Elsevier

Urology

Volume 62, Issue 2, August 2003, Page 352
Urology

Case report
Isolated testicular polyarteritis nodosa mimicking testicular neoplasm—long-term follow-up

https://doi.org/10.1016/S0090-4295(03)00388-1Get rights and content

Abstract

Polyarteritis nodosa is a systemic vasculitis characterized by segmental necrotizing lesions of medium and small-size arteries. Rarely, the inflammatory process is isolated and involves a single organ without systemic manifestations. We describe a patient with isolated polyarteritis nodosa of the testis who presented with a testicular mass mimicking primary testicular tumor. The postoperative laboratory evaluation was negative. Long-term follow-up, without systemic treatment, showed no evidence of recurrence in the remainder of the testis or development of systemic vasculitis.

Section snippets

Comment

Polyarteritis nodosa is systemic vasculitis characterized by segmental transmural involvement of middle-size arteries resulting in a variety of clinical manifestations in the involved organs. The disease has a male predominance and occurs mainly in the fourth to sixth decades. Involvement of the epididymis is a common finding at autopsy of patients with systemic polyarteritis nodosa, although only the minority of them will have had clinical signs and symptoms.1

Histologically, isolated

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    Isolated organ involvement by PAN is well recognized and sites such as testis, epididymis, appendix, uterus, gallbladder, and breast can be affected.8-11 In cases reported in the literature as isolated testicular PAN, it is interesting to note that although some patients subsequently developed evidence of systemic PAN, others did not show systemic signs and remained asymptomatic after long-term follow-up.1,2,5,6 Therefore, and because PAN is by definition a systemic disease, it is unclear whether similar cases that present locally in the absence of systemic symptoms are best classified as isolated PAN as has mostly been reported in the literature, or as isolated testicular vasculitis with PAN-like features.

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    To our knowledge, the present is also the second report of a presumed isolated genitourinary PAN with no immunosuppressive therapy and long-term follow-up. In the other case with an equal 5-year monitoring [13], PAN affected solely the testis, whereas in the present one kidney and, possibly, penis were involved as well. The management of patients with isolated genitourinary PAN is not standardized.

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    Increased resistive indices may be detected as long as the intratesticular arteries are visible.7 The absence of color flow on Doppler US does not necessarily suggest the diagnosis of ischemia, however, because other conditions such as polyarteritis nodosa can also mimic torsion.23 Earlier, the documentation of testicular or epididymal venous flow by pulsed Doppler was suggested to be indicative mostly of inflammatory diseases or detorsion.24

  • Isolated polyarteritis nodosa of the male reproductive system associated with a germ cell tumor of the testis: a case report

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    Isolated forms of PAN without evidence of widespread disease are very rare. They have been observed in different organs [1] including the male reproductive system, where they presented mostly as an intrascrotal mass suspicious of neoplasm [3,4], rather than an inflammatory process [2,5]. The clinical course of isolated forms of PAN is usually indolent without need of further treatment after orchiectomy [3,4,6].

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