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Necrotizing granulomatous epididymo-orchitis (pathology)

Case contributed by Andrew Ryan
Diagnosis certain

Presentation

Testicular mass lesion on ultrasound

Patient Data

Age: 20 years
Gender: Male

Right testis

Circumscribed but unencapsulated, firm, pale lesion, 20 x 10 mm, centered on the hilum of the testis and focally extending into the testicular parenchyma.

Histology

Low power (fig. 1, 40x) - An unencapsulated inflammatory lesion involving the testicular hilum and parenchyma, with residual normal parenchyma (left) and paratesticular/cord structures (right).

Medium power (fig. 2, 100x) - Angular zones of brightly eosinophilic necrosis with palisading inflammatory cells, including abundant epitheliod histiocytes (activated macrophages).

High power (fig. 3 and 4, 400x) - Zones of necrosis with palisading epithelioid histiocytes (fig. 3) and scattered multinucleate giant cells (fig. 4).

Case Discussion

Necrotizing granulomatous inflammation is most frequently the result of infection, particularly mycobacterial infections, but can also be seen in the setting of other inflammatory conditions, e.g. granulomatosis with polyangiitis (previously known as Wegener granulomatosis). 

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