle kronikleştiğinden akciğer tutulumu olmayan olgularda testis tümörüyle karışabilir; gereksiz orşiektomiler yapılabilir (5). Nitekim yakın zamanda yapılan bir çalışmada 26-52 yaş aralığındaki kişilerde orşiektomi nedenleri arasında tüberkülozun %10.6 oranında olduğu bildirilmiştir (9).…”

“…Erkek genital tüberkülozunda epididim, prostattan sonra en sık tutulan bölgedir; testisler daha az etkilenir ve sıklıkla epididimdeki infeksiyonun yayılmasıyla olaya karışır (4). Epididimoorşit olgularında, akciğer ve böbrek tutulumu olmadığında olası testiküler malignitenin de dışlanması gerekeceğinden tüberkü-loz tanısı konulması zor olabilir (5). Bu çalışmada tüberküloz için başka odağı saptanmayan, nonspesifik tedaviyle kronikleşen, immünosüprese bir hastada gelişen izole tüberküloz epididimoorşiti olgusu sunulmuştur.…”