Schistosomiasis of the Testis and Other Intra-Scrotal Organs: A Review and Update

Abstract

Schistosomiasis of the testis and other intra-scrotal contents is a very rare condition which can be encountered within Schistosomiasis endemic areas of the world. Because of global travelling and swimming in rivers within Schistosomiasis endemic areas of the world, intra-scrotal Schistosomiasis tends to be sporadically reported in all areas of the world in male children and adults. Intra-scrotal Schistosomiasis may manifest as (a) testicular mass that may be painless and thus simulate testicular tumour, other intra-scrotal Schistosomiasis may present as hydrocele, epididymal cyst or solid/firm epididymal mass, a mass on the tunica or extra-testicular parts of the scrotum, testicular/intra-scrotal discomfort / pain. The lesion could mimic epididymo-orchitis on very rare occasions. There would tend to be a history of travel to or return from a Schistosomiasis endemic region in patients who normally dwell within the non-Schistosomiasis endemic areas of the world. There may also be a history of a previous episode of haematuria in some cases. The levels of serum Beta-Human Chorionic antigen, Alpha fetoprotein and Lactate Dehydrogenase usually tends to be normal. Some cases of Schistosomiasis of the testis had been mis-diagnosed as testicular cancer and the diagnosis of Schistosomiasis had been established based upon the histopathology examination findings of Schistosoma within the orchidectomy testis, but if there is a high-index of suspicion for Schistosomiasis of the scrotal content based upon a patient dwelling within or having travelled to a Schistosomiasis endemic area supported by a history of haematuria and the tumour or tumoral mass is completely excised for frozen section pathology examination, then the diagnosis of Schistosomiasis of the testis would be confirmed and the rest of the testis can be saved from excision. If all cases of excised epididymal cysts and Tunica from hydrocele operations are submitted for histopathology examination, then incidental cases of Schistosomiasis of scrotal contents would be made. Complete treatment of Schistosomiasis of testis and or scrotal contents does include excision / biopsy of the lesion for pathology examination confirmation and utilization of anti-Schistosomiasis medicaments. Schistosomiasis of intra-scrotal/testicular contents may be responsible for infertility and azoospermia and if this is properly investigated, diagnosed and treated this could be ensued by resolution of infertility with resulting pregnancy of the spouse and the production of a baby and because of this, individuals who have azoospermia and infertility in Schistosomiasis endemic areas, a high index of suspicion would be required in other to establish the cause as well as treat the cause of the infertility. Treatment of intra-scrotal content Schistosomiasis does entail excision / biopsy of the lesion plus utilization of anti-Schistosoma medicament and Praziquantel is a common medication that tends to be given and this tends to yield good outcome.