Testis and epididymis
Nonneoplastic testicular lesions
Vasculitis

Author: Sean Williamson, M.D. (see Authors page)

Revised: 10 April 2017, last major update October 2014

Copyright: (c) 2002-2017, PathologyOutlines.com, Inc.

PubMed Search: testicular vasculitis

Cite this page: Vasculitis. PathologyOutlines.com website. http://pathologyoutlines.com/topic/testisvasculitis.html. Accessed April 28th, 2017.
Definition / general
  • Polyarteritis nodosa (PAN) is the most common form of testicular vasculitis, predominantly seen in the fourth to sixth decades of life; often associated with hepatitis B virus and human immunodeficiency virus; although 60% to 86% of patients with PAN show testicular involvement at autopsy (ScientificWorldJournal 2010;10:1915), testicular symptoms are present in less than 20% of patients (Hum Pathol 1988;19:186)
  • Necrotizing vasclulitis: systemic disease which manifests as inflammation of arteries with fibrinoid necrosis and fibrosis of the vascular wall
    • May be associated with polyarteritis nodosa or an isolated finding; can be associated with a variety of other entities or may be idiopathic (Cardiovascular Pathology 1994;3:197)
    • While necrotizing vasculitis can involve any organ, isolated testicular involvement is rare and can pose diagnostic difficulties, especially in the absence of clinical and laboratory evidence of systemic involvement (World J Surg Oncol 2011;9:63)
  • Other vasculitides that may involve the testes include Wegener granulomatosis, Henoch-Schönlein purpura, giant cell arteritis and various autoimmune connective tissue disorders such as systemic lupus erythematosis (J Urol 2006;176:2682)
Clinical features
  • Can present with acute onset of pain and swelling, presumably related to intratesticular hemorrhage (Ir Med J 2006;99:27)
  • Systemic disease is frequently already present at the time of initial presentation of testicular vasculitis or develops shortly thereafter
  • Some cases, however, remain isolated to the testes with no evidence of progression to systemic disease (J Clin Pathol 1994;47:1121)
  • It is, therefore, unclear whether isolated testicular vasculitis represents an early site of involvement by systemic disease or a separate entity (World J Surg Oncol 2011;9:63)
  • Only several cases of isolated testicular vasculitis were reported in the literature and a presentation suggestive of a testicular neoplasm is even less common (J Clin Pathol 1994;47:1121)
  • Since testicular biopsy is contraindicated when malignancy is suspected, the diagnosis is usually reported postorchiectomy in these cases (ScientificWorldJournal 2010;10:1915, Urology 2003;61:1035)
  • Biopsy most likely diagnostic in patients with testicular symptoms (pain, enlargement or shrinking)
  • Wedge biopsy should contain capsule, tunica vasculosa and testicular parenchyma
Radiology images

Images hosted on PathOut server:

Case of the Week #328:

Scrotal ultrasound demonstrated a left testicular heterogeneous hypoechoic lesion with no significant internal vascularity

Case reports
Treatment
  • Treatment options are still debated and frequently hinge on individual factors which need to be carefully considered in each patient
  • Immunosuppressive therapy has been administered to some of the patients
  • In other cases, careful follow up to exclude progression to systemic disease was preferred (J Clin Pathol 1994;47:1121)
  • Some authors have even postulated that the excision of the affected organ might be curative, obviating the need for pharmacologic therapy (ScientificWorldJournal 2010;10:1915)
  • Close follow up, including serology, is recommended since the risk of progression to systemic disease is unknown (J Clin Pathol 1994;47:1121)
Gross description
Gross images

Images hosted on PathOut server:

Case of the Week #328

Microscopic (histologic) description
  • Focal hemorrhage with early organization and small arteries around the area of hemorrhage (Case of the Week #328)
Microscopic (histologic) images

Images hosted on PathOut server:

Case of the Week #328

Differential diagnosis
  • Although uncommon, isolated necrotizing testicular vasculitis remains in the differential diagnosis of hypovascular testicular lesions; long term follow up and additional research is needed in order to further elucidate the pathogenesis of isolated organ vasculitis and the subsequent risk of disease progression