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PubMed1991

Idiopathic granulomatous orchitis.

Our paper reports 7 cases of idiopathic granulomatous orchitis. Testicular trauma and genitourinary tract infection were the only important conditions in the past history, and were possibly related to the etiology of this disease. The clinical appearance of idiopathic granulomatous orchitis varies, and it is difficult to differentiate from testicular cancer, the diagnosis usually being made on histological examination after orchiectomy. For young patients and those with single testis, inguinal exploration and frozen section are recommended.

Adult↗

PubMed1994

Granulomatous orchitis--an analysis of clinical presentation, pathological anatomic features and possible etiologic factors.

Granulomatous orchitis is an inflammatory change of the testis, rarely bilaterally, which cannot be distinguished from testis cancer with clinical modalities and therefore the diagnosis is usually made after orchiectomy. We reviewed our experience with 5 cases of granulomatous orchitis all treated with orchiectomy for suspected testicular cancer. Patients' age ranged from 52 to 69 years; three times the right side was affected, histologically intratubular and interstitial type were identified as well as complete testicular destruction. Testicular intraepithelial neoplasia was not detected in any of the specimens.

Diagnosis, Differential↗

PubMed2006

Mumps orchitis.

Although the incidence of mumps orchitis has dramatically declined since the introduction of the childhood vaccination programme, a sharp increase in reported cases of both mumps and mumps orchitis has been seen recently in the UK. There are great concerns about mumps outbreaks and the associated risk of infertility; it remains an important clinical condition. Immunization is the best policy to avoid this viral disease.

Azoospermia↗

PubMed1997

Seminal vesiculitis and orchitis caused by Brucella abortus biovar 1 in young bison bulls from South Dakota.

Specimens of blood, lymph nodes, spleens, and genitalia were collected at slaughter from seven 3- and 4-year-old male bison that had recently become seropositive for brucellosis. The animals were from a captive herd of approximately 3,500 bison located in central South Dakota. Brucella abortus biovar 1 was isolated from 2 or more specimens from each of 6 bison. Severe necrotizing and pyogranulomatous orchitis was present in 1 testicle from 1 bull, and 4 animals had mild to marked seminal vesiculitis. Immunohistochemical staining labeled organisms in seminal vesicles and the testicle with orchitis. Ultrastructurally, intact bacilli were present in cytoplasmic vacuoles of some macrophages; other macrophages contained intracytoplasmic aggregates of calcified coccobacilli.

Abscess↗

PubMed2004

Metastatic appendiceal adenocarcinoma presenting late as epididymo-orchitis: a case report and review of literature.

BACKGROUND: Whereas testicular metastases are in themselves a rare entity, testicular secondaries from an appendiceal carcinoma have not yet been described. The case also illustrates the diagnostic dilemma of a tumour presenting as epididymo-orchitis. CASE PRESENTATION: The authors present a case of an appendiceal carcinoma that, two years after radical therapy, manifested as a secondary in the testis. It was misdiagnosed as an epididymo-orchitis and was only revealed through histology. CONCLUSIONS: Practitioners need to remember that long-standing testicular inflammation may result form secondary tumours. Even "exotic" primary tumours in the medical history of the patient must give rise to an increased suspicion threshold.

Adenocarcinoma, Mucinous↗

PubMed2004

The role of tumor necrosis factor-alpha and interleukin-1 in the mammalian testis and their involvement in testicular torsion and autoimmune orchitis.

This review will focus the roles of TNF-alpha, IL-1 alpha, and IL-1 beta in the mammalian testis and in two testicular pathologies, testicular torsion and orchitis. TNF alpha in the testis is produced by round spermatids, pachytene spermatocytes, and testicular macrophages. The type 1 TNF receptor has been found on Sertoli and Leydig cells and numerous studies suggest a paracrine mode of action for TNF alpha in the normal testis. IL-1 alpha has been reported to be produced by Sertoli cells, testicular macrophages, and possibly postmeiotic germ cells. IL-1 receptors have been reported on Sertoli cells, Leydig cells, testicular macrophages, and germ cells suggesting both autocrine and paracrine functions. While these proinflammatory cytokines have important roles in normal testicular homeostasis, an elevation of their expression can lead to testicular dysfunctions. Testicular torsion is a clinical pathology with results in testicular ischemia and surgical intervention is often required for reperfusion. A pivotal role for IL-1beta in the pathology of testicular torsion has been recently described whereby an increase in IL-1beta production after reperfusion of the testis is correlated with the activation of the stress-related kinase, c-jun N-terminal kinase, and ultimately resulting in neutrophil recruitment to the testis and germ cell apoptosis. In autoimmune orchitis, on the other hand, TNF alpha produced by T-lymphocytes and macrophages of the testis has been implicated in the development and progression of the disease. Thus, both proinflammatory cytokines, TNF alpha and IL-1, have significant roles in normal testicular functions as well as in certain testicular pathologies.

Animals↗

PubMed1993

Experimental autoimmune orchitis induced by testis and sperm antigen-specific T cell clones: an important pathogenic cytokine is tumor necrosis factor.

Testicular autoimmune disease (autoimmune orchitis) develops in mice immunized with testis antigen in adjuvant, occurs spontaneously in dogs, mink, and horses, and is a potential cause of human infertility. This is the first study to investigate autoimmune orchitis using monoclonal T cells. Despite the use of crude tissue antigens, 100% of the T cell lines/clones transferred autoimmune disease of the male gonad to normal syngeneic mice, with pathology that affected the testis, the epididymis and/or the vas deferens. Thus orchitogenic peptides are likely of restricted number and/or of dominant immunogenicity. Upon transfer to normal mice, the mildest and earliest pathology elicited by the cloned T cells invariably occurred in a specific region, the testicular straight tubules. Although testis antigen-derived T cell clones responded preferentially to testis antigen, and sperm antigen-derived clones responded more to sperm antigens, each of the 16 clones respond to both antigens. Thus common orchitogenic antigens exist in these germ cell populations though their quantity may differ in distribution. All orchitogenic T cell lines and clones expressed CD4 and the alpha beta T cell receptor; and when activated, they produced interleukin 2, interferon gamma, and tumor necrosis factor (TNF), but not interleukin 4. This cytokine profile characterizes the Th1 CD4+ T cell subset, known to be responsible for the delayed type immunological reaction. Importantly, since disease transfer was significantly and reproducibly attenuated when recipients were injected with neutralizing antibody to TNF, but not neutralizing antibody to interferon gamma, TNF has been defined as a cytokine important in the pathogenesis of this autoimmune disease.

Animals↗

PubMed1997

Interstitial orchitis with impaired steroidogenesis and spermatogenesis in the testes of rabbits infected with an attenuated strain of myxoma virus.

The pathogenesis of infertility associated with acute viral orchitis was investigated in a rabbit model. Infection of postpubertal male European rabbits with an attenuated strain of myxoma virus caused systemic disease with viral replication to high titres in the testes. Infected rabbits developed an interstitial orchitis and epididymitis. This was associated with degeneration of the seminiferous epithelium, decreased serum testosterone concentrations and increased serum LH concentrations. Virus was localized within the interstitial cells. Clearance of infectious virus from the testis occurred between day 20 and day 30 after infection, although viral DNA could still be detected by polymerase chain reaction at 120 days. Viral clearance was associated with a return to normal serum testosterone and LH concentrations. Anti-sperm antibodies were present in the serum as early as 5 days after infection and declined during the recovery phase. Rabbits were infertile at 60 days but returned to normal fertility 60-90 days after infection.

Animals↗

PubMed1991

Cryptococcal epididymo-orchitis complicating steroid therapy for relapsing polychondritis.

Disseminated cryptococcosis is a known complication of steroid therapy. Infection within the genito-urinary tract is usually assumed to be part of generalized cryptococcosis complicating a primary pulmonary focus. A case of isolated testicular cryptococcal orchitis complicating steroid therapy for relapsing polychondritis is presented. To the authors' knowledge isolated cryptococcal orchitis has not been previously described.

Aged↗

PubMed1990

Adoptive transfer of murine autoimmune orchitis with sperm-specific T lymphoblasts.

A protocol was successfully developed for reproducibly transferring experimental autoimmune orchitis (EAO) to naive recipient mice with sperm-specific T lymphoblasts. Cell donors were Balb/c mice immunized about 12 days earlier with homologous epididymal sperm capacitated in vitro with complete Freund's adjuvant. Draining lymph node cells were collected and subjected to a second challenge with the same sperm antigen in vitro. Sperm-specific T lymphoblasts were isolated on Percoll density gradients and propagated in the presence of interleukin-2 for 3 days and then were transferred intraperitoneally to naive recipients. As few as 3 x 10(6) sperm-specific T lymphoblasts were able to transfer EAO, which began on day 7 as infiltration of lymphocytes and macrophages and on days 14 to 21 developed to degenerative changes of spermatids and exfoliation of germinal epithelium. These pathologic alterations resemble a delayed type of hypersensitivity. The results show that sensitized T lymphoblasts can mediate an antigen-specific, mononuclear cell-invasive lesion in autoimmune orchitis.

Animals↗

PubMed1991

A new murine model of autoimmune orchitis induced by immunization with viable syngeneic testicular germ cells alone. II. Immunohistochemical findings of fully-developed inflammatory lesion.

Previous studies demonstrated that experimental autoimmune orchitis (EAO) was produced in C3H/He mice with very high incidence by two or three subcutaneous injections of viable syngeneic testicular germ cells, without the use of any adjuvants or immunopotentiators and that the disease induced was characterized by a complete lack of epididymitis despite a definite orchitis with hypospermatogenesis. In this report, immunohistochemical characterization of immune cells in the fully-developed orchitic lesion was carried out using monoclonal antibodies and immunoperoxidase staining. Thy-1.2+ cells, Mac-1+ cells, B220+ cells and cytoplasmic Ig-bearing cells in the lesion were estimated to be approximately 30, 15, 20 and 30% of all inflammatory cells, respectively. Major phenotype of T cells in the lesion was CD4+ (approximately 85%) with the remainder (approximately 15%) being CD8+. The percentages of cytoplasmic IgG-, IgA- and IgM-bearing cells were estimated as approximately 35, 60 and 5% of all cytoplasmic Ig-bearing cells, respectively. Deposits of immunoglobulins and third component of complement were identified on the basement membrane of the seminiferous tubules, interstitium between the tubules, vessel endothelium and degenerated germ cells in the lesion. Circulating antibodies directed against the acrosomal portion of germ cells were detected in IgG and IgM classes but not in IgA class. Inflammatory cells (including macrophages, B cells and, probably, activated T cells) in the lesion were Ia+, but Leydig cells, Sertoli cells and germ cells did not stain for Ia at all.

Animals↗

PubMedDate not supplied

Addisonian crisis and tuberculous epididymo-orchitis.

OBJECTIVE: To describe a case of acute primary adrenal insufficiency in which tuberculosis was subsequently detected as the etiologic factor when the patient presented with tuberculous epididymo-orchitis. METHODS: A case of acute primary adrenal insufficiency associated with bilaterally enlarged adrenal glands is reported, along with the subsequent finding of a scrotal mass diagnosed as tuberculous epididymo-orchitis. Diagnosis, adrenal function, and results of imaging studies after institution of antituberculous treatment are discussed. RESULTS: A 41-year-old Egyptian man, who had immigrated to the United States 5 years previously, had acute psychosis and addisonian crisis. A substantially increased early morning level of plasma adrenocorticotropic hormone and a low level of serum cortisol confirmed the diagnosis of primary adrenal insufficiency. Both adrenal glands were enlarged but without calcification on computed tomography. A previous bacille Calmette-Guérin vaccination complicated the interpretation of a positive tuberculin skin test result. Both lungs were clear on chest radiography and computed tomography. Seven months later, the patient had a left scrotal mass and underwent radical orchiectomy. Examination of the pathology specimen showed caseous granulomatous inflammation and necrosis, and acid-fast bacilli were identified. Culture was positive for Mycobacterium tuberculosis. CONCLUSION: In a patient from a country where tuberculosis is endemic, tuberculosis should be considered in the differential diagnosis when primary adrenal insufficiency is detected, especially in association with enlarged or calcified adrenal glands. Extra-adrenal tuberculous involvement should be actively sought because it may provide indirect microbiologic or histologic clues. Other than the lungs, special attention should be paid to the genitourinary system.

Addison Disease↗

PubMed2002

Focal orchitis in undescended testes: discussion of pathogenetic mechanisms of tubular atrophy.

OBJECTIVE: To evaluate seminiferous epithelium lesions in adult cryptorchid testes showing lymphoid infiltrates in seminiferous tubules and interstitium (i.e., focal orchitis). Also, to consider the possible role of this lesion in the etiology of tubular atrophy. METHODS: We performed a histopathologic study of the cryptorchid testes and adjacent epididymides removed from 50 adult men who had not been previously treated for cryptorchidism. The study included morphologic and semiquantitative evaluation of seminiferous tubule pathology (according to germ cell numbers), Sertoli cell morphology, tubular lumen dilation, rete testis pattern (normal, hypoplastic, or cystic), and epididymal pattern (normal or epididymal duct hypoplasia). The study also included immunohistochemical evaluation of immune cell markers. The results were compared with clinical and laboratory findings. RESULTS: Focal lymphoid infiltrates (mainly lymphocytes) in seminiferous tubules and interstitium were found in 22 patients (44%), all of whom had unilateral cryptorchidism. The course of orchitis was asymptomatic, and laboratory data were normal. According to the seminiferous tubule pathology, a variety of histopathologic diagnoses, were made: (1) mixed atrophy consisting of Sertoli cell-only tubules intermingled with tubules showing maturation arrest of spermatogonia (11 testes, 4 of which also showed hyalinized tubules); (2) Sertoli cell-only tubules plus hyalinized tubules (4 testes); (3) Sertoli cell-only tubules (3 testes); (4) intratubular germ cell neoplasia (2 testes, 1 of which also showed hyalinized tubules); (5) complete tubular hyalinization (1 testis); and (6) tubular hyalinization plus some groups of tubules with hypospermatogenesis (all germ cell types were present although in lower numbers, 1 testis). Dysgenetic Sertoli cells, that is, Sertoli cells that had undergone anomalous, incomplete maturation, were observed in all nonhyalinized seminiferous tubules with inflammatory infiltrates. Tubular ectasia was observed in 13 cases. The rete testis was hypoplastic and showed cystic transformation in 18 testes, and the epididymis was hypoplastic in 15 testes. CONCLUSIONS: The causes of these focal inflammatory infiltrates are unknown. It is possible that tubular ectasia and Sertoli cell dysgenesis are involved and that these alterations cause a disruption of the blood-testis barrier and allow antigens to enter the testicular interstitium, giving rise to an autoimmune process.

Adult↗

PubMed1995

[Murine "sympathetic orchitis" induced by unilateral testicular injury and autoimmune response].

BACKGROUND: Experimental autoimmune orchitis (EAO) has been studied as an animal model for human male immunological infertility. Most EAO models have been induced by immunization with testis antigens in artificial adjuvants. In this paper, we report a more clinical EAO model. METHODS: Ten to 20 needle punctures were made to the unilateral testis of mice and it was crushed by a needle-holder. RESULTS: Contralateral EAO (so-called "sympathetic orchitis") was gradually induced starting on Day 28. Delayed type hypersensitivity (DTH), one of the cell-mediated immunities, to autologous testicular cells (TC) as well as anti-TC antibodies, humoral immunity, were both detected in those mice. Repeated crush(es) of the ipsilateral testis two weeks later (and four weeks later) as a booster did not enhance the contralateral lesion or autoimmune responses. CONCLUSION: Our present injury model mimics clinical testicular trauma; therefore, this testicular injury model can be very useful in studying the immunological mechanism of EAO and of human immunological male infertility.

Animals↗

PubMed1989

Sonographic features of focal orchitis.

High-resolution sonography is a very sensitive imaging modality for detecting intratesticular pathology and is an accurate means of distinguishing intratesticular lesions (usually malignant) from extratesticular ones (usually benign). Unfortunately, there are no reliable sonographic criteria to distinguish testicular neoplasms from focal benign intratesticular lesions such as infarction, hemorrhage, or infection. We describe three cases of focal orchitis in which the sonographic features did allow a confident diagnosis of intratesticular infection. In each case a focal peripheral hypoechoic intratesticular abnormality was seen that was poorly defined or crescent-shaped, adjacent to an enlarged epididymis. The specific sonographic features suggest the diagnosis of focal orchitis and orchiectomy can be prevented. Rapid improvement (2 to 4 weeks) should be seen sonographically and in all cases the intratesticular lesions should be followed to complete resolution.

Adult↗

PubMed1999

[Syphilitic orchitis: a case report].

Syphilitic orchitis is recently a rare disease in Japan. A 75-year-old man was referred to our hospital with the complaint of persistent swelling of the left scrotal contents in spite of prior antibiotic therapy. We suspected a testicular tumor because of lack of pain, and performed high orchiectomy. The specimen showed wide-ranged necrosis with a non-specific inflammatory change of the testis on hematoxylin-eosin stain. After performing analysis using a polymerase chain reaction method, we reached the final diagnosis of syphilitic orchitis.

Aged↗

PubMed2000

Septic orchitis in an alpaca.

An adult, intact male alpaca was presented with an acute onset of unilateral scrotal swelling. Following complete physical and ultrasonographic examination, the most likely differential diagnoses were orchitis, hematoma, and testicular torsion. The animal was castrated and histopathologic evaluation revealed unilateral orchitis. Streptococcus equi subsp. zooepidemicus was cultured.

Animals↗

PubMedDate not supplied

Tuberculous epididymo-orchitis following intravesical BCG for superficial bladder cancer.

A seventy-two-year-old man with transitional cell carcinoma of the bladder received intravesical Bacillus Calmette-Guérin (BCG) following which he developed left testicular pain and swelling that partially resolved with conservative treatment. Six months later a second course of BCG was given for recurrent disease. Ten months later, he developed left testicular swelling and severe induration along with a draining scrotal sinus. Tuberculous orchitis was suspected and a left orchiectomy was performed. Pathology showed caseating granulomatous orchitis and epididymitis with numerous acid fast bacilli on Ziehl-Neelson stain. The patient received a six-month course of antituberculous therapy. This case highlights a rare but serious complication of intravesical BCG.

Administration, Intravesical↗