Published papers

A 72-year-old male with indolent scrotal swelling of one month’s duration was admitted to urology. Scrotal ultrasonography showed abnormalities of the right epididymis and testis. An enlarged epididymal head was heterogeneously hypoechoic, and the border of the right epididymis and testis was ill-demarcated because an epididymal hypoechoic lesion spread into the testis. A sonogram of the right testis revealed multiple small hypoechoic nodules. In addition, there were moderate hydrocele, thick tunica albuginea, and scrotal wall edema. Color Doppler imaging revealed a few signals localized to the periphery of the epididymis. We suspected a right testicular tumor and performed high orchidectomy. Pathologically, there were granulation tissues with abscess, caseation necrosis, and Langhans giant cells. The patient had no history of pulmonary tuberculosis, and Mycobacterium tuberculosis was not detected by Ziehl-Neelsen stain nor isolated from the sputum and urine. We ultimately diagnosed tuberculous granulomatous epididymo-orchitis based on positive interferon-gamma release assays and computed tomography findings of old tuberculous pleurisy. It is often difficult to differentiate this disease from testicular tumor, but the presence of an enlarged epididymis, multiple small hypoechoic nodules in the testis, and Doppler signals localized at the periphery may be useful in making an accurate diagnosis. Findings that suggest inflammatory disease rather than a testicular tumor might be also helpful: scrotal wall thickening, thick tunica albuginea, and hydrocele.