Autoimmune testicular vasculitis

Raj, Ganesh V.; Ellington, Kenneth S.; Polascik, Thomas J.

doi:10.1016/s0090-4295(02)02596-7

Cited by 6 publications

(5 citation statements)

References 3 publications

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“…, 1989; Warfield et al. , 1994; Raj et al. , 2003), and blood disorders (sickle cell disease and polycythaemia) are among the possible aetiologies claimed for segmental testicular infarction (Brehmer‐Andersson et al.…”

Section: Discussionmentioning

confidence: 99%

“…Partial ischaemia is thought to be secondary to venous thrombosis, for which various local and systemic disorders have been involved as causal factors (El et al, 2007). Inflammatory events (epididymitis or orchitis) (Bird & Rosenfield, 1984;Chin et al, 1998), autoimmune diseases (vasculitis or hypersensitivity angiitis) (Baer et al, 1989;Warfield et al, 1994;Raj et al, 2003), and blood disorders (sickle cell disease and polycythaemia) are among the possible aetiologies claimed for segmental testicular infarction (Brehmer-Andersson et al, 1985;Baratelli et al, 1996;Nayal et al, 1996;Costa et al, 1999;Ruibal et al, 2003;Fernandez-Perez et al, 2005;Secil et al, 2006). Over 70% of known cases of segmental infarction have been reported as idiopathic.…”

Section: Discussionmentioning

confidence: 99%

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Segmental testicular ischaemia: presentation, management and follow‐up

2009

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Segmental infarction of the testis is a rare event. Less than 40 cases have been reported in the literature and its aetiology remains largely unknown. The diagnosis is challenging and its identification crucial as partial ischaemia is frequently confused with testicular tumours and unnecessarily treated with orchiectomy. The objectives of this study are to: (i) raise awareness of this rare condition, (ii) provide the distinctive clinical and radiological features enabling pre-operative diagnosis, (iii) promote appropriate screening of causative factors and (iv) propose an alternative management approach to avoid surgery and preserve fertility. We describe three cases of partial testicular ischaemia in men presenting with reduced sperm quality. The cases demonstrate the ultrasound and magnetic resonance imaging appearance of testicular ischaemia. The surveillance strategy adopted for these lesions indicates that over 2 years of follow-up, marginal changes in the lesions can occur. Histology revealed that infiltration by stromal cells, leucocytes and macrophages is responsible for the remodelling of these lesions. Screening of risk factors for thromboembolism revealed that all patients carried a methylenetetrahydrofolate reductase 677C-->T (MTHFR) mutation in a gene involved in folate metabolism, and either borderline or elevated homocysteine levels. Distinctive features permit the pre-operative diagnosis of segmental testicular ischaemia. There are sufficient data to assert that a surveillance strategy is safe and feasible. We speculate that the defects in folate metabolism may pre-dispose individuals to the development of testicular infarction and infertility.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Segmental testicular ischaemia: presentation, management and follow‐up

2009

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“…Upon follow-up the patients were found to have elevation of erythrocyte sedimentation rate, C-reactive protein, and/or serum antineutrophilic cytoplasmic antibody and a positive antinuclear antibody titer. 5,6,14,23 In contrast, there are many more reports of "isolated" testicular vasculitis lacking abnormal laboratory tests and evidence of systemic vasculitis after long-term follow-up, 5-20 an observation that calls into question whether or not at least some such cases represent true vasculitis or are secondary to another process. All of our 30 cases showed both acute and chronic vascular injury, with 28 having intimal thickening and medial fibrosis of vessels and 28 showing organizing and remote thrombi.…”

Section: Discussionmentioning

confidence: 99%

“…[1][2][3] Sometimes testicular infarct or hemorrhage, especially when localized and remote, is unsuspected clinically and presents as a mass that mimics a neoplasm resulting in orchiectomy. 4 When hemorrhage and necrosis are seen in a testis that also has damaged blood vessels (testicular vasculopathy) there may be concern for systemic vasculitis, even though most reports of "testicular vasculitis" are said to be of "limited" type without clinical evidence of systemic disease, [5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20] and it is distinctly rare for true systemic vasculitis to initially present with findings confined to the testis. 5,6,[21][22][23][24][25][26][27][28][29][30][31] We herein report our experience with 30 cases of testicular hemorrhage and necrosis with associated vasculopathy to bring attention to this pseudoneoplastic condition and also to investigate its possible etiology and relationship with systemic vasculitis.…”

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confidence: 99%

Testicular Hemorrhage, Necrosis, and Vasculopathy

Kao

Zhang

Ulbright

2014

American Journal of Surgical Pathology

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We report 30 cases of testicular hemorrhage and/or necrosis with associated vascular damage that caused clinical concern for a neoplasm and that raised the question of a vasculitis syndrome on pathologic examination. The patients were 12 to 66 years old (median, 33 y) and presented with pain (n=15), mass (n=12), or both (n=2); 1 case had no available clinical information. Ultrasonographic interpretations included a neoplasm in the differential diagnoses in 14 of 18 cases in which this information was available, and most (n=24) had orchiectomy because of this possibility. Only 4 were clinically suspected to represent testicular infarction. Circumscribed, hemorrhagic lesions occurred in 10 cases, less demarcated hemorrhagic foci in 5, and discrete nodules or ill-defined foci of varying color and consistency in the remainder. No clear testicular lesion was described in 2, with 1 of these having a "dusky" appearance. On microscopic examination all but 1 case showed damaged blood vessels (vasculopathy), with either associated hemorrhage/hematoma (n=24) and/or areas of parenchymal necrosis (n=21). One case showed only segmental tubular atrophy with interstitial inflammation and vasculopathy; no infarct or hemorrhage was identified. A variety of vascular changes was identified, including prominent intimal thickening in arteries (n=22) and fibrinoid change in both arteries (n=5) and vessels of indeterminate type (n=8). Medial fibrosis was present in veins (n=12) and vessels of indeterminate type (n=4), whereas thrombi (remote, recanalized, and/or recent) occurred in arteries (n =7), veins (n=9), and vessels of indeterminate type (n=11). Dilated, blood-filled vessels were present in the testis and/or paratestis in 15 cases. In addition, 7 cases showed arteriolar hyalinization, and 19 had inflammation of blood vessels. The latter was lymphohistiocytic and mostly light but occasionally prominent (n=5). Interstitial inflammation was seen adjacent to damaged testicular parenchyma in all 30 cases. Clinical follow-up in 20 patients (4 to 131 mo, mean 38 mo) showed no evidence of recurrence in the contralateral testis or later development of systemic vasculitis. The histologic findings were compared with those in 11 orchiectomies resected for clinical acute torsion. All clinical acute torsion cases showed both parenchymal and fibrinoid vascular necrosis, and 10 had hemorrhage/hematoma; they lacked vasculitis, interstitial inflammation, and chronic vascular changes. Testicular vasculopathy, characterized by acute and chronic vascular injury, commonly occurs in testes with parenchymal hemorrhage and necrosis that clinically mimic a tumor. It shares the acute features of recent torsion but also has findings indicative of chronic injury. Testicular vasculopathy is most likely a result of chronic intermittent torsion that leads to localized hemorrhage/necrosis and should be distinguished from cases of systemic vasculitis given the significantly different clinical implications.

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“…SOV may present in areas that are common with systemic vasculitis, therefore it is difficult to assume that the initial surgical specimen or biopsy is not part of a systemic condition. The pathogenesis of isolated organ vasculitis is unknown, similarly why only one organ may be affected [5]. The majority of SOV is cured by surgical resection of the affected site.…”

Section: Introductionmentioning

confidence: 99%

Testicular Vasculitis - Literature Review and Case Report in Queensland

Lintern¹,

Johnson²,

Martin³

2013

Current Urology

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A 21-year-old male presented with acute onset, sharp right sided testicular pain. The testicle was removed with a histological diagnosis of testicular vasculitis. Anti-neutrophil cytoplasmic antibodies were negative. Although rare, males who present with acute onset pain should be screened for testicular vasculitis with a scrotal ultrasound and blood investigations including tumor markers and anti-neutrophil cytoplasmic antibodies.

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Autoimmune testicular vasculitis

Cited by 6 publications

References 3 publications

Segmental testicular ischaemia: presentation, management and follow‐up

Segmental testicular ischaemia: presentation, management and follow‐up

Testicular Hemorrhage, Necrosis, and Vasculopathy

Testicular Vasculitis - Literature Review and Case Report in Queensland

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