RESUMO
Testicular vasculitis is uncommon and can be easily misdiagnosed. Early identification and treatment are essential for patient care. A 63-year-old man, presenting with testicular pain and swelling, had been treated with antibiotics for weeks. A month later, he developed severe left testicular pain and systemic symptoms. Scrotal ultrasound was suggestive of testicular torsion due to no blood flow. Pathology of the orchiectomy specimen demonstrated testicular granulomatous vasculitis involving small- to medium-sized arteries. Additional work-up of blood tests contained positive antinuclear, anti-proteinase 3 and anti-myeloperoxidase antibodies. Erythrocyte sedimentation rate and C-reactive protein were also elevated. Diagnosis of anti-neutrophil cytoplasmic antibody-associated vasculitis was made and prednisone was started. During more than 1-year follow-up, the patient's systemic symptoms were resolving gradually with no involvement of the other testis.
RESUMO
Sclerosing thymoma is an extremely rare entity described mostly in the recent past and, to our knowledge, described in only 14 cases, including one we recently diagnosed at our institution. The pathogenesis and biologic behavior of this relatively unknown entity is still largely uncertain. However, there are several consistent findings among the cases described so far. It is mostly asymptomatic or patients may present with shortness of breath or chest pain due to a large, well-circumscribed mass in the anterior mediastinum. It has a characteristic homogeneously white-tan, solid cut surface without any necrosis, hemorrhage, or cystic change. Microscopically, it is characterized by extensive sclerosis, hyalinization, and calcification. Only scant evidence of residual thymoma may be present to characterize this entity. Complete surgical resection has, so far, been curative. Knowledge of this rare entity in the general practice of surgical pathologists is important when considering the differential diagnosis of anterior mediastinal lesions.
