罕見案例報告: 副睪丸炎病史之中年男性罹患睪丸膽固醇肉芽腫

蘇奕瑋、賴昱維、薛又仁、黃建榮、蕭毅君、李淑文、高國維、陳修聖、邱文祥

台北市立聯合醫院仁愛院區外科部泌尿科

A rare case report: Cholesterol Granuloma of the Testis in a Middle-Aged Man with a History of Prior Epididymitis

Yi-Wei Su, Yu-Wei Lai, Thomas Y. Hsueh, Andy C. Huang, Yi-Chun Hsiao, Shu-Wen Li, Kuo-Wei Kao, Shiou-Sheng Chen, Allen W. Chiu

Division of Urology, Department of Surgery, Taipei City Hospital Renai branch

Introduction:

Testicular tumors most commonly occur in patients aged 20 to 40 years and should not be ignored due to the rapid progression of malignancy. While some tumors may be painless, others may be associated with testicular pain, scrotal swelling, or hydrocele. Common types of testicular tumors include seminomas, non-seminomas, and sex cord-stromal tumors. However, there are also rare histological types of testicular tumors with different underlying causes. In this report, we present a rare histological type of testicular tumor in a 50-year-old man with a history of prior epididymitis.

Case presentation: 

A 50-year-old man with a medical history of being a hepatitis B carrier visited our Genitourinary (GU) outpatient department (OPD) with complaints of left testicular pain for two months. According to his report, he had been receiving treatment for epididymitis at a local clinic, where a left testicular mass was discovered. A sonogram of the testis revealed a testicular tumor with associated inflammation. A computed tomography (CT) scan was arranged, which showed complex cystic enlargement of the left testis and raised suspicion of an epidermoid cyst or another type of testicular tumor. Blood tests revealed normal levels of alpha-fetoprotein (AFP), beta-human chorionic gonadotropin (bHCG), and lactate dehydrogenase (LDH), but elevated levels of carcinoembryonic antigen (CEA) (11.4 ng/ml) and cancer antigen 199 (CA 199) (1689 U/ml) were noted.

We initially prescribed levofloxacin antibiotics for two weeks, but the mass did not decrease in size. A follow-up examination showed that CEA (45.2 ng/ml) and CA 199 (79.0 U/ml) levels remained elevated. Due to suspicion of testicular malignancy, the patient was admitted and underwent a radical orchiectomy. The postoperative course was uneventful, and he was discharged the following day. The pathology report confirmed a diagnosis of cholesterol granuloma. Further OPD follow-up was smooth, with no complications.

Conclusion:

        Cholesterol granuloma is a very rare condition in the testis, with only a few cases reported in the literature. It is benign and has an excellent prognosis. The exact pathophysiology remains unknown but may be associated with preceding trauma or infection. In our case, the patient had a history of prior epididymitis and subsequently developed a left testicular tumor. Observation may be the initial treatment, while partial or radical orchiectomy can be performed for definitive treatment. Further follow-up is necessary for these patients.