Malakoplakia of testis and epididymis: A Review of the Literature
Journal Title: Journal of Medical Science and Technology - Year 2015, Vol 4, Issue 1
Abstract
Malakoplakia of the testis / epididymis is uncommon therefore most clinicians globally would be unfamiliar with the disease. Malakoplakia is an extremely rare chronic inflammatory disease which usually affects the genitourinary tract and it is often associated with Escherichia coli infection. Malakoplakia characterized by the observation of Von Hansemann cells and intracytoplasmic inclusion bodies called “Michaelis-Gutmann Bodies (M-G bodies).” The testes are affected in 12% of cases of malakoplakia and isolated malakoplakia of the epididymis is even rarer. To the knowledge of the author, less than 50 cases of malakoplakia of the testis and less than 15 cases of malakoplakia of the epididymis have been reported so far world-wide. Malakoplakia of the testis / epididymis may present with pain in the testicular area, fever, chills and or a hemi-scrotal mass. Malakoplakia of testis / epididymis is usually seen in middle aged men and they tend to appear clinically as epididymo-orchitis or testicular enlargement with fibrous consistency and some soft areas. Ultrasound scan findings of the testis are non-specific revealing hypo-echogenic or hyper-echogenicity with increased vascularity on Doppler scanning. A number of cases of malakoplakia of the testis and epididymis are associated with immunosuppression, renal transplantation and diabetes. Treatment of malakoplakia includes medical and surgical treatment. The quinolones and trimethoprim-sulfamethoxazole have been most commonly used. Orchidectomy has been the only way to differentiate malakoplakia from other malignant and infective processes. If a patient with malakoplakia of testis is immunosuppressed then a period of withdrawal may perhaps be beneficial to speed up the recovery process. With the knowledge that malakoplakia of the testis is more common in middle aged men and the fact that testicular tumours are uncommon in the middle aged group perhaps ultrasound guided biopsy of a hypo-echoic or hyper-echogenic testicular lesion with increased vascularity could be undertaken to establish the diagnosis if there is evidence of coliform urinary tract infection and a clinical diagnosis of epididymoorchitis has been made but the lesion has not resolved. In that case perhaps prolonged antibiotic treatment with quinolones may help the lesion to resolve and thus avoiding orchidectomy. Malakoplakia involving the testis and or epididymis is an uncommon chronic inflammatory condition which clinicians should consider in the differential diagnosis of testicular swellings. The disease tends to be associated with gram negative infections especially coliform infections.
Authors and Affiliations
Anthony Kodzo- Venyo
Keywords
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