Diagnostic delay in a patient with reactional lepromatous leprosy treated as testicular tuberculosis

Abstract Leprosy is a chronic neglected and stigmatizing disease. Due to involvement of the peripheral nerves, it can result in physical disabilities, deformities, and emotional damage if not diagnosed and treated promptly. This is the case of a young patient with testicular pain and swelling and no improvement after a specific therapeutic scheme for tuberculosis. Clinical and laboratory reevaluation revealed hypoesthetic skin patches associated with post-burn crusted ulcers on the left arm, thickening of ulnar nerves, atrophy of interosseous muscles of the hands, positive skin smear microscopy, and testicular histopathology with numerous bacilli forming globi. These findings indicated lepromatous leprosy with type II reaction.

Cocaine abuse that presents with acute scrotal pain and mimics testicular torsion

ABSTRACT Report case (s) relevant aspects: Man, 27 years old, complaining of acute testicular pain by 2 hours in the remaining left testicle. Denies fever, lower urinary tract symptoms such as dysuria, urinary frequency, concommitant or prior urethral discharge to the painful condition. He underwent right orchiectomy 13 years ago by testicular torsion. He is a chronic user of cocaine for 15 years and during the last three days the drug use was continuous and intense. Proposed premise substantiating case (s) description: Initial diagnostic hypothesis: Syndromic: Acute Scrotum Syndrome (SEA) Main Etiologic (testicular torsion) Secondary Etiologic (acute orchiepididymitis) Briefly delineates what might it add? Lines of research That Could be Addressed: In this challenging clinical case we presented an alternative and new etiologic diangosis for the acute scrotum which the main etiologic factor remains testicular torsion. This new diangosis is acute testicular ischemia as a complication of cocaine abuse.

Testicular calculus: A rare case

Testicular calculus is an extremely rare case with unknown etiology and pathogenesis. To our knowledge, here we report the third case of testicular calculus. A 31-year-old man was admitted to our clinic with painful solid mass in left testis. After diagnostic work-up for a possible testicular tumour, he underwent inguinal orchiectomy and histopathologic examination showed a testicular calculus.

Quiste epidermoide testicular: diagnóstico ecográfico preoperatorio y correlación radiopatológica / Testicular epidermoid cyst. preoperative ultrasound diagnosis and radiopathological correlation

The low incidence of testicular epidermoid cyst (1-2 percent of all testicular tumors), makes ultrasound findings the key to making, or at least suggesting, a precise preoperative diagnosis, thus making a conservative treatment possible. We present two cases with ultrasound diagnosis of epidermoid cyst, confirmed later after surgery. We review the literature, emphasizing the evaluation of the ultrasound images and their correlation with the anatomopathological findings.

La escasa incidencia del quiste epidermoide de testículo (1-2 por ciento de todos los tumores testiculares), hace de los hallazgos ecográficos la clave para realizar o al menos sugerir un diagnóstico prequirúrgico preciso, haciendo por tanto posible un tratamiento conservador. Presentamos dos casos con diagnóstico ecográfico de quiste epidermoide, confirmado posteriormente tras cirugía. Realizamos una revisión de la bibliografía, enfatizando en la valoración de las imágenes ecográficas y su correlación con los hallazgos anatomopatológicos.

La lepra y el testículo / Leprosy and the testis

Introducción. La afección testicular es frecuente en la lepra lepromatosa, daño que se incrementa cuando cursa con eritema nudoso leproso. Objetivo. Presentar un paciente con lepra lepromatosa y eritema nudoso leproso con grave compromiso testicular. Materiales y métodos. Se estudió un hombre de 28 años con lepra lepromatosa desde los 22, que durante la poliquimioterapia para la lepra presentó eritema nudoso leproso crónico que afectó ambos testículos y no respondió al manejo convencional. El dolor persistente obligó a practicar orquidectomía izquierda. Resultados. Este testículo presentaba atrofia tubular y fibrosis notorias, conglomerados de macrófagos espumosos, sin bacilos, hiperplasia focal de células de Leydig, endarteritis y arteritis linfocitaria y granulomatosa de vasos pequeños y medianos; estos cambios también estaban presentes en el epidídimo. Un estudio llevado a cabo dos años después de terminar su tratamiento y de la orquidectomía izquierda, demostró azoospermia, testosterona total normal, testosterona libre discretamente disminuida y hormonas lutropina (luteinizante) y folitropina (estimulante del folículo) elevadas. No había disminución de la libido ni de su actividad sexual. Se revisaron los conceptos generales sobre el eritema nudoso leproso y las alteraciones que la lepra produce en el testículo. Conclusión. La lepra lepromatosa puede conducir a hipogonadismo. Los programas de lepra deben contemplar esta complicación para corregir y evitar sus secuelas.

Introduction. Damage of testicles is frequent in lepromatous leprosy and worsened by the presence of erythema nodosum leprosum. Objective. A patient is presented who developed lepromatous leprosy and erythema nodosum leprosum with major testicular compromise. Material and methods. The 28-year-old male patient had lepromatous leprosy since age 22. During a polychemotherapy treatment for the lepromatous leprosy, he presented chronic erythema nodosum leprosum that affected both testicles; he did not respond to the conventional treatment. A left orchidectomy was performed to treat the persistent pain. Results. The extracted testis evidenced the following: tubular atrophy, extensive fibrosis, cumulus of foamy macrophages without rods, focal Leydig cell hyperplasia, linfocitary and granulomatous arteritis and endarteritis of small and medium size vessels. These changes were also observed in the epididymis. Two years after the polychemoterapy and the orchidectomy, the patient exhibited azoospermy, normal total testosterone, slightly diminished free testosterone and elevated levels of luteinizing hormone and follicle-stimulating hormone. No loss of libido or sexual activity was reported. General concepts of erythema nodosum leprosum were reviewed, as well as the pathologic changes produced by leprosy in the testis. Conclusion. Lepromatous leprosy may lead to hypogonadism. This condition is recommended for inclusion in leprosy diagnostic programs in order to detect and treat the consequences of the possible hypogonadism.

Tuberculosis generalizada: a propósito de un caso / Generalized tuberculosis: case report

La tuberculosis extrapulmonar supone el 10-20 por ciento del total de tuberculosis que padecen los enfermos inmunocompetentes. En los casos de tuberculosis extrapulmonar existe un foco primario pulmonar desde donde se puede producir un diseminación, bien por contigüidad, vía linfática o por vía hematógena, siendo esta última vía la causante de la mayoría de las tuberculosis extrapulmonar.

Epididymo-testicular malacoplakia--a case report.

Malacoplakia is one of the rare, chronic inflammatory disorders affecting the epididymis and testis. Diagnosis of the same is important as the treatment differs from the other granulomatous lesions in this area. We present a case of malacoplakia involving both the epididymis and testis with a brief review of literature.

Análise da expressão de TGFalfa(Transforming Growth Factor Alpha) nas células germinativas e a frequência de células de sertoli em touros de raças sintéticas com alteração na qualidade seminal / Analysis of the TGFalpha(transforming growth factor alpha) expression in germinative cells and the frequency of Sertoli cells in bulls of synthetic breed with deficient seminal quality

O fator de crescimento transformante alfa (TGFα) é uma molécula da família dos fatores de crescimento transformantes, que tem sido apontado como provável regulador do desenvolvimento testicular. A hipótese do presente estudo foi de que touros de raças sintéticas com deficiente qualidade seminal apresentam um padrão de expressão de TGFα e uma freqüência média de células de Sertoli, diferentes quando comparados aos touros com adequada qualidade seminal. Foram utilizados para o estudo, testículos de seis touros Braford e oito touros Brangus-Ibagé com e sem problemas na qualidade seminal. A técnica de imuno-histoquímica foi empregada para determinar a expressão de TGFα no epitélio seminífero e também para marcar o núcleo das células de Sertoli, com o uso do anticorpo monoclonal TGFα (Ab-2; Calbiochem) e anticorpo policlonal antiproteína S100 (DAKO). A média geral de espermatogônias marcadas pelo anticorpo foi diferente para raça: 9.2±0.4 para Braford e 11.0±0.3 para Brangus-Ibagé (P<0.05), porém não houve diferença estatisticamente significativa entre as fases analisadas. A média de células de Sertoli foi similar entre as raças de touros. Porém houve uma interação significativa (P<0.05) entre raça e condição reprodutiva, representada por uma menor freqüência de células Sertoli nos touros Brangus-Ibagé considerados aptos à reprodução. Este achado que pode ser um indicador de que a origem da menor qualidade de sêmen nestes animais de raças sintéticas deve estar desvinculada da fase embrionária ou neonatal, já que é nesta fase que o número de células de Sertoli é estabelecido para o indivíduo adulto. O entendimento das interações celulares do epitélio seminífero, envolvendo os fatores de crescimento no controle parácrino da espermatogênese, requer não somente a identificação do local de expressão destes fatores, como também o seu significado in vivo.

The transforming growth factor alpha (TGFα) is a molecule from the family of the transforming growth factors and has been pointed out as a probable regulator of testicular development. The hypotheses in the present study was that bulls from synthetic breeds with deficient seminal quality presented different TGFα expression and average number of Sertoli cells when compared to normal bulls. Testicles from six Braford and eight Brangus-Ibagé bulls with and without problems in semen quality were used. The immunohistochemical technique was employed to determine the TGFα expression in seminiferous epithelium and to mark the nucleus of the Sertoli cells with the use of respectively of monoclonal antibody anti-TGFα (Ab-2; Calbiochem) and anti-S100 protein polyclonal antibody (DAKO). The general average of spermatogonia marked by the antibody was different for each breed: 9.2±0.4 for Braford and 11.0±0.3 for Brangus-Ibagé. No difference regarding the expression of TGFα was found between sound and unsound bulls. The average number of Sertoli cells was similar between bull breeds. A smaller Sertoli cell population was found in the sound Brangus-Ibagé bulls, which may be an indication that the origin of the low seminal quality in synthetic bulls should be detached from the embryonic or the early newborn phase when the total number of such cells in adults is established. The understanding of cell interaction in the seminiferous epithelium, involving growth related factors, requires not only the identification of the expression site but also the in vivo meaning to spermiogenesis. The study of the growth factors in the testicle in adult bulls is worth further research in order to understand the regulation of spermiogenesis at the paracrine level in adult animals.

Germ cell death and their removal during initial stages of testicular ischemia and cryptorchidism: a comparative analysis.

Germ cell death and their removal from the seminiferous epithelium are common in the affected testis in conditions of unilateral ischemia or cryptorchidism; the similarities and differences, however, have not been studied between these two conditions. The present study was designed to examine the severity of the effect on testicular germ cells during the initial stages of both ischemia and cryptorchidism, which have significant implications on the restoration of fertility following surgical repair. Complete absence of spermatids was observed following 12 hr of ischemia as compared to 7 days of cryptorchidism. Germ cell removal in either case was in the direction of lumen to basement membrane leaving only a single layer of cells by 24 hr of unilateral ischemia as compared to 15 days of cryptorchidism. Levels of intratesticular testosterone was found lower in cryptorchidism (7 days) but not in ischemia till 24 hrs. Giant cells frequently observed in cryptorchid testis were absent in the ischemic seminiferous epithelium. There was a gradual increase in the number of apoptotic and non-viable cells; the latter was more than 95% by 24 hr of ischemia. In contrast, approximately 85% testicular cells were nonviable till 15 days of cryptorchidism. The 1c peak representing the population of haploid cells was significantly reduced in cryptorchidism (7 days), while the peak was completely abolished by 24 hr of ischemia. Rise in the levels of oxidative stress in the affected testis was observed identically during the initial stages. These findings indicate that coupled with the rise in tissue oxidative stress, the number of apoptotic/nonviable germ cells was alarmingly high (> 80%) by 15 days of cryptochidism or 24 hr of ischemia. Restoration of complete spermatogenesis following surgical repair may not be possible in such cases because of these acute adverse effects.

Microlitiasis testicular en el niño: ¿una entidad potencialmente maligna? rol de la ultrasonografía / Testicular Microlithiasis in the boy: an entity potentially malignant? role of the ultrasonography

La microlitiasis testicular (MT) es una entidad poco común, caracterizada por el depósito de calcio en el lumen de los túbulos seminíferos. Su verdadera incidencia y etiopatogenia no han sido definidos. La MT tiene una apariencia ultrasonográfica característica, que consiste en la presencia de focos hiperecogénicos menores de 2 mm, distribuidos en forma difusa en el parénquima testicular, generalmente en forma bilateral.

Tumours and tumour-like conditions of the para-testicular region--a study of morphological features.

Twenty two patients with tumours or tumour-like conditions of the para-testicular region (PTR) were diagnosed over a 5 year period. Of these, 16 (73%) were benign with only one true neoplasm (papillary cystadenoma). The tumour-like conditions were comprised of 6 cases of adenomatous hyperplasia of epididymis, 4 cases of spermatic granuloma, 2 cases each of spermatocele and nodular-fibrous proliferation and one mesothelial cyst. Three patients with spermatic granuloma gave a history of trauma. No case of adenomatoid tumour was encountered. Six malignant neoplasms were diagnosed (27%) all of which were sarcomas. Five were primary to the PTR and one was a metastatic deposit from a primary leiomyoblastoma of the mesentery. Among the 5 primary sarcomas were 2 cases each of rhabdomyosarcoma and leiomyosarcoma, and 1 case of liposarcoma. The patient with leiomyoblastoma presented first with a measenteric mass which was followed a month later by a rapidly growing mass in the scrotum. Immunohistochemical staining (IHC) and Electron microscopy (EM) were done in this case. Intra-cytoplasmic myofilaments as well as desmosomes were observed. The patients ranged from 14 to 65 years of age and most presented with painless mass in the scrotum. Follow-up was not possible due to practical difficulties.

Alteraçöes do sistema genital de ovinos deslanados / Genital anatomo-histopathological alterations in sheep rams

Foram examinados anátomo-histopatologicamente os diversossegmentos do sistema genital de 16 ovinos machos adultos, das raças Morada Nova (6), Santa Inês (7) e Somalis (3), procedentes do município de Sobral/CE. Os animais foram sacrificados após exames clínico-andrológicos ao se diagnosticar algum problema reprodutivo. As lesöes foram registradas, apenas, nos testículos, nosepidídimos e na bolsa escrotal, apresentando a seguinte ordem de freqüência: degeneraçäo testicular (37,50//), epididimite näo infecciosa (25,00//) e calcificaçäotesticular, orquite-epididimite, hipoplasia testicular e epididimária ocorrendo em 8,33//cada uma. A lesäo menos freqüente foi o abscesso escrotal devido ao Corynebacterium pseudotuberculosis na frequência de 4,1//. O diagnóstico clínico-andrológico das alteraçöes gonadais é de fundamental importância pois a maioria delas causa subfertilidade ou esterilidade

Microlitiasis testicular asociada a infertilidad / Testicular microlithiasis associated with infertility

Presentamos un caso de microlitiasis asociado a infertilidad masculina. Microlitiasis testicular es una entidad poco frecuente que se caracteriza por una detención de la maduración del epitelio germinal y presencia de microcálculos dentro del lumen de los túbulos seminíferos. Han sido comunicados pocos casos de esta asociación (4), sin haberse dilucidado si la microlitiasis es causa de la infertilidad o si ambas son el resultado de una condición aún no conocida