Testis & epididymis

Nonneoplastic lesions

Vasculitis



Topic Completed: 1 October 2014

Minor changes: 26 January 2021

Copyright: 2002-2021, PathologyOutlines.com, Inc.

PubMed Search: testicular vasculitis

Sean R. Williamson, M.D.
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Cite this page: Williamson S. Vasculitis. PathologyOutlines.com website. https://www.pathologyoutlines.com/topic/testisvasculitis.html. Accessed December 3rd, 2021.
Definition / general
Clinical features
  • Can present with acute onset of pain and swelling, presumably related to intratesticular hemorrhage (Ir Med J 2006;99:27)
  • Systemic disease is frequently already present at the time of initial presentation of testicular vasculitis or develops shortly thereafter
  • Some cases, however, remain isolated to the testes with no evidence of progression to systemic disease (J Clin Pathol 1994;47:1121)
  • It is, therefore, unclear whether isolated testicular vasculitis represents an early site of involvement by systemic disease or a separate entity (World J Surg Oncol 2011;9:63)
  • Only several cases of isolated testicular vasculitis were reported in the literature and a presentation suggestive of a testicular neoplasm is even less common (J Clin Pathol 1994;47:1121)
  • Since testicular biopsy is contraindicated when malignancy is suspected, the diagnosis is usually reported postorchiectomy in these cases (ScientificWorldJournal 2010;10:1915, Urology 2003;61:1035)
  • Biopsy most likely diagnostic in patients with testicular symptoms (pain, enlargement or shrinking)
  • Wedge biopsy should contain capsule, tunica vasculosa and testicular parenchyma
Radiology images

Case #328

Testicular heterogeneous hypoechoic lesion

Case reports
  • 34 year old man with hypoechoic testicular lesion (Case #328)
Treatment
  • Treatment options are still debated and frequently hinge on individual factors which need to be carefully considered in each patient
  • Immunosuppressive therapy has been administered to some of the patients
  • In other cases, careful follow up to exclude progression to systemic disease was preferred (J Clin Pathol 1994;47:1121)
  • Some authors have even postulated that the excision of the affected organ might be curative, obviating the need for pharmacologic therapy (ScientificWorldJournal 2010;10:1915)
  • Close follow up, including serology, is recommended since the risk of progression to systemic disease is unknown (J Clin Pathol 1994;47:1121)
Gross description
Gross images

Case #328
Microscopic (histologic) description
  • Focal hemorrhage with early organization and small arteries around the area of hemorrhage (Case of the Week #328)
Microscopic (histologic) images

Case #328


Differential diagnosis
  • Although uncommon, isolated necrotizing testicular vasculitis remains in the differential diagnosis of hypovascular testicular lesions; long term follow up and additional research is needed in order to further elucidate the pathogenesis of isolated organ vasculitis and the subsequent risk of disease progression
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