PMC6341501_01
Scrotal ultrasound images during the first and second presentations of testicular pain and swelling. (a, b) Normal bilateral and left testicular blood flow during the first presentation: (a) transverse Doppler image of bilateral testes and (b) sagittal Doppler image of the left testis; (c, d) absence of blood flow in the left testis during the second presentation: (c) transverse Doppler image of the left testis and (d) sagittal Doppler image of the left testis.
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Scrotum ultrasound showed no signs of continued infectious process or testicular torsion (Figure 1(a) and (b)). Emergent scrotal ultrasound demonstrated no flow to the left testicle (Figure 1(c) and (d)) and he was brought to the operating room for urgent operative treatment.
Multiple foci of granulomatous vasculitis in the left spermatic cord: (a, c, d) H&E sections show small- and medium-sized arteries with fibrinoid necrosis and surrounding mixed inflammation; (b) Verhoeff-Van Gieson (VVG) is negative in the involved arteries.
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Microscopically, the left testicle and spermatic cord showed multiple foci of vasculitis ranging from small- to medium-sized arteries in a patchy distribution; most showed advanced features with fibrinoid necrosis and surrounding mixed inflammation including macrophages, giant cells, small lymphocytes, plasma cells, neutrophils and eosinophils (Figure 2).
Involvement of tunica vaginalis and testicular parenchyma by granulomatous vasculitis (a, b). The thickened tunica vaginalis shows numerous foci of vasculitis (a), which is negative for Verhoeff-Van Gieson (VVG) special stain (b); (c, d) the seminiferous tubules show extensive infarct-type necrosis with occasional foci of neutrophils.
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The thickened tunica vaginalis also showed numerous foci of vasculitis, often with multiple associated giant cells (Figure 3).