Tuberculous Epididymo-Orchitis Might Mimick Testicular Tumors

Abstract

Objective: To evaluate the rate of tuberculosis epididymo-orchitis (EO) in patients undergoing radical orchiectomy due to scrotal mass. Materials and Methods: Between years 2009 and 2014, 70 patients undergoing radical orchiectomy were evaluated retrospectively. Patients were evaluated via ultrasound and tumor markers at the baseline. Chest radiograph, serology, routine blood tests, hematocrit, liver function tests and coagulation tests were performed preoperatively for all patients. There was no prior history of tuberculosis or drug therapy for tuberculosis. Urine of six patients underwent microscopic examination using fluorescent microscopy. Surgical exploration was performed through an inguinal incision and orchiectomy was performed. Testes samples were sent both for pathological examination and Lowenstein-Jensen culture. Results: Inguinal orchiectomy was performed for all patients without any complications. Histological diagnoses of six patients' were granulomatous EO. These patients' symptoms were recurrent scrotal swelling and pain in 5 (83.3%), and scrotal discharge in 1 patient (16.6%). The age range was 47-73 years. Of the masses 4 (66.6%) were located in the right testicle and 2 (33.3%) were located in the left testicle. Of 6 patients one patient was diagnosed with papillary urothelial carcinoma of the bladder. These 6 patients were clinically diagnosed with EO preoperatively. They were treated with antibiotics however a complete recovery could not be observed in the symptoms and EO episodes repeated for two or three times. Laboratory test results were within normal ranges. There was no pathological evidence of tuberculosis on the chest radiograph and human immunodeficiency virus (HIV) serology was negative for all of the patients. Fluorescent microscopic examination of urine was negative for acid-fast bacilli. The levels of tumor markers; beta-HCG and AFP were within normal limits preoperatively. Conclusion: Any lump, enlargement, hardness, pain, or tenderness of the testicle should be accepted as cancer until the contrary is proven. Although it is not very common, especially in endemic regions tuberculosis EO should be considered in differential diagnosis. Key Words: Epididymo-orchitis, tuberculosis, acid-fast bacilli, testicular cancer, differential diagnosis Amaç: Skrotal kitle nedeniyle radikal orşiektomi yapılan hastalardaki tüberküloz epididimo-orşiti (EO) saptanma oranlarını araştırmak. Gereç ve Yöntem: 2009-2014 tarihleri arasında radikal orşiektomi yapılan 70 hasta retrospektif olarak değerlendirildi. Tüm hastalar bazal olarak ultrasonografi ve tümör belirteçleri ile değerlendirildi. Bu hastaların hepsine preoperatif olarak akciğer grafisi, seroloji, rutin kan testleri, hematokrit, karaciğer fonksiyon testleri ve koagülasyon tetkikleri yapıldı. Hastaların hiçbirinin tüberküloz hastalığı öyküsü ve/veya tüberküloz ilacı kullanma öyküsü yoktu. Altı hastanın da idrarından floresan mikroskopi incelemesi yapıldı. Hastalara inguinal insizyonla eksplorasyon yapıldı ve orşiektomi uygulandı. Çıkarılan ...