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Background Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), involves multiple organs. Testicular involvement is largely unknown. Objective To determine the pathological changes and whether SARS-CoV-2 can be detected in the testes of deceased COVID-19 patients. Design, setting, and participants Postmortem examination of the testes from 12 COVID-19 patients was performed using light and electron microscopy, and immunohistochemistry for lymphocytic and histiocytic markers. Reverse transcription-polymerase chain reaction (RT-PCR) was used to detect the virus in testicular tissue. Outcome measurements and statistical analysis Seminiferous tubular injury was assessed as none, mild, moderate, or severe according to the extent of tubular damage. Leydig cells in the interstitium were counted in ten 400× microscopy fields. Results and limitations Microscopically, Sertoli cells showed swelling, vacuolation and cytoplasmic rarefaction, detachment from tubular basement membranes, and loss and sloughing into lumens of the intratubular cell mass. Two, five, and four of 11 cases showed mild, moderate, and severe injury, respectively. The mean number of Leydig cells in COVID-19 testes was significantly lower than in the control group (2.2 vs 7.8, p, Take Home Message We found significant injury in the testes of coronavirus disease 2019 (COVID-19) patients. However, the virus was not detected in the testes in the majority of cases. These findings can provide evidence-based guidance for sperm donation and inform management strategies to mitigate the risk of testicular injury during the COVID-19 disease course.

Background/Purpose To present clinical and laboratory features, treatment options, and outcome in patients with brucellar testicular infection and to compare them with analogous in brucellar patients without testicular involvement. Methods Thirty four brucellar patients with testicular infection treated in two general hospitals in the Republic of Macedonia, during the period 1998–2009, were retrospectively analyzed. Their clinical and laboratory characteristics were compared with analogous in 364 male brucellar patients without testicular infection, who were treated at the same hospitals during the same time period. Results Brucellar testicular infection was evident in 34 (8.5%) out of 398 male patients with brucellosis. The median age of the patients was 46.5 years. In all patients testicular involvement was presented as an acute form with a median duration of 5 days (range, 2–14 days) prior to diagnosis. Twenty-three of the patients had at least one other simultaneous focal infection. After starting with the treatment testicular infection lasted a median 10 days, range 7–21 days. Brucellar patients with testicular infection when compared with other brucellar patients more frequently manifested fever (97% vs. 61%), concomitant spondylitis (32% vs. 16%), and urinary system involvement (12% vs. 2%). Also, the relapse rate in patients with testicular involvement was significantly higher (24% vs. 9%). Conclusion In endemic regions brucellosis should be taken into consideration in any patient with testicular infection. Brucellar testicular involvement is usually characterized with a severe acute clinical presentation and a high percentage of relapses which entails the need of timely recognition and proper treatment duration of at least 60 days.

Summary Objective To review retrospectively the clinical symptoms, laboratory findings and treatment outcomes of patients with Brucellar epididymo-orchitis. Material and method Retrospective data of 28 patients with Brucellar epididymo-orchitis who admitted to four medical centers between 2005 and 2013 were retrospectively reviewed. Positive blood culture, positive Rose Bengal test results or high agglutination titres of ≥1/160 with the positive clinical and ultrasonographic findings of orchitis were accepted as the main criteria for Brucellar epididymo-orchitis. Results The mean patient age was 31 ± 16.9 years. Testicular involvement was on the left side in 16 patients and on the right side in 11 patients, one had bilateral disease. Testicular pain and swelling were the most common symptoms and elevation of C-reactive protein (CRP), erythrocyte sedimentation rate (ESR) and leucocytosis were the most common laboratory findings. Initial treatment was orchidectomy in six patients due to malignancy suspicion. All but three patients were successfully treated with antibiotic combinations of rifampicin, doxycycline and streptomycin. Two of three treatment resistant patients underwent orchidectomy. Conclusion Brucellosis is a common cause of epididymo-orchitis in endemic regions. Early diagnosis and treatment is crucial in the management and thus it must be kept in mind in endemic and non-endemic regions.

Acute myeloid leukaemia (AML) can involve the testis as a site of disease recurrence or as a site of tissue involvement at the time of leukaemia diagnosis. AML may mimic primary testicular neoplasms or testicular involvement by metastatic disease processes. It is therefore relevant to utilize ancillary testing, such as immunohistochemistry, cytochemistry, flow cytometry and cytogenetics, to aid in this potentially difficult differential diagnosis. We describe a patient with primary testicular presentation of monocytic sarcoma with rapid evolution to acute monocytic leukaemia (AML-M5b), initially thought to represent a seminoma.

Summary We report a patient having disseminated tuberculosis (TB) with negative smear and culture for Mycobacterium tuberculosis , left testicular mass, and an increase in tumour markers; alpha-fetoprotein (AFP), CA-125, and CA-19-9. The patient was a 53-year-old Caucasian male, presented with night sweat, weakness, and weight loss. Radiological findings were compatible with tuberculosis, however, sputum, bronchoalveolar lavage and biopsy materials were negative for malignancy or tuberculosis. A testicular mass was detected during the physical examination and orchidectomy material revealed acid-fast bacilli containing caseating granuloma. The patient responded well to anti-tuberculous therapy; clinical and radiological improvements observed at the end of the treatment period. Tumour markers were also decreased.

In a Danish population-based non-Hodgkin's lymphoma registry, 2687 newly diagnosed patients were registered from 1983 to 1992. 39 had testicular involvement (TL) (incidence 0.26/10(5)/year). Median age was 71 years. 24 cases had localised and 15 had disseminated disease. Histologically, all cases were diffuse (65% diffuse centroblastic type). Of the 27 tested, 11% were of T- and 89% of B-immunophenotype. In localised cases, where surgery was supplemented by combination chemotherapy (CCT), the relapse rate was 15.4%. The relapse rate for cases with localised disease treated with other regimens (orchiectomy and/or radiotherapy) was 63.6% (P < 0.05). Median relapse-free survival was 28 and 14 months, respectively. Overall 5-year survival for all cases was 17%. Adverse prognostic factors at the univariate level were stage IV, constitutional symptoms, serum lactic dehydrogenase elevation and performance score (WHO 3-4). It is suggested that the treatment of stage IE/IIE TL should include early CCT and CNS prophylaxis.

Several aspects of acute lymphoblastic leukemia (ALL) converge towards the testis: (1) the overall prognosis is worse for boys than for girls; (2) the testis is a more frequent site of relapse of ALL than other organs; (3) age over 10 years (coinciding with the start of pubertal activation) is a recognized "high risk" background factor; (4) occult testicular relapse of ALL seems to be common. The underlying mechanisms behind these observations are discussed. If immunological defence mechanisms are important for the rejection of ALL cells from the body, the immunological tolerance of the testicular microenvironment might favour growth of ALL cells. Alternatively, the presence of specific growth promoting factors in the testis might enhance tumour cell proliferation. In this context, the newly discovered presence of a lymphocyte growth factor (interleukin-1-like, IL-1) at high concentrations in the testis of several mammals, including man, is of great interest. As this factor seems to be under hormonal control, in future it may offer opportunities to influence the tendency to testicular involvement, and thus prognosis, in ALL.

Aim: Testicular lymphoma is characterised by aggressive clinical course and in cases of treatment failure frequently involviesCNS and contralateral testis. Late relapses have been reported in occasional series. Here we looked at clinical features and outcome of patients treated at a single instiution over a period of 25 years. Methods: We retrospectively reviewed medical records of consecutive patients diagnosed with primary testicular lymphoma treated at our institution between 1988 and 2013. Results: Sixty four patients with a diagnosis of diffuse large B-cell lymphoma and primary testicular involvement were identified. Median age was 67. All patients had initial surgery including bilateral orchiectomy in 5 patients. Majority of patients (n = 48, 75%) were in clinical stage IE ad IIE at presentation. Risk category according to the modified NCCN-IPI was low or low-intermediate in 48 (75%) patients. Chemotherapy was given to 57 (89%) inluding rituximab in 29 (45%) of patients. CNS prophylaxis with intrathecal methotrexate was applied in 35 (55%) patients. Radiotherapy to contralateral testis was applied to 3 patients. Out of 48 (70%) patients in complete remission after initial treatment, 19 (38%) subsequently relapsed at median (range) of 36 (3.5 -144) months with many relapses occuring far beyond of 3 years. 62% of relapsed patients died of disease. In patients who relapse late, extranodal sites were frequently involved. Eight patients had CNS relapse including 6 patients not given CNS prophylaxis. Four patients relapsed in contralateral testis. Conclusions: Despite low- or low-intremediate risk status of majority of patients median time to relapse of 3years is disappointing and many relapses occurred late. Non-use of radiotherapy seems unlikely reason as only 4 patients relapsed in contralateral testis. Less than half of the patients received rituximab which might contribute to the worse outcome. Disclosure: All authors have declared no conflicts of interest.

Testicular involvement in acute lymphocytic leukemia is considered an indicator of extramedullary relapse following chemotherapy. Biopsy of the testes prior to the cessation of chemotherapy has yielded early diagnosis and treatment of relapse, with an improved prognosis. Scrotal ultrasonography successfully guided the biopsy of palpably normal testes in a boy with acute lymphocytic leukemia. This success suggests that ultrasound may be a useful adjunct in localizing occult testicular leukemia prior to biopsy.

Background Lymphomatoid granulomatosis (LYG) is an angio-centric and angiodestructive lymphoproliferative disorder which involves the lungs, skin, central nervous system, liver, spleen and kidneys. Only a single case of testicular LYG has been reported. LYG is an EBV driven process, with demonstration of EBV positive large B cells required for diagnosis. Case presentation We report a case of a 51-year-old man with a testicular mass. At orchidectomy, a polymorphous lymphoid infiltrate was present incorporating scattered, large, atypical cells with a vaguely granulomatous appearance. A polyclonal B cell population was demonstrated on flow cytometry. The case was reported as a granulomatous orchitis. Five months later he developed leg ulcers and bilateral pulmonary infiltrates. He was diagnosed with LYG and responded to treatment with R-CHOP. Five years later he developed further nodular infiltrates within the lungs and leg ulceration. A wedge biopsy of the lung showed an angiocentric lymphoid infiltrate with numerous large, atypical, CD20 positive B cells showing EBV positivity. Thus, a histological diagnosis of LYG was made. Conclusion Lymphomatoid granulomatosis is a rare lymphoproliferative disorder, with only a single case report of testicular involvement. It may be considered in the differential diagnosis of granulomatous orchitis or testicular lymphoma.

Non-Hodgkin's lymphomas with testicular involvement are unfrequent. Most cases occur in elderly subjects and are of intermediate or high grade malignancy. Our study suggests that an early intensive chemotherapy improves survival. Lymphoblastic or Burkitt's lymphomas have a poor outcome and CNS relapses are frequent.

Toxoplasma gondii is a common pathogen in patients with acquired immune deficiency syndrome (AIDS). The most common modes of presentation are related to the central nervous system (CNS), usually with headache, fever, and focal neurological signs. Extra-neural manifestations are unusual in patients with AIDS. The authors present a patient with AIDS who had disseminated toxoplasmosis whose initial clinical presentation was symptomatic orchitis and the nephrotic syndrome (NS). Testicular involvement with toxoplasmosis has been described only rarely, predominantly as an incidental finding at autopsy. Toxoplasmosis is a rare cause of nephrotic syndrome, with the majority of cases associated with congenital infection. In this case, the nephrotic syndrome remitted only after orchiectomy and chemotherapy for toxoplasmosis, but recurred when the patient had a relapse of his CNS disease. Toxoplasmosis in AIDS may present with extra-neural manifestations and may be an etiologic agent for NS in some patients with AIDS.

Contemporary therapy of acute leukemia frequently achieves long-term continued complete remission (CCR) of bone marrow disease and prevents central nervous system relapse. However, accompanying improved survival is an increasing incidence of overt testicular relapse either during CCR or associated with bone marrow relapse. In 7 boys testicular abnormalities developed during CCR, 6 had open biopsy and 5 had histologically confirmed leukemic infiltration. Despite local therapy of orchiectomy or irradiation and chemotherapy reinduction, 2 of 6 had testicular relapse and 4 of 6 died. Three boys with coexistent overt testicular and systemic relapse died. Nine boys with normal testes had testicular biopsy during CCR prior to discontinuation of chemotherapy. Results of all biopsies were benign, but one boy had a relapse. The diagnosis of occult testicular leukemia prior to discontinuation of chemotherapy allows selection of high-risk boys requiring prolonged, intensive, and possibly alternative therapy. The indication for testicular biopsy in boys with acute leukemia is documented, and appropriate clinical management of testicular leukemia is presented.

Malignant lymphoma is reviewed briefly. Recent literature emphasizes the rarity, bilateral tendency, and poor prognosis of primary testicular involvement. Lymphoma, however, is the most frequent metastatic tumor in this location. A case is reported of a patient living and well ten years after orchiectomy for reticulum cell sarcoma.

A case is presented of a sixty-three-year-old man with multiple myeloma which progressedto plasma-cell leukemia.

Testicular biopsy has become a routine procedure before discontinuing chemotherapy in male children being treated for acute lymphocytic leukemia (ALL). Before a decision can be made to discontinue multiple drug therapy, all possible sites of occult tumor such as the testis, cerebrospinal fluid, and bone marrow must be sampled. Between December 1978 and November 1981, 25 male children underwent testicular biopsies after two or more years of combination chemotherapy at the Babies Hospital, Columbia-Presbyterian Medical Center. Only 3 of the 25 patients (12%) were found to have leukemic infiltrates on histologic sections. Two of 3 patients, however, were noted preoperatively to have either irregular testicular contours or testicular enlargement and induration. Occult testicular infiltration discovered after two or more years of chemotherapy is rare. Most children with a histologically positive biopsy result were at least suspected preoperatively to have testicular involvement.

In a retrospective review (1950-1975) of the Mayo Clinic experience with seminomas (483 cases), twelve patients (2.5%) were found to have a retroperitoneal seminoma without evidence of testicular involvement. The mean age was 47 years (range, 31-67). Eleven patients were treated by radiation alone, with doses ranging from less than 2,000-5,800 rads. Seven patients are alive with a median follow-up of six years. The median survival of the five that died is ten months. Good prognostic factors are typical histopathology and an encapsulated tumor. Poor prognostic factors are atypical histopathology, a nonencapsulated tumor, a symptomatic abdominal mass and a nonfunctioning kidney at the time of diagnosis. Although the review includes few patients, it seems reasonable to suggest irradiation of the tumor bed and para-aortic lymph nodes to a minimum dose of 2,000 rads. Prophylactic treatment of the mediastinum and supraclavicular lymph nodes should be considered if one or more of the poor prognostic factors are present.

We describe a case of primary retroperitoneal seminoma with metastasis to the left kidney, left adrenal gland, and other organs without evidence of testicular involvement. We determined this disease at autopsy.