Fine needle aspiration cytology of tubercular epididymitis and epididymo-orchitis.
OBJECTIVE
To study the role of fine needle aspiration cytology (FNAC) and ancillary studies in the diagnosis of tubercular epididymitis or epididymo-orchitis.


METHODS
Forty patients with tubercular epididymitis or epididymoorchitis diagnosed on FNAC underwent a detailed clinical workup, imaging and microbiologic studies before being started on antitubercular treatment (ATT). One patient underwent orchiectomy.


RESULTS
Clinically, the disease presented in patients of all ages usually as a scrotal swelling or rarely as a scrotal sinus (3) or abscess (3) or as part of disseminated tuberculosis (2). Three patients gave a history of previous tuberculosis. Scrotal sonography confirmed the involvement of the epididymis, testis or spermatic cord in each case. FNAC was diagnostic in 27 aspirates (epithelioid cell granulomas with caseation) but nondiagnostic in the rest. Tubercular etiology was confirmed directly by detection of acid-fast bacilli (AFB) on FNA smears in 24 (60%) patients and urine samples in 11 and indirectly in 9 patients with negative AFB by using a combination of a positive Mantoux test (5 of 9), presence of caseating granulomas on FNA smears (7 of 9) and therapeutic response to ATT (9 of 9).


CONCLUSIONS
FNA as a minimally invasive technique plays a prime role in the diagnosis of tubercular epididymitis and epididymoorchitis. It provides adequate material for cytologic and microbiologic examination and helps to avoid unnecesary orchiectomy.
Sah
Shatrughn Prasad
SP
Department of Pathology, B. P. Koirala Institute of Health Sciences, Dharan, Nepal. sah_sp@yahoo.com
Bhadani
Punam Prasad
PP
Regmi
Rajendra
R
Tewari
Awadesh
A
Raj
Gita Ashok
GA
D000293:Adolescent; D000328:Adult; D000368:Aged; D000995:Antitubercular Agents / Q000627:therapeutic use; D044963:Biopsy, Fine-Needle; D002648:Child; D002675:Child, Preschool; D003937:Diagnosis, Differential; D004823:Epididymitis / Q000188:drug therapy / Q000382:microbiology / Q000473:pathology*; D005834:Genital Neoplasms, Male / Q000473:pathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009390:Nepal; D009920:Orchitis / Q000188:drug therapy / Q000382:microbiology / Q000473:pathology*; D012611:Scrotum / Q000473:pathology*; D014389:Tuberculosis, Male Genital / Q000188:drug therapy / Q000382:microbiology / Q000473:pathology*
D000995:Antitubercular Agents