 |
| About Bioline | All Journals | Testimonials | Membership | News |
|
||||||
|
||||||
Indian Journal of Medical Sciences, Vol. 58, No. 6, June, 2004, pp. 254-255 Letter To Editor Epididymal tuberculosis with elevated oncofetal marker Kumar Jaya , Kumar Rajeev Department of Urology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi-110029 Code Number: ms04047 Sir, Tubercular epididymo-orchitis usually presents as an acute episode with generalized involvement of the epididymis and the testis. It is often difficult to arrive at a preoperative diagnosis of tuberculosis in a scrotal mass. We encountered a case where elevated beta-hCG levels further confounded the diagnosis and this association merits further study. A seventeen-year-old boy presented with a painless scrotal swelling of two months duration. Examination revealed a 3 x 2 cm hard mass arising from the lower pole of right testis and epididymis. The mass was non-tender and fixed to the overlying skin. The rest of the testis and spermatic cord was normal with intact sensations. Abdominal examination was normal and no nodes were palpable in the inguinal region. Hemogram, serum chemistry and chest x-ray were normal while serum beta-hCG was 28.4 mIU/ml (normal < 0.5 mIU/ml). Contrast enhanced CT scan of the abdomen revealed right-sided hydronephrosis with non-functioning kidney and small aorto-caval and retro-caval adenopathy. A diagnosis of non-seminomatous germ cell tumor with retroperitoneal spread and right uretero-pelvic junction obstruction was made and the patient underwent right inguinal orchidectomy with hemi-scrotectomy the next day. Histopathology revealed a paratesticular lesion with large areas of necrosis, multiple epitheloid and giant cell granulomas and diffuse lymphocytic infiltration consistent with tuberculosis. Step sections of the testis were normal. Three weeks following the surgery, repeat beta-hCG was normal (0.3 mIU/ml). Urine examination for acid-fast bacilli (AFB) and polymerase chain reaction for AFB were negative. The patient was started on four-drug anti-tubercular therapy. Epididymal involvement in tuberculosis is through primary hematogenic spread to the globus minor which has a rich vascular supply. Diagnosis is based on the presentation and isolation of bacteria in the morning urine specimen or culture of material from discharging sinuses.[1] However, a pre-operative diagnosis can often not be made necessitating an inguinal orchidectomy with the suspicion of a testicular tumor.[2] Beta-hCG is usually undetectable in normal adult men and elevated serum levels in any form of tuberculosis have not been reported. Affronti and DeBlaker demonstrated an association between mycobacterium tuberculosis and hCG in 1986.[3] They noticed the production of hCG like substances by two non-tumor associated, virulent mycobacteria apart from other species of tumor associated aerobic bacteria. They postulated this production to be a variable character among bacterial species and a sign of conservation of similar features seen in prokaryotes and unicellular eukaryotes which also produce hormone like substances. The histopathological diagnosis of tuberculosis makes this the first case of epididymal tuberculosis with elevated beta-hCG in the literature. REFERENCES
Copyright 2004 - Indian Journal of Medical Sciences |
| |||||||||
