Fine needle aspiration cytology of epididymal nodules

Abstract

Background: The incidence of non neoplastic lesions are much more common in epididymis. Clinically, epididymal nodules are easily accessible to fine needle aspiration cytology (FNAC) procedure. There are very few literature reports documenting the role of cytology in evaluation of epididymal nodules. Thus, we studied patients presenting with palpable epididymis nodules in the out patient department (OPD) from a tertiary care general hospital.

Aim: This study is aimed to put forth the diagnostic utility of FNAC in palpable lesions of epididymis.

Materials and methods: A total of 40 palpable epididymal nodules were aspirated as a routine OPD procedure as part of this study. Smears were fixed in isopropyl alcohol and air dried. In all the cases, wet fixed papanicoloau stained and air dried giemsa stained smears were studied. Zeihl Neelsen stain was performed in cases which yielded caseous aspirate.

Results: Except for two cases of adenomatoid tumor of epididymis all other lesions were nonneoplastic and included 14 cases (35%) of tuberculous granulomatous inflammation, 10 (25%) cystic nodules (9 spermatoceles and 1 encysted hydrocele), 5 (12.5%) of nonspecific inflammations, 3 (7.5%) filarial infection, 3 (7.5%) sperm granulomas and 3 (7.5%) adenomatous hyperplasia of rete testes. Except for the two tumors, one adenomatous hyperplasia and one tuberculous lesion, no other lesion was excised. Follow up and response to therapy was available in 78% patients and resolution indicated appropriateness of the diagnosis

Conclusions: Thus, as most of the lesions in epididymis are non neoplastic responding to medical line of treatment and FNAC served to aid diagnosis of non specific inflammation and avoid surgical excision in most cases.

Keywords: Epididymal nodules; inflammatory; non-neoplastic; tuberculous.

Figure 1

(a) Tuberculous epididymitis: Smear showing epithelioid cell granuloma [arrow] against caseous necrotic background (Pap stain, ×400). (b) Smear showing only caseous necrosis and inset showing acid-fast tubercle bacilli [arrowhead] (Ziehl Neelsen stain, ×1000). (c) Gross of epididymal nodule showing foci of yellow cheesy necrosis. (d) Histopathology of the nodule showing epithelioid granulomas (arrow) (H and E, ×400)

Figure 2

(a) Non-specific epididymitis: Cytology showing acute inflammatory cells (Pap stain ×100). (b) Microfilarial parasite in epididymis showing adult worm identified by the hyaline sheath [arrow]. The hyaline sheath shows multiple larvae within it, indicated by arrowhead (Giemsa stain, ×400). (c) Spermatic granuloma: Smear showing plenty of degenerating sperms amongst inflammatory cells, giant cells and histiocytes, few of which had also engulfed the sperms. (d) Histopathology of spermatic granuloma showing granulomas around the sperms [arrow] (H and E, ×100)

Figure 3

(a) Spermatocele: Cytologic smears showing numerous sperms against a clear background (Giemsa stain, ×100). (b) High magnification of the same demonstrating the sperms (Giemsa stain, x400). (c) Encysted hydrocele: Lymphocytes in the background and mesothelial cells [arrow] seen (Giemsa stain, ×100). (d) Adenomatous hyperplasia: Smears showing clusters of polygonal cells with vesicular nuclei and a moderate amount of cytoplasm along with sperm heads [arrow] (Giemsa stain, ×400)

Figure 4

Adenomatoid tumor of the epididymis: (a) Multi-layering of tumor cells (Giemsa stain, ×400) (b) Monolayered tumor cells, in cords (Pap stain, ×100) (c) Cells with optically clear cytoplasm [arrow] (Giemsa stain, ×400). (d) Histopathology of adenomatoid tumor of the same case (H and E, ×400)