模拟睾丸恶性肿瘤的孤立性附睾结核性肿块:一例有趣的病例报告和经验教训

T. Manne, Solomon Nazareth, Pavithra Vittalraj, S. Sundaram, S. Krishnamoorthy, N. Kumaresan
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引用次数: 0

摘要

结核性附睾肿块是一种表现为无痛性阴囊肿胀的疾病。它类似于睾丸肿块,通常在睾丸切除术后诊断出来。大约22%的泌尿生殖系统结核累及附睾,22%的附睾结核是双侧的。本报告重申需要提高泌尿科医生的认识,以便在大多数情况下能够早期诊断,适当治疗,并可能避免需要进行睾丸切除术。一位35岁男性糖尿病患者表现为右睾丸迅速增大并伴有近期睾丸疼痛。他还发烧和发冷。18岁时,他接受了肺结核治疗。右睾丸肿大,不规则,轻度压痛。右侧附睾也呈不规则结节状,与右侧睾丸混在一起,难以区分。临床诊断为睾丸肿瘤。肿瘤标志物正常,他接受了高位睾丸切除术。组织病理学诊断证实右侧附睾结核。本病例报告主要强调了在治疗医生中需要高度的怀疑指数。既往的肺结核治疗史也应提醒医生考虑附睾的结核病理。在大多数情况下,及时诊断和早期适当治疗将在很大程度上防止睾丸切除。
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Isolated tuberculous epididymal mass mimicking testicular malignancy: an interesting case report and lessons learnt
Tuberculous epididymal mass is a condition that presents as a painless scrotal swelling. It resembles a testicular mass and is more often diagnosed after orchidectomy. About 22% of all genitourinary tuberculosis show epididymal involvement and 22% of epididymal tuberculosis are bilateral. This report reiterates the need for an increased awareness amongst the treating urologists that would enable an earlier diagnosis, appropriate treatment and may avert the need for orchidectomy in most cases. A 35-year-old diabetic male presented with rapidly enlarging right testicle associated with recent onset of pain over the testis. He also had fever and chills. At the age of 18, he was treated for pulmonary tuberculosis. The right testicle was enlarged, irregular and mildly tender. The right epididymis was also irregular and nodular, blended with the right testicle and indistinguishable from it. A clinical diagnosis of testicular tumour was made. Tumour markers were normal and he underwent high orchidectomy. Histopathological diagnosis confirmed right epididymal tuberculosis. This case report mainly highlights the need for a high index of suspicion amongst the treating physicians. A previous history of treatment for pulmonary tuberculosis should alert the physician to think in lines of tuberculous pathology in epididymis too. A prompt diagnosis and early, appropriate treatment would largely prevent removal of testicles in most cases.
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