Xanthogranulomatous Orchitis Presenting as a Scrotal Mass in an Elderly Male: Malignancy or Mimicker?

Xanthogranulomatous Orchitis With Testicular Atrophy in a Case of Chronic Pyocele: A Rare Case

Xanthogranulomatous orchitis (XGO) is a benign non-inflammatory condition predominantly affecting the testicular tissue and characterized by the infiltration of lipid-laden macrophages leading to substantial tissue damage. We present the case of an 80-year-old gentleman with chronic pyocele and concurrent testicular atrophy secondary to XGO, a seldom-reported manifestation in the testicular milieu. The patient presented with a protracted history of left-sided scrotal swelling and underwent left orchidectomy subsequent to preoperative diagnosis via ultrasonography. Intraoperative exploration revealed the presence of purulent fluid, and histopathological analysis confirmed characteristic features of XGO, including seminiferous tubule destruction and infiltration of fibroconnective tissue by histiocytes and dilated blood vessels. Differential diagnosis with testicular neoplasms posed a challenge, accentuating the pivotal role of histopathological scrutiny in achieving precise diagnosis. Orchidectomy remains the cornerstone of treatment for XGO. This case underscores the imperative of considering XGO in the diagnostic spectrum of testicular masses and the indispensable role of histopathology in confirming the diagnosis and guiding optimal therapeutic interventions.

Xanthogranulomatous epididymo-orchitis: A single-institutional case series and systematic review

Introduction

Xanthogranulomatous inflammation is a rare nonneoplastic and chronic inflammatory process, characterized by proliferation of foamy macrophages resulting in damage and necrosis of the affected tissue. Involvement of the testis/epididymis by the disease is a rare event.

Methods

A case series of four male patients diagnosed with xanthogranulomatous epididymitis/orchitis (XGEO) at our institute was reviewed. In addition, a systematic review of XGEO was carried out using PRISMA Guidelines 2020. Twenty-nine articles describing 38 patients of XGEO were included in the study.

Results

XGEO usually has a subacute or chronic presentation and affects male individuals in the 5th or 6th decades of life. The disease is also known to occur in the pediatric age group. The patients present with swelling, tenderness, or pain in the scrotal region. Bilateral involvement has also been documented. Thirty patients were known to have one or more causal risk factors including diabetes mellitus (23.7%), spinal cord injury/neuropathic bladder (7.9%), prostatectomy (7.9%), trauma (4.1%), and transurethral resection of prostate procedure (4.1%). Complications observed were scrotal fistula, adhesions, and abscess formation. Radiological features reported are nonspecific and include heterogeneous echotexture, hypoechoic areas, and/or scrotal wall collections. Bacterial microorganisms isolated from the affected tissue demonstrated the presence of Escherichia coli, Pseudomonas aeruginosa, and Staphylococcus aureus. Histological subtypes of XGEO are diffuse and focal. In the diffuse subtype, which is more common, there is extensive parenchymal destruction by inflammatory process accompanied by widespread ischemic necrosis.

Conclusion

The mainstay of treatment in XGEO cases is surgical excision preferably orchidectomy. Conservative management has been attempted in young individuals and in patients with focal XGEO, but there is limited supporting evidence. We present data of four cases along with detailed systematic review of the disease examining its clinicopathological behavior and associated risk factors followed by operative approach.

Xanthogranulomatous epididymo-orchitis: A case report with review of the literature

INTRODUCTION

Xanthogranulomatous orchitis is an extremely rare condition of the test is marked by the necrosis and effacement of testicular parenchyma by an inflammatory process. The current study aims to report a case of xanthogranulomatous epididymo-orchitis.

CASE REPORT

A 35-year-old man presented with a history of recurrent attacks of dull pain and swelling of the right side of the scrotum for 3 weeks. He denied having any history of trauma or urinary symptoms. Physical examination revealed tenderness and warmth of the right side of the scrotum. Urine culture was negative. The patient managed operatively.

DISCUSSION

The underlying pathophysiology of xanthogranulomatous orchitis is yet unknown. The pathogenesis of this inflammatory process in the testis is frequently driven by obstruction of the epididymis or the urinary tract. Urinary tract infection has also been considered as an etiologic factor.

CONCLUSION

Xanthogranulomatous orchitis is an uncommon testicular inflammatory condition. Histopathologic examination is required for definitive diagnosis and for the exclusion of occult germ cell malignancy.

Identifying the deceiver: the non-neoplastic mimickers of genital system neoplasms

Tumors of the genital system are common and imaging is of crucial importance for their detection and diagnosis. Several non-neoplastic diseases may mimic these tumors and differential diagnosis may be difficult in certain cases. Misdiagnosing non-neoplastic diseases as tumor may prompt unnecessary medical treatment or surgical interventions. In this article, we aimed to present the imaging characteristics of non-neoplastic diseases of the male and female genital systems that may mimic neoplastic processes. Increasing awareness of the imaging specialists to these entities may have a severe positive impact on the management of these patients.