Histological Basis for the Interpretation of Granulomatous Orchitis

Abstract

The presence of granulomas in the epididymis and the testis is a frequent occurrence in chronic orchioepididymitis. A granulomatous reaction occurs in the presence of poorly digestible agents. Although the development of a granuloma is a process that takes several days and acquires its typical characteristics only at the end, it tends to persist over time, so the pathologist has an image of inestimable value that directs his steps toward a diagnosis when, as it often happens, the clinical information is not complete or the form of the disease presentation is not conventional. The presence of granulomas that destroy the structure of the testis or the epididymis, necrosing tubules, or interstitium is characteristic of tuberculosis, syphilis, and fungi. Noncaseating epithelioid granulomas suggest brucellosis or sarcoidosis, while foreign body granulomas suggest parasites. The presence of a granulomatous reaction with testicular structure preservation is characteristic of idiopathic granulomatous orchitis and granulomatous orchitis associated with germ cell tumors. In many cases the diagnosis can be made through the use of special staining techniques or the culture of aspirates or a serologic test. This is the case of tuberculosis, syphilis, brucella, fungi, and parasites. In other instances, as in sarcoidosis and idiopathic granulomatous orchitis, the agent is unknown.