British Journal of Urology (1998), 82, 601–602

CASE RE PORT

Testicular anginaS.P. CHAUHAN, S.C. LODHA and R.L. SOLANKI*Departments of Surgery and *Pathology, S.P. Medical College and A.G. Hospitals, Bikaner, Rajasthan, India

could be identified, a biopsy was taken from the aggre-Case reportgated tissue. Histologically, the biopsy material showedmarked thickening of the coverings, 4–5 mm thick, withA 26-year-old man was admitted complaining of an

enlarged testicle that was painful when both standing evidence of the organization of an old haemorrhage; italso showed hyalinized thrombus in the vessel (Fig. 1)and lying, although the pain disappeared on walking.

The patient gave a history of accidental trauma 4 years with a variably thick collar of fibrous tissue aroundindividual seminiferous tubules. The blood vessels wereearlier and subsequent right testicular swelling, which

reverted to normal after 8 weeks. On physical examin- dilated and congested. The diCuse thickening of thebasement membrane with collagen tissue showed infil-ation, the right testis was enlarged and soft compared

with the left. It was very tender but the epididymis was tration by mature small lymphocytes, a few plasma cellsand haemosiderin-laden macrophages. After dischargefirm and of normal size. Routine investigations, except

fine-needle aspiration cytology (FNAC), were with the patient was maintained on vasodilators over a follow-up of 6 months, with no significant symptoms.normal limits. However, a chest X-ray showed a promi-

nent right hilar shadow, infective changes in the rightlower zone and coarse lung marking on both sides. The Commentcardiac shadow was enlarged and the costophrenicangles were clear. Two-dimensional echo and colour DiCuse fibrous thickening of the testicular tunicae with or

without hyalinization or calcification, along with throm-Doppler studies showed a large atrial septal defect of thesecondary type, and the right ventricle and right atrium bosis of the testicular vessel causing intermittent testicular

pain, is an unusual feature in a patient presenting withwere dilated, with grade I mitral valve prolapse anddilatation of the pulmonary root. The left pulmonary testicular swelling. We have therefore coined the term

‘testicular angina’ in this patient, because of his vascularvein was normal and there was no evidence of pulmon-ary hypertension. Ultrasonography of the scrotum insuBciency. Mostofi and Price [1] reported the testicular

tunica presenting as a diCuse thickening with single orshowed gross thickening of the head and body of theright epididymis with flecks of calcification; otherwise multiple fibrous nodules of 0.5–8 cm. These conditions can

occur in any age group, with a similar distribution in theboth testes were normal with no collection in the tunicavaginalis. Based on these findings, tubercular epididym-itis was diagnosed. FNAC of the right testis showed amoderately cellular smear with cells arranged discretely,comprising spermatogenic cells of uneven maturity, amoderate amount of cytoplasm, with enlarged nucleihaving prominent nucleoli. Some of these cells werebinucleate with scattered mitotic figures. There were alsoa few lymphocytes. The smears were interpreted assuggestive of testicular tumour. Repeat ultrasonography6 days later showed a normal testis with inflammatorychanges in the right epididymis. A repeat FNAC fromthe right testis showed a hypocellular smear, with sperm-atogenetic cells ranging from spermatogonia to maturespermatozoa. On exploration for tumour, the tunicavaginalis and albuginea could not be diCerentiated and Fig. 1. Microphotograph showing a markedly thickened tunicawere markedly thickened; the consistency on incision albuginea with one blood vessel occupied by organized attachedwas like leather and the soft testicular tissue automati- thrombus and other half showing seminiferous tubules separated

by hyalinized fibrous septa. Haematoxylin and eosin. ×100.cally separated from the tunica. As no testicular tumour

601© 1998 British Journal of Urology

602 CASE REPORT

third to sixth decades. Clinically they may be asymptomatic Referenceand may be associated with a history of trauma, epididymo- 1 Mostofi SK, Price BE. Tumors of the male genital system. In

Atlas of Tumor Pathology, Fasc 8, 2nd series, Washington:orchitis, or hydrocele. The cut surface is white and fibrous,Armed Forces Institute of Pathology, 1973: 151–4and on incision cuts like leather. These lesions have been

described as ‘fibrous pseudotumours’ (fibromas, psuedofib-romatous periorchitis, relative periorchitis, and inflamma- Authorstory pseudotumours) [1]. Hyalinization of vessels may S.P. Chauhan, MD, Assistant Professor.produce ischaemia and associated symptoms. However, in S.C. Lodha, MD, Principal and Controller.the present patient, thrombosis of the testicular artery R.L. Solanki, MD, Associate Professor.cannot be excluded because the patient had foramen ovale, Correspondence: Dr S.P. Chauhan, A-3, PBM, Hospital Campus,

Bikaner, Rajasthan 334003, India.a prolapsed valve and pulmonary hypertension.

© 1998 British Journal of Urology 82, 601–602