ABSTRACT
Testicular tuberculosis (TB) is rare, and, because of this, the lack of pathognomonic clinical features and its tendency to mimic other commoner conditions, the diagnosis is frequently delayed or may be missed. In this case, the initial clinical presentation was typical for bacterial epididymo-orchitis in a 38-year-old man. When the patient failed to improve with standard treatment including broadening of antibiotics, the diagnosis was re-considered because some unusual signs suggested testicular malignancy or lymphoma. Further, history-taking and subsequent cross-sectional imaging with CT/MRI identified co-existent pulmonary nodularity, thoracic and abdominal lymphadenopathy and bony changes that, together, raised the suspicion of TB. Mycobacterium tuberculosis was confirmed on DNA-based testing of the hydrocele fluid, although standard acid-fast bacilli culture was negative. This case prompted a review of the literature to explore the optimal steps in the investigation and diagnosis of this rare disease.
Subject(s)
Mycobacterium tuberculosis/isolation & purification , Pain/diagnosis , Testicular Diseases/microbiology , Testicular Hydrocele/microbiology , Tuberculosis, Urogenital/drug therapy , Abdominal Cavity/diagnostic imaging , Abdominal Cavity/microbiology , Abdominal Cavity/pathology , Adult , Antitubercular Agents/administration & dosage , Antitubercular Agents/therapeutic use , Diagnosis, Differential , Epididymitis/diagnosis , Epididymitis/drug therapy , Humans , Lymphadenopathy/microbiology , Lymphadenopathy/pathology , Magnetic Resonance Imaging , Male , Orchitis/diagnosis , Orchitis/drug therapy , Pain/etiology , Testicular Diseases/diagnosis , Testicular Hydrocele/genetics , Testis/pathology , Tomography, X-Ray Computed , Treatment Outcome , Tuberculosis, Urogenital/diagnosis , Tuberculosis, Urogenital/microbiologyABSTRACT
INTRODUCTION: We present our experience with patients who had suspected testicular masses, managed by a frozen section assessment and testicular sparing surgery. MATERIAL AND METHODS: We performed a retrospective review of all patients over the last 5 years, who underwent a frozen section assessment and testicular sparing surgery for small testicular lesions. The frozen section assessment was compared with the final histology. RESULTS: Twelve patients were identified. The mean age of patients was 40 years (22-58 years). The mean lesion size was 9.8 mm (3-18 mm). Presentations varied: a testicular lump was palpable in 7 patients and 3 patients were referred due to infertility with a subsequent ultrasound, which showed incidental testicular lesions. Two patients presented with testicular pain. Tumour marker levels were within the normal limits in all patients.The frozen section assessment correctly determined 10 out of 12 (83%) lesions, showing 1 (8%) lymphoma, 2 (17%) seminomas, 3 (25%) fibrosis, 3 (25%) low-grade Leydig cell tumours and 1 (8%) adenomatous tumour. The frozen section reported a benign epidermal cyst in 1 case, whilst the final histology showed a pre-pubertal type teratoma, a rare and low risk tumour. One patient (8%) had an indeterminate lesion, which proved to be a benign adenomatous tumour on final histology. All malignant cases were correctly identified.There was no malignancy in 9 out of 12 (75%) patients therefore they had testicular sparing surgery. Three patients had orchidectomy, two due to a seminoma and one due to an indeterminate lesion. One patient developed a postoperative haematoma requiring antibiotics but there were no other complications. CONCLUSIONS: Our findings demonstrate that partial orchidectomy with a frozen section assessment is useful in small testicular masses and testicular sparing surgery can be considered in order to prevent a radical orchidectomy in selected patients.