PDF(Pubmed)
Abstract：
UNASSIGNED: Tuberculosis is prevalent in African countries especially in sub-Saharan Africa where HIV/AIDS is common. While Testicular tuberculosis is uncommon in the young as well as the elderly, pulmonary tuberculosis is commonly observed in these populations. History, physical examination, scrotal ultrasonography, and fine needle biopsy are important in diagnosis of suspected cases of testicular tuberculosis. Anti-TB therapy is the mainstay of treatment to ensure complete resolution of the lesion. However, in a few cases, orchidectomy is required for both diagnosis and treatment. When treating testicular tuberculosis, it is crucial to do a thorough assessment and investigations to exclude testicular malignancy because tuberculosis can present similarly to a testicular tumor.
METHODS: We report a rare case of right sided isolated testicular tuberculosis in a 45-year-old male who came with right sided testicular pain and swelling. Blood workups and testicular tumor markers were all normal, scrotal ultrasound reported right heterogenous testicular mass with avascular areas of necrosis and septated fluid collections in the tunica vaginalis with features suggestive of testicular tumor. Right orchiectomy through inguinal approach was done, findings included testicular mass with pus pockets and caseous necrosis occupying the whole testis. Specimen was sent for histopathology which revealed chronic granulomatous inflammation, most likely tuberculosis, and ZN stain confirmed the diagnosis of testicular tuberculosis. In accordance with national TB guidelines, the patient had anti-TB medication for six months, and after 12-months serial follow-up, the patient had completely recovered.
UNASSIGNED: Genitourinary tuberculosis is the second most common form of extrapulmonary TB after lymph node tuberculosis. 0.5 % of genitourinary TB involves the testes; On the other hand, isolated testicular TB as presented in our patient, is extremely uncommon, thus may mimic other testicular conditions including testicular tumor, so the diagnosis is challenging. It is important to accurately diagnose testicular TB and differentiate it from other scrotal pathologies especially testicular malignancy as the management is totally different. Testicular tuberculosis is diagnosed by tissue Cytology using FNAC or after an orchidectomy. It requires early, regular, full course combined anti-tuberculosis treatment. The drug treatment method uses three to four anti-tuberculosis drugs for 6-9 months. Surgical treatment is necessary if there is no response to drug treatment or in cases of abscess formation.
CONCLUSIONS: Testicular TB is a curable disease, but its diagnosis remains challenging. It is often missed owing to its non- specific symptoms. Thus, testicular TB should be suspected in patients with a notion of contagion or history of tuberculosis. Some of the radiological features are highly suggestive of testicular TB. FNAB could prevent unnecessary orchidectomy. In our case, the presentation was typically mimicking a testicular cancer and the patient underwent trans inguinal orchiectomy, and histology and ZN stain confirmed the diagnosis followed by subsequent six-month anti TB therapy.
METHODS: We report a rare case of right sided isolated testicular tuberculosis in a 45-year-old male who came with right sided testicular pain and swelling. Blood workups and testicular tumor markers were all normal, scrotal ultrasound reported right heterogenous testicular mass with avascular areas of necrosis and septated fluid collections in the tunica vaginalis with features suggestive of testicular tumor. Right orchiectomy through inguinal approach was done, findings included testicular mass with pus pockets and caseous necrosis occupying the whole testis. Specimen was sent for histopathology which revealed chronic granulomatous inflammation, most likely tuberculosis, and ZN stain confirmed the diagnosis of testicular tuberculosis. In accordance with national TB guidelines, the patient had anti-TB medication for six months, and after 12-months serial follow-up, the patient had completely recovered.
UNASSIGNED: Genitourinary tuberculosis is the second most common form of extrapulmonary TB after lymph node tuberculosis. 0.5 % of genitourinary TB involves the testes; On the other hand, isolated testicular TB as presented in our patient, is extremely uncommon, thus may mimic other testicular conditions including testicular tumor, so the diagnosis is challenging. It is important to accurately diagnose testicular TB and differentiate it from other scrotal pathologies especially testicular malignancy as the management is totally different. Testicular tuberculosis is diagnosed by tissue Cytology using FNAC or after an orchidectomy. It requires early, regular, full course combined anti-tuberculosis treatment. The drug treatment method uses three to four anti-tuberculosis drugs for 6-9 months. Surgical treatment is necessary if there is no response to drug treatment or in cases of abscess formation.
CONCLUSIONS: Testicular TB is a curable disease, but its diagnosis remains challenging. It is often missed owing to its non- specific symptoms. Thus, testicular TB should be suspected in patients with a notion of contagion or history of tuberculosis. Some of the radiological features are highly suggestive of testicular TB. FNAB could prevent unnecessary orchidectomy. In our case, the presentation was typically mimicking a testicular cancer and the patient underwent trans inguinal orchiectomy, and histology and ZN stain confirmed the diagnosis followed by subsequent six-month anti TB therapy.
摘要：
结核病在非洲国家很普遍，特别是在撒哈拉以南非洲，那里的艾滋病毒/艾滋病很普遍。虽然睾丸结核在年轻人和老年人中并不常见，肺结核在这些人群中很常见。历史,体检,阴囊超声检查,细针活检对睾丸结核疑似病例的诊断具有重要意义。抗结核治疗是确保病变完全消退的主要治疗手段。然而,在少数情况下，诊断和治疗都需要睾丸切除术。治疗睾丸结核时，进行彻底的评估和调查以排除睾丸恶性肿瘤至关重要，因为结核病的表现与睾丸肿瘤相似。
方法：我们报告了一例罕见的右侧孤立性睾丸结核病例，该病例为45岁男性，右侧睾丸疼痛和肿胀。血液检查和睾丸肿瘤标志物都正常,阴囊超声报告右侧异质性睾丸肿块，阴道鞘膜无血管区坏死和分隔积液，特征提示睾丸肿瘤。通过腹股沟入路进行右睾丸切除术，结果包括睾丸肿块，脓袋和干酪样坏死占据整个睾丸。标本被送去组织病理学检查，发现慢性肉芽肿性炎症，很可能是肺结核,ZN染色证实了睾丸结核的诊断。根据国家结核病指南，病人服用了6个月的抗结核药物,经过12个月的连续随访，病人已完全康复。
泌尿生殖道结核是仅次于淋巴结结核的第二常见肺外结核。0.5%的泌尿生殖系统结核涉及睾丸;另一方面,在我们的病人中出现的孤立的睾丸结核，非常罕见，因此可以模仿其他睾丸疾病，包括睾丸肿瘤，所以诊断很有挑战性.重要的是准确诊断睾丸结核并将其与其他阴囊病理尤其是睾丸恶性肿瘤区分开来，因为管理完全不同。使用FNAC或在睾丸切除术后通过组织细胞学诊断睾丸结核。它需要早期，常规,全程联合抗结核治疗。药物治疗方法使用3至4种抗结核药物治疗6-9个月。如果对药物治疗没有反应或脓肿形成，则需要手术治疗。
结论：睾丸结核是一种可治愈的疾病，但它的诊断仍然具有挑战性。它经常由于其非特异性症状而被遗漏。因此，有感染或结核病史的患者应怀疑睾丸结核.一些放射学特征高度提示睾丸结核。FNAB可以防止不必要的睾丸切除术。在我们的案例中,表现通常是模仿睾丸癌，患者接受了经腹股沟睾丸切除术，组织学和ZN染色证实了诊断，随后进行了6个月的抗结核治疗。
方法：我们报告了一例罕见的右侧孤立性睾丸结核病例，该病例为45岁男性，右侧睾丸疼痛和肿胀。血液检查和睾丸肿瘤标志物都正常,阴囊超声报告右侧异质性睾丸肿块，阴道鞘膜无血管区坏死和分隔积液，特征提示睾丸肿瘤。通过腹股沟入路进行右睾丸切除术，结果包括睾丸肿块，脓袋和干酪样坏死占据整个睾丸。标本被送去组织病理学检查，发现慢性肉芽肿性炎症，很可能是肺结核,ZN染色证实了睾丸结核的诊断。根据国家结核病指南，病人服用了6个月的抗结核药物,经过12个月的连续随访，病人已完全康复。
泌尿生殖道结核是仅次于淋巴结结核的第二常见肺外结核。0.5%的泌尿生殖系统结核涉及睾丸;另一方面,在我们的病人中出现的孤立的睾丸结核，非常罕见，因此可以模仿其他睾丸疾病，包括睾丸肿瘤，所以诊断很有挑战性.重要的是准确诊断睾丸结核并将其与其他阴囊病理尤其是睾丸恶性肿瘤区分开来，因为管理完全不同。使用FNAC或在睾丸切除术后通过组织细胞学诊断睾丸结核。它需要早期，常规,全程联合抗结核治疗。药物治疗方法使用3至4种抗结核药物治疗6-9个月。如果对药物治疗没有反应或脓肿形成，则需要手术治疗。
结论：睾丸结核是一种可治愈的疾病，但它的诊断仍然具有挑战性。它经常由于其非特异性症状而被遗漏。因此，有感染或结核病史的患者应怀疑睾丸结核.一些放射学特征高度提示睾丸结核。FNAB可以防止不必要的睾丸切除术。在我们的案例中,表现通常是模仿睾丸癌，患者接受了经腹股沟睾丸切除术，组织学和ZN染色证实了诊断，随后进行了6个月的抗结核治疗。
