以慢性睪丸疼痛做為表現之黃色肉芽腫副睪丸炎:個案分享與文獻回顧

李翊維、唐靖、陳國強

國泰綜合醫院 外科部 泌尿科

Xanthogranulomatous Epididymitis as a Rare Cause of Chronic Scrotal Pain – Case Report and Review of Literature

Yi-Wei Lee, Chin Tang, Kuo-Chiang Chen

Division of Urology, Department of Surgery, Cathay General Hospital, Taipei City, Taiwan

Abstract

We report a 79-year-old-man with a history of stage IV diffuse large B cell lymphoma, advanced prostate cancer under androgen deprivation therapy, coronary artery disease, heart failure, hypertension, and diabetes mellitus coming to our urology out-patient department complaining right scrotal pain and swelling. Initially, acute orchitis was suspected and the patient was prescribed with oral antibiotics and analgesics. However, his symptom persisted for a month with limited improvement. In the meantime, he denied fever, dysuria, frequency or other systemic discomfort. Upon further questioning, he also denied similar episodes before this visit. Physical examination showed a right palpable testicular mass without tenderness or erythematous change. Urinalysis revealed no signs of pyuria or hematuria. Tumor makers such as AFP, b-HCG, LDH were checked, all of which were in normal limits. Scrotal ultrasound reported a right hyperechoic epididymal mass with enlarged vessels at the epididymis, and epididymal tumor could not be ruled out. Under the above impression we arranged biopsy of the right epidydimal mass via scrotal approach. Intra-operatively, severe inflammation and bleeding tendency around the epididymis were noted. Histopathologic examination revealed cellular infiltration of the epididymal tissues with foamy macrophages, which was consistent with diagnosis of xanthogranulomatous epididymitis. The patient was discharged home with antibiotics, analgesics, and daily wound care.

Xanthogranulomatous inflammation is a destructive process that reflects a stage in chronic suppuration in which stasis and host-microbe interactions give birth to a localized proliferation rich in macrophages and copious phagocytic material with distinct gross and microscopic characteristics. Although the exact cause is yet unknown, ascending or hematogenous infection is thought to be the most common. One of the most prominent etiologic determinants in the pathogenesis of this process in the testis is obstruction of the epididymis or the urinary tract. Because tissue damage is a characteristic of xanthogranulomatous inflammation, definitive and curative therapy in most cases resides in surgical excision of the damaged organ, either completely or partially. Antimicrobial treatment is suggested for anaerobic infections as anaerobes are recognized as a potential etiologic agent for xanthogranulomatous inflammation.

We herein report a rare case of xanthogranulomatous epididymitis and with smooth diagnosis and treatment course.