We report the case of a 76-year-old patient, without known allergies, with a history of dyslipidemia, hypertension, old myocardial infarction, and a triple anti-leukomatous hyperplasia due to three-vessel disease.
No previous testicular trauma was reported.
No clinical history, laboratory tests for tuberculosis or brucellosis were available.
She came to the urology service due to testicular discomfort, consisting of intermittent chronic mild pain of 4 months of evolution, appreciating the examination hard and irregular nodule in the right testicle without spontaneous pain or accompanying pain.
Findings reveal a lobule focal nodular lesion with low echogenicity of 2 cm in diameter in the lower pole of the right testis, vascularized and therefore compatible with neoformation.
Left testicle with no pathological findings of interest.
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Contrast-enhanced abdominal CT showed no evidence of retroperitoneal lymphadenopathy.
Blood analysis showed normal values for alpha-fetoprotein, HCG and LDH (HCG: 1.74 U/l; Alpha-fetoprotein: 2.07 ng/ml; LDH: 299 m/ml).
The patient underwent right inguinal orchiectomy.
Macroscopic anatomopathological study showed sac and hydrocele with 8 x 5 x 2.5 cm and 5 cm of epididymal duct.
The section showed a testicle of 5.5 x 2.5 x 2.5 cm, with fibrous consistency, without macroscopic lesions compatible with neoplasia.
The microscopic study shows testicular parenchyma with vacuolated degeneration of germinal cells and Sertoli, with vesicular nuclei, appreciating in the walls of the seminiferous inflammatory tubules and mononuclear cells.
There are numerous granulomatous formations with abundant giant multinucleated cells located in the stroma between the seminiferous tubules and some of them within them.
Cellularity is not observed.
When PAS and Ziehl Nielsen stains were performed, no fungal or mycobacterial microorganisms were observed.
Histopathological findings suggest the diagnosis of idiopathic granulomatous orchitis.
