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Testicular vasculitis: findings differentiating isolated disease from systemic disease in 72 patients.
MedLine Citation:
PMID:  22391469     Owner:  NLM     Status:  In-Data-Review    
Abstract/OtherAbstract:
Testicular vasculitis (TV) may be part of systemic (testicular) vasculitis (STV) or may exist as single-organ/isolated (testicular) vasculitis (ITV). In the current study we sought to identify clinical and histologic features that distinguish STV from ITV. The distinction was deemed important because it is already well established that in other forms of single organ vasculitis, surgical therapy alone may be curative. We identified patients with biopsy-proven TV from pathology databases from our institution and from an English-language PubMed search. Patients were included if data were available to determine TV extent confidently. Data recorded included clinical, laboratory, and histologic features; treatment; and clinical follow-up.The study included 72 patients with TV (mean age, 42 yr; range, 4-78 yr) (7 from our institution). About 74% of patients presented with painful testicular swelling/mass, 10% with a painless testicular swelling/mass, and 4% with epididymal swelling/mass. Eleven percent had no testicular complaints and vasculitis was discovered at autopsy or in other surgical interventions. Vasculitis involved the testicle in 80.3% of cases, the epididymis in 44.6%, and the spermatic cord in 30.6%. Thirty-seven (51%) patients had ITV and 35 (49%) had STV. No differences between ITV and STV patients were found in regards to age, presenting testicular features, duration of testicular symptoms, and time of follow-up. Compared to ITV patients, STV patients presented more often with constitutional/musculoskeletal symptoms (74.3% vs. 8.3%, respectively; p = 0.0001), elevated erythrocyte sedimentation rate (94.7% vs. 16%; p = 0.0001), and anemia (50% vs. 0%; p = 0.0001). Neoplasm was more frequently suspected in ITV than in STV (74.2% vs. 31.6%; p = 0.001), but only occurred in 2 ITV patients. Long-term glucocorticoid therapy was given only to STV patients, and 59.1% of them also received cytotoxic agents. ITV was diagnosed more often by orchiectomy (81.1% vs. 42.9%; p = 0.001) and less frequently by testicular biopsy (2.7% vs. 28.6%; p = 0.003) than STV. Nongranulomatous inflammation affecting medium-sized vessels occurred in most patients with both ITV and STV. Among STV, polyarteritis nodosa was the most frequently diagnosed (63%), followed by Wegener granulomatosis (17%).In summary, TV occurs as ITV in men usually presenting with a testicular mass in the absence of systemic symptoms and normal laboratory results. In most ITV patients, a testicular neoplasm is initially suspected, and TV is an unexpected finding. After surgical removal, ITV does not require systemic therapy. Polyarteritis nodosa is the systemic vasculitis most frequently associated with testicular involvement. ABBREVIATIONS: ACR = American College of RheumatologyANCA= antineutrophil cytoplasmic antibodiesCRP = C-reactive proteinESR = erythrocyte sedimentation rateGC = glucocorticoidsHBV = hepatitis B virusHCV = hepatitis C virusITV = isolated testicular vasculitisMR = magnetic resonancePAN = polyarteritis nodosaSTV = systemic vasculitis with testicular involvementTV = testicular vasculitisWG = Wegener granulomatosis.
Authors:
José Hernández-Rodríguez; Carmela D Tan; Curry L Koening; Atul Khasnis; E René Rodríguez; Gary S Hoffman
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Medicine     Volume:  91     ISSN:  1536-5964     ISO Abbreviation:  Medicine (Baltimore)     Publication Date:  2012 Mar 
Date Detail:
Created Date:  2012-03-06     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  2985248R     Medline TA:  Medicine (Baltimore)     Country:  United States    
Other Details:
Languages:  eng     Pagination:  75-85     Citation Subset:  AIM; IM    
Affiliation:
From the Department of Autoimmune and Systemic Diseases, Hospital Clínic, Barcelona, Spain (JHR); Center for Vasculitis Care and Research, Department of Rheumatic and Immunologic Diseases (AK, GSH) and Department of Anatomic Pathology (CDT, ERR), Cleveland Clinic, Cleveland, Ohio; and Division of Rheumatology (CLK), University of Utah, Salt Lake City, Utah.
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