IgG4-Related Disease of Genitalia: When Inflammation Imitates Cancer | Chapter 6 | Newer Frontiers in Urology

The systemic fibro-inflammatory disease known as immunoglobulin G4-related disease (IgG4-RD) usually shows multiorgan involvement. A unique instance of a solitary IgG4-RD of the epididymis in a male adult, age 54, was reported. A painless mass over the lower aspect of the left testicle was his initial presentation. Tuberculosis was diagnosed based on the clinical findings. A comparatively hetero-echoic mass lesion on the left epididymis near the left testis was visible on the scrotum ultrasound. The patient was planned for surgical removal of the epididymal mass. However, intraoperative findings showed the mass was tightly stuck to the left testicle and indivisible from it, which required left total orchiectomy. The histopathology showed that the number of plasma cells and keloid-like collagen was increased along with focal spindle cell proliferation. Vimentin and IgG4 immunohistochemistry were positive, while CD34 was negative. IgG4 was high in the serum (165 mg/dL). There was no evidence of systemic involvement on the abdomen or thorax computed tomography. IgG4-RD of the epididymis was diagnosed and validated by immunohistochemistry and histopathology with high blood IgG4 levels. The medical literature only reports a very small number of solitary cases of IgG4-RD of epididymis with no other systemic manifestations. This study highlights the significance of this rare inflammatory condition mimicking epididymal tuberculosis or testicular malignancy.

 

Author (s) Details

 

Nakul Aher
Department of Urology & Renal Transplantation, Sri Ramachandra Institute of Higher Education & Research, Chennai, India.

 

Pradhumna Koushik
Department of Urology & Renal Transplantation, Sri Ramachandra Institute of Higher Education & Research, Chennai, India.

 

Velmurugan Palaniyandi
Department of Urology & Renal Transplantation, Sri Ramachandra Institute of Higher Education & Research, Chennai, India.

 

Hariharasudhan Sekar
Department of Urology & Renal Transplantation, Sri Ramachandra Institute of Higher Education & Research, Chennai, India.

 

Sriram Krishnamoorthy
Department of Urology & Renal Transplantation, Sri Ramachandra Institute of Higher Education & Research, Chennai, India.

 

Please see the book here:- https://doi.org/10.9734/bpi/mono/978-93-49238-86-2/CH6

A Rare Complication of Poorly Controlled Diabetes Mellitus: Testicular Necrosis | Chapter 21 | Recent Developments in Medicine and Medical Research Vol. 6

 In this case, a 45-year-old male patient with diabetes was diagnosed with testicular necrosis. Past medical history suggests diabetes, with treatment taken seldom. The patient's right testicular enlargement has been gradually rising for three weeks. In the right testis, ultrasonography revealed an abscess with no vascularity. The orchiectomy on the right side was completed. Histopathology confirmed testicular necrosis. Torsion-induced testicular necrosis is a common condition that leads to orchiectomy. Patients with acute onset scrotal pain, which is frequently unilateral, occur in these cases. The testis is extremely painful on inspection, with red, angry-looking skin overlaying it. Diabetic people are prone to urinary tract infections and epididymo-orchitis. Testicular discomfort, fever, leucocytosis, and other symptoms are common in patients.

Testicular necrosis, on the other hand, is extremely rare. Long-term consequences of diabetes mellitus include retinopathy, nephropathy, and neuropathy. Patients with long-term diabetes, including both insulin-dependent and non-insulin-dependent diabetes mellitus, are susceptible to various consequences, which can result in substantial morbidity. Testicular necrosis is a fairly uncommon consequence of diabetes mellitus. There were no articles about testicular necrosis as a diabetes consequence when I searched the internet. A case of unilateral testicular necrosis as a consequence of diabetes mellitus is given for the first time. Accelerated microangiopathy in combination with inadequate blood glucose management most likely produced this rare consequence.

Author(S) Details

Parthasarathi Hota
Department of General Surgery, Pacific Institute of Medical Sciences, Udaipur, Rajasthan, India.

View Book:- https://stm.bookpi.org/RDMMR-V6/article/view/4547