An unusual case of extensive epididymotesticular malakoplakia in a diabetic patient.

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.

Proximal-type epithelioid sarcoma in the groin presenting as a diagnostic dilemma.

Epithelioid sarcoma is an uncommon soft-tissue sarcoma typically presenting as a subcutaneous or deep dermal mass in the distal extremities of young adults. Lately, a 'proximal' subtype has been described, which occurs in the pelvic and genital areas of somewhat older individuals and tends to behave more aggressively than the conventional subtype. The correct diagnosis of this subtype is essential, since this tumor can be easily mistaken for other malignant tumors that exhibit epithelioid morphology. We report a case of proximal-type epithelioid sarcoma that presented as an inguinal mass in a 47-year-old man. Histologically, the tumor consisted of diffuse sheets of epithelioid cells with scattered rhabdoid morphology. By immunohistochemistry, the neoplastic cells expressed cytokeratin, epithelial membrane antigen, vimentin, CD34, CD99 and showed complete loss of nuclear INI1 protein expression. Fluorescence in situ hybridization was considered borderline for 22q deletion. We present this case to emphasize the importance of diagnosing this uncommon tumor and the role of INI1 immunohistochemistry in establishing the diagnosis.

An unusual case of extensive xanthogranulomatous orchitis in a diabetic patient.

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.