Clinicopathological Spectrum of Chronic Filarial Epididymo-Orchitis
Experience from a Tertiary Care Institute
Keywords:
Filariasis, epididymo-orchitis, Wuchereria bancrofti, hydrocoele, elephantiasis
Abstract
Background: Filariasis is a vector-borne neglected tropical disease, most commonly caused by Wuchereria bancrofti. Chronic lymphatic filariasis in males usually presents as scrotal swelling with hydrocoele, although, a variety of other genital manifestations can also be seen. This study was undertaken to establish the clinicopathological spectrum of chronic filarial epididymo-orchitis (FEO) in a tertiary care institution in India. Methods: Cross-sectional observational study spanning a retrospective period of 17 years from 2000-2017. Results: Nineteen cases of chronic FEO were diagnosed, comprising 1.8% of all testicular and paratesticular biopsies (n=1055). Median age was 40 years. All patients presented with scrotal swelling. Examination revealed hydrocoele (12/19), lymph scrotum (5/19), epididymal nodules (4/19) or scrotal elephantiasis mimicking testicular tumour (3/19). Gross examination of orchidectomy specimens revealed cystic hydrocoele sacs with markedly thickened tunica, while four cases showed extensive parenchymal necrosis. Histopathology revealed adult filarial worms either within the epididymal/paratesticular tissues (9/19) or in the tunica vaginalis (7/19). Two cases, in addition, showed microfilarial larvae within the tissues. Six cases showed characteristic Meyers-Kouvenaar bodies surrounding adult worms. Conclusion: This single institution study from India identifies chronic FEO as a rare but important cause of scrotal swelling. Since chronic FEO may be clinically mistaken for testicular tumour, awareness of the clinicopathological spectrum is essential. Biopsies with intense infiltrate of eosinophils and lymphangiectasia need high index of suspicion for filariasis and warrant careful search for adult filarial worm as well as microfilaria in tissue sections.References
1. World Health Organization. Global programme to eliminate lymphatic filariasis. WHO Wkly Epidemiol Rec 2009;84:437-44.
2. World Health Organization. Global programme to eliminate lymphatic filariasis. WHO Wkly Epidemiol 2006;61:395-441.
3. Lymphatic filariasis: the disease and its control. Fifth report of the WHO Expert Committee on Filariasis. World Health Organ Tech Rep Ser 1992;821:1-71.
4. Chatterjee KD. Parasitology. 13th ed. New Delhi: CBS Publishers; 2009.
5. Weerasooriya MV, Weerasooriya TR, Gunawardena NK, Samarawickrema WA, Kimura E. Epidemiology of bancroftian filariasis in three suburban areas of Matara, Sri Lanka. Ann Trop Med Parasitol 2001;95:263-73.
6. S Sabesan, Palaniyandi M, Das PK, Michael E. Mapping of lymphatic filariasis in India. Ann Trop Med Parasitol. 2000;94:591-606.
7. Pfarr KM, Debrah AY, Specht S, Hoerauf A. Filariasis and lymphoedema. Parasite Immunol 2009;31:664-72.
8. Richens J. Genital manifestations of tropical diseases. Sex Transm Infect 2004;80:12-7.
9. Ramaiah KD, Ramu K, Kumar KN, Guyatt H. Epidemiology of acute filarial episodes caused by Wuchereria bancrofti infection in two rural villages in Tamil Nadu, south India. Trans R Soc Trop Med Hyg 1996;90:639-43.
10. Devi TS, Nirmala BV, Srivani N, Kumar OS. Spectrum of orchidectomy lesions: 5 years study. J Evidence Based Med Healthcare. 2015;26:3880-92.
11. Lichtenberg F, Medina E. Bancroftian filariasis in the etiology of funiculoepididymitis, periorchitis and hydrocoele in Puerto Rico (statistical study of surgical and autopsy material over a 13-year period). Am J Trop Med Hygiene 1957;6:739-51.
12. Pani SP, Kumaraswami V, Das LK. Epidemiology of lymphatic filariasis with special reference to urogenital-manifestations. Indian J Urol 2005;21:44-9.
13. Sabesan S, Vanamail P, Raju K, Jambulingam P. Lymphatic filariasis in India. Epidemiology and control measures. J Postgrad Med 2010;56:232-8.
14. Thapliyal N, Joshi U, Bhadani P, Jha RS. First report of filariasis in a non-endemic hill state of India. Indian J Pathol Microbiol 2009;52:293.
15. Kaur R, Philip KJ, Laxman KR, Masih K. Filarial abscess in the submandibular region. J Oral Maxillofac Pathol 2013;17:320.
16. Handa U, Kundu R, Singhal N, Mohan H. Diagnosis of filariasis on cytology: a series of 24 cases. Trop Doct 2014;44:92-5.
17. DeVries CR. Basic science of lymphatic filariasis. Indian J Urol 2005;21:5-8.
18. Mishra A, Bhadoriya RS. An epidemiological study of filariasis in a village of District Datia, MP. Indian J Community Med 2009;34:202-5.
19. Dreyer G, Noroes J, Figueredo-Silva J, Piseens WF. Pathogenesis of lymphatic disease in bancroftian filariasis: a clinical perspective. Parasitol Today 2000;16:544-8.
20. Barreto SG, Rodrigues J, Pinto RGW. Filarial granuloma of the testicular tunic mimicking a testicular neoplasm: a case report. J Med Case Reports 2008;2:321.
21. Shah VB, Shet TM, Lad SK. Fine needle aspiration cytology of epididymal nodules. J Cytol 2011;28:103-7.
22. Figueredo-Silva J, Noroes J, Cedenho A, Dreyer G. The histopathology of bancroftian filariasis revisited: the role of the adult worm in the lymphatic-vessel disease. Ann Trop Med Parasitol 2002;96:531-41.
23. Mak JW. Pathology of lymphatic filariasis. IeJSME 2012; 6 Suppl 1:S80-6.
24. Figueredo-Silva J, Jungmann P, Noroes J, Piessens WF, Coutinho A, Brito C, et al. Histological evidence for adulticidal effect of low doses of diethylcarbamazine in bancroftian filariasis. Trans R Soc Trop Med Hyg 1996;90:192-4.
25. Mahalingashetti PB, Subramanian RA, Jayker SS, Vijay A. Lymphatic filariasis: A view at pathological diversity. Trop Parasitol 2014;4:128-32.
26. Paul J, Krishnamoorthy S, Teresa M, Kumar S. Isolated tuberculous orchitis: A mimicker of testicular malignancy. Indian J Urol 2010;26:284-6.
27. McAdam AJ, Sharpe AH. Infectious diseases. In: Kumar V, Abbas AK, Fausto N, Aster JC, editors. Robbins and Cotran Pathological Basis of Disease. 8th ed. Pennsylvania: Elseiver; 2010. pp. 395.
28. World Health Organization. Global programme to eliminate lymphatic filariasis. WHO Wkly Epidemiol Rec 2015;90:489-504.
2. World Health Organization. Global programme to eliminate lymphatic filariasis. WHO Wkly Epidemiol 2006;61:395-441.
3. Lymphatic filariasis: the disease and its control. Fifth report of the WHO Expert Committee on Filariasis. World Health Organ Tech Rep Ser 1992;821:1-71.
4. Chatterjee KD. Parasitology. 13th ed. New Delhi: CBS Publishers; 2009.
5. Weerasooriya MV, Weerasooriya TR, Gunawardena NK, Samarawickrema WA, Kimura E. Epidemiology of bancroftian filariasis in three suburban areas of Matara, Sri Lanka. Ann Trop Med Parasitol 2001;95:263-73.
6. S Sabesan, Palaniyandi M, Das PK, Michael E. Mapping of lymphatic filariasis in India. Ann Trop Med Parasitol. 2000;94:591-606.
7. Pfarr KM, Debrah AY, Specht S, Hoerauf A. Filariasis and lymphoedema. Parasite Immunol 2009;31:664-72.
8. Richens J. Genital manifestations of tropical diseases. Sex Transm Infect 2004;80:12-7.
9. Ramaiah KD, Ramu K, Kumar KN, Guyatt H. Epidemiology of acute filarial episodes caused by Wuchereria bancrofti infection in two rural villages in Tamil Nadu, south India. Trans R Soc Trop Med Hyg 1996;90:639-43.
10. Devi TS, Nirmala BV, Srivani N, Kumar OS. Spectrum of orchidectomy lesions: 5 years study. J Evidence Based Med Healthcare. 2015;26:3880-92.
11. Lichtenberg F, Medina E. Bancroftian filariasis in the etiology of funiculoepididymitis, periorchitis and hydrocoele in Puerto Rico (statistical study of surgical and autopsy material over a 13-year period). Am J Trop Med Hygiene 1957;6:739-51.
12. Pani SP, Kumaraswami V, Das LK. Epidemiology of lymphatic filariasis with special reference to urogenital-manifestations. Indian J Urol 2005;21:44-9.
13. Sabesan S, Vanamail P, Raju K, Jambulingam P. Lymphatic filariasis in India. Epidemiology and control measures. J Postgrad Med 2010;56:232-8.
14. Thapliyal N, Joshi U, Bhadani P, Jha RS. First report of filariasis in a non-endemic hill state of India. Indian J Pathol Microbiol 2009;52:293.
15. Kaur R, Philip KJ, Laxman KR, Masih K. Filarial abscess in the submandibular region. J Oral Maxillofac Pathol 2013;17:320.
16. Handa U, Kundu R, Singhal N, Mohan H. Diagnosis of filariasis on cytology: a series of 24 cases. Trop Doct 2014;44:92-5.
17. DeVries CR. Basic science of lymphatic filariasis. Indian J Urol 2005;21:5-8.
18. Mishra A, Bhadoriya RS. An epidemiological study of filariasis in a village of District Datia, MP. Indian J Community Med 2009;34:202-5.
19. Dreyer G, Noroes J, Figueredo-Silva J, Piseens WF. Pathogenesis of lymphatic disease in bancroftian filariasis: a clinical perspective. Parasitol Today 2000;16:544-8.
20. Barreto SG, Rodrigues J, Pinto RGW. Filarial granuloma of the testicular tunic mimicking a testicular neoplasm: a case report. J Med Case Reports 2008;2:321.
21. Shah VB, Shet TM, Lad SK. Fine needle aspiration cytology of epididymal nodules. J Cytol 2011;28:103-7.
22. Figueredo-Silva J, Noroes J, Cedenho A, Dreyer G. The histopathology of bancroftian filariasis revisited: the role of the adult worm in the lymphatic-vessel disease. Ann Trop Med Parasitol 2002;96:531-41.
23. Mak JW. Pathology of lymphatic filariasis. IeJSME 2012; 6 Suppl 1:S80-6.
24. Figueredo-Silva J, Jungmann P, Noroes J, Piessens WF, Coutinho A, Brito C, et al. Histological evidence for adulticidal effect of low doses of diethylcarbamazine in bancroftian filariasis. Trans R Soc Trop Med Hyg 1996;90:192-4.
25. Mahalingashetti PB, Subramanian RA, Jayker SS, Vijay A. Lymphatic filariasis: A view at pathological diversity. Trop Parasitol 2014;4:128-32.
26. Paul J, Krishnamoorthy S, Teresa M, Kumar S. Isolated tuberculous orchitis: A mimicker of testicular malignancy. Indian J Urol 2010;26:284-6.
27. McAdam AJ, Sharpe AH. Infectious diseases. In: Kumar V, Abbas AK, Fausto N, Aster JC, editors. Robbins and Cotran Pathological Basis of Disease. 8th ed. Pennsylvania: Elseiver; 2010. pp. 395.
28. World Health Organization. Global programme to eliminate lymphatic filariasis. WHO Wkly Epidemiol Rec 2015;90:489-504.
Published
2018-07-20
Issue
Section
Original Article
Authors who publish with this journal agree to the following terms:
- Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
- Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
- Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work (See The Effect of Open Access at http://opcit.eprints.org/oacitation-biblio.html).
