Nodules of epithelioid granulomatous inflammation can be appreciated. In this case, a 60 yo M presented with 3.8cm epididymal mass.
Large zones of caseous necrosis with surrounding pallisading histiocytes are key findings.
Central caseation with surrounding dense inflammation are seen.
A normal efferent ductule of the epididymis (with pseudostratified epithelium and cilia in the lumen) is seen in the upper right. Nodules of granulomatous inflammation are seen on the bottom image.
Multinucleated giant cells are often present in the inflammatory milieu.
Most cases of genitourinary tuberculosis involves the kidneys and a minority of cases involve the genital tract. In the male genital region, the infection usually involves the epididymis or the prostate. The testicle and seminal vesicles may be secondarily affected.
Routes of infection include descending infection from the kidneys, direct extension from foci in the the genital tract and hematogenous seeding (Gorse). Microscopically, the typical findings of a tubercular infections are seen including caseous necrosis with pallisading epithelioid histocytes and giant cells, otherwise known as necrotizing granulomas.
Patients may present with dysuria with sterile pyuria or a testicular mass which may or may not be painful. Diagnosis can be made on pathological specimens obtained by FNA using stains that highlight the mycobacteria and subsequently confirmed with PCR or cultures. In most instances, the patients have concurrent renal or pulmonary disease (Jacob).
Four-drug regimen of rifampicin, isoniazid with pyridoxine supplementation, pyrazinamide, and ethambutol is usually employed (Jacob). Sometimes medical therapy is ineffective, however, in eradicating the infection and surgical resection is employed.
Urogenital tuberculosis is a destructive disease which may result in contracted bladder and/or end stage kidney disease.
Gorse GJ, Belshe RB. Male genital tuberculosis: a review of the literature with instructive case reports. Rev Infect Dis. 1985 Jul-Aug;7(4):511-24.
Jacob JT, Nguyen TM, Ray SM. Male genital tuberculosis. Lancet Infect Dis. 2008 May;8(5):335-42.