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Testicular vasculitis: implications for systemic disease
1Department of Pathology, Johns Hopkins Hospital, Baltimore, MD 21205.
Insights
Testicular vasculitis, often a sign of polyarteritis nodosa, can present as an initial symptom. Pathologists should recognize this rare presentation, as it may also occur independently of systemic vasculitis.
Area of Science:
- Pathology
- Urology
- Rheumatology
Background:
- Testicular vasculitis is a rare condition affecting the testes.
- Polyarteritis nodosa (PAN) is a systemic vasculitis that can involve the testes.
Observation:
- Nine cases of testicular vasculitis were reviewed from surgical pathology and autopsy files.
- Three cases presented as the initial manifestation of polyarteritis nodosa.
- Other cases involved systemic PAN, Goodpasture's syndrome, or were incidental findings.
Findings:
- Polyarteritis nodosa was the most common cause of necrotizing testicular vasculitis.
- Testicular vasculitis can be an isolated finding, not necessarily linked to systemic vasculitis.
- Presentations included recurrent testicular pain, fever, and epididymitis.
Implications:
- Pathologists must be aware of the rare testicular presentation of polyarteritis nodosa.
- Testicular biopsy can aid in diagnosing systemic vasculitis.
- Isolated testicular vasculitis may occur without systemic disease, requiring careful evaluation.
Abstract:
Nine cases of testicular vasculitis were identified from the surgical pathology and autopsy files of the Johns Hopkins Hospital. In three cases this was the initial manifestation of polyarteritis nodosa. Two of these men presented with recurrent testicular pain and fever, with orchiectomy samples showing focal infarcts and necrotizing vasculitis. The third man presented with epididymitis, with his biopsy specimen showing vasculitis. In two cases, men presented with systemic and testicular signs of polyarteritis nodosa, and the diagnosis was made on testicular biopsy and later studied at autopsy. In another case, the testicular lesions were seen with Goodpasture's syndrome; the patient was thoroughly studied at autopsy, and no evidence of polyarteritis nodosa was found. In the remaining three cases, testicular vasculitis was identified incidentally without diseases associated with vasculitis, one at orchiectomy for prostate adenocarcinoma and the other two at autopsy. Polyarteritis nodosa is the most common cause of necrotizing vasculitis of the testes, and pathologists should recognize the rare testicular presentation of this disease. However, testicular vasculitis also may be seen with other systemic diseases associated with vasculitis. Three of our cases were seen without systemic vasculitis, suggesting that testicular vasculitis may occur as an isolated finding without being a manifestation of systemic disease.