ABSTRACT
A 67-year-old Saudi man with poorly controlled diabetes-mellitus underwent orchiectomy for a painful left testicular swelling that did not respond to antibiotics. Clinical diagnosis was testicular malignancy. Histologic workup demonstrated extensive involvement of the testis and epididymis by diffuse infiltrate of large histiocytes with eosinophilic granular cytoplasm and numerous Michaelis-Gutmann bodies, which were diagnostic of malakoplakia. Very rarely, malakoplakia has been described in association with diabetes mellitus. Such an extensive malakoplakia occurring at an unusual site in association with systemic illness lends support to the view that a compromised immune status could be etiologically important in malakoplakia. We present this case to highlight the importance of diagnosing malakoplakia when it occurs at unusual locations. We also explore the role of diabetes mellitus in the pathogenesis of malakoplakia and compare the relationship between malakoplakia and xanthogranulomatous inflammation, which are closely related to each-other on both clinical and morphologic grounds.
Subject(s)
Diabetes Complications , Epididymis , Genital Diseases, Male/diagnosis , Malacoplakia/diagnosis , Testicular Diseases/diagnosis , Aged , Diagnosis, Differential , Genital Diseases, Male/complications , Genital Diseases, Male/pathology , Humans , Malacoplakia/complications , Malacoplakia/pathology , Male , Testicular Diseases/complications , Testicular Diseases/pathologyABSTRACT
OBJECTIVE: We report an unusual case of extensive xanthogranulomatous orchitis (XGO) in association with poorly controlled diabetes mellitus. CLINICAL PRESENTATION AND INTERVENTION: A 65-year-old Kuwaiti man with poorly controlled diabetes mellitus presented with a painful left testicular swelling of 1 year duration. Testicular tumor markers were normal. Scrotal ultrasonography showed a mass lesion of mixed echotexture, which almost replaced the testicular parenchyma. Left-sided orchiectomy was performed with the clinical diagnosis of testicular neoplasia. Subsequent examination revealed the diagnosis of XGO, and the patient is well 2 years after the operation. CONCLUSION: Extensive tumorous XGO associated with diabetes mellitus has not been previously reported. We offer this case to highlight the implied role of poorly controlled diabetes mellitus in the pathogenesis of XGO.
