Xanthogranulomatöse Epididymitis

Abstract

Xanthogranulomatous epididymitis is an uncommon non-neoplastic process with destruction of tissue and replacement by striking cellular infiltration of foamy macrophages, dense lymphocytes and plasma cells. We report on a 72-year-old man with a clinical history of inadequately treated arterial hypertension, who presented with a right scrotal mass associated with right scrotal pain for 10 days. Physical examination revealed pyogenic discharge from the hyperemic and edematous scrotum, with normal body temperature. Testicular tumor markers were normal. Ultrasonography (US) of the right testis showed edematous scrotal layers and a heterogeneous area of poorly defined margins within the testis and epididymis. There was minimal hydrocele, and the right funiculus was of normal diameter with no edema or pathologic formation. The progression of clinical findings, inflammatory parameters, US and color Doppler US findings with negative testicular tumor markers indicated surgical treatment. After preoperative treatment, right orchiepididymectomy was performed. Histology confirmed the diagnosis of xanthogranulomatous epididymitis.

Xanthogranulomatous epididymo-orchitis

“…Eight cases reported isolation of Escherichia coli in culture and 3 cases showed the presence of Pseudomonas aeruginosa. [ 1 6 8 9 11 13 17 18 20 25 32 ] Although Gram-negative bacterial infection is common, in one of our cases, Gram-positive Staphylococcus aureus was isolated in culture. Role of Staphylococcus aureus in the pathogenesis of xanthogranulomatous adrenalitis has also been emphasized by one of the authors.…”

“…XGEO is a rare disease process with a description of 38 cases reported in 29 articles in medical literature. [ 1 2 6 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 ] The details of demographics and clinical profile of the patients are summarized in Table 1 . Most of these cases have been reported from the Asian continent ( n = 18), followed by Europe ( n = 13), North America ( n = 3), Africa ( n = 2), and 1 case each from South America and Australia.…”

Xanthogranuloma of the epididymis

“…To our knowledge, only 20 or so cases have been reported that involve the male genital system, and here we present the first intraoperative image showcasing caseating exudate in an epididymal xanthogranuloma. [ 2 , 3 ]…”

“…Historically, xanthogranulomas of the genitourinary system were attributed to gram negative bacteria, when organisms could be isolated, [ 2 ] and usually in the context of local obstruction and recurrent infections. This case was unusual as the patient had no prior history of bacterial urinary infections.…”