Isolated tuberculous epididymitis presenting as a painless scrotal tumor.
Genitourinary tuberculosis, the second most common extrapulmonary tuberculosis (TB), is very difficult to diagnose unless one maintains a high index of suspicion. Isolated tuberculous epididymitis (ITE), defined as tuberculous epididymitis without clinical evidence of either renal or prostate involvement, is a rare entity among genitourinary tuberculosis. When diagnosed correctly, ITE can be cured with anti-TB medications. However, patients with poor response to medical treatment may require surgery. Here, we report a 20-year-old man who presented with a slow-growing painless scrotal tumor for 2 months, with the initial workup suspicious for a right paratesticular tumor. Surgical resection of the tumor was therefore scheduled. However, severe pain and redness over the patient's right hemi-scrotum were noted on the day of surgery. A repeat scrotal ultrasound was performed that revealed findings suggesting a chronic inflammatory process rather than a malignancy. Frozen section of the lesion confirmed the ultrasonographic findings, and the pathology established the diagnosis of ITE. The patient remained on anti-TB therapy postoperatively for 6 months and had an excellent outcome.
Division of Urology, Department of Surgery, Far Eastern Memorial Hospital and Medical Center, Banciao, New Taipei City, Taiwan, ROC.
Victor Ka-Siong
VK
Kho
Pei-Hui
PH
Chan
D000328:Adult; D003937:Diagnosis, Differential; D004823:Epididymitis / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000473:pathology; D005834:Genital Neoplasms, Male / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000473:pathology; D006801:Humans; D008297:Male; D012611:Scrotum / Q000000981:diagnostic imaging / Q000473:pathology*; D014376:Tuberculosis / Q000175:diagnosis* / Q000473:pathology; D014463:Ultrasonography