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PATHOLOGY
doi: 10.1590/S1677-55382011000200022
Testicular
Vasculitis: A Series of 19 Cases
Brimo F, Lachapelle J, Epstein JI
Department of Pathology, McGill University Health Center, Montreal, Canada
Urology. 2011; 16. [Epub ahead of print]
- Objectives:
Because of limited reported cases, it is unknown how often testicular
vasculitis represents isolated or systemic disease.
Methods: We report 19 cases (15 consultation; 4 in-house cases) of localized
testicular infarction with associated vasculitis spanning 24 years.
Results: All were orchiectomy specimens; detailed clinical information
was available in 16 cases. Mean age was 38 years. Clinical presentation
was testicular pain in 13 and mass in 3 patients. Preoperative impression
was testicular cancer in 13 cases. In all cases, localized testicular
infarction associated with vasculitis was present and in none was tumor
identified. Most cases (n = 14) showed polyarteritis nodosa (PAN)-like
features with transmural necrotizing inflammation of small-medium arteries.
In 4 cases, vasculitis was granulomatous (2 necrotizing; 2 non-necrotizing)
and in 1 case was lymphocytic. An infectious etiology was excluded clinically
and by special stains. Four patients were subsequently confirmed with
systemic vaculitis: one with PAN, one with Wegener vasculitis, one with
vasculitis not otherwise specified and one with subclinical systemic
vasculitis. Two of those 4 patients had testicular PAN-like vasculitis
and 2 had granulomatous vasculitis.
Conclusions: Testicular vasculitis can cause localized infarction that
clinically mimics cancer. Although testicular vasculitis is an isolated
finding in most patients an associated systemic vasculitis is not a
rare event (4/16, or 25%), especially if the vasculitis is granulomatous
(50% in this series). All patients should be clinically investigated
for systemic disease.
- Editorial
Comment
This is a large series of a rare condition in the testis. Testicular
vasculitis can cause localized infarction that clinically may mimic
cancer (1). Testicular vasculitis may be an isolated finding, however,
in most patients is associated with systemic vasculitis. All patients
should be clinically investigated for systemic disease. In this series
of 19 cases the mean age was 38 years and most cases (n = 14) showed
polyarteritis nodosa-like features with transmural necrotizing inflammation
of small-medium arteries (2). The pathologist must be aware of this
condition and look for vasculitis whenever a patient with an infarcted
testis has no history of torsion or trauma.
References
- Atis G,
Memis OF, Güngör HS, Arikan O, Saglican Y, Caskurlu T: Testicular
polyarteritis nodosa mimicking testicular neoplasm. ScientificWorldJournal.
2010; 10: 1915-8.
- Meeuwissen
J, Maertens J, Verbeken E, Blockmans D: Case reports: testicular pain
as a manifestation of polyarteritis nodosa. Clin Rheumatol. 2008; 27:
1463-6.
Dr.
Athanase Billis
Full-Professor of Pathology
State University of Campinas, Unicamp
Campinas, São Paulo, Brazil
E-mail: athanase@fcm.unicamp.br
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