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Introduction

The term filariasis usually refers to lymphatic filariasis caused by Wuchereria bancrofti and Brugia malayi and mainly involves lymphatic system of the body [1, 2]. It is very rare to find filarial worm in testis. Here we report a case of testicular filariasis presented as a pyocele.

Case presentation

A 29-years-old year male hailing from Nizamabad presented with right testicular swelling to surgery department. There was a history of trauma three days back and swelling gradually increased in size. Clinically diagnosed as pyocele and right low orchidectomy was done and specimen sent to histopathology, Department of Pathology, Government General Hospital Nizamabad. Blood smear does not reveal peripheral eosinophilia. Figure 1 shows gross picture of specimen and globular mass measuring 6.8×3×3cm, firm to hard in consistency, external surface grey brown, cut section showed variegated appearance with grey white to grey brown areas and specks of calcified areas. Multiple sections were taken from testis. H and E stained multiple and serial sections studied from testis and paratesticular region showed large collections of inflammatory cells composed predominantly of lymphocytes, eosinophils and histiocytes (Figure 2 and Figure 3). Collection is predominantly around blood vessels and seminiferous tubules. Also localised area composed of cyst like space lined by homogeneous eosinophilic material with calcified concretions noted with surrounding granulomatous reaction composed predominantly of lymphocytes, eosinophils and histiocytes- possibility of calcified parasite, filarial worm was suggested.

Figure 1: Cut section of testis showing variegated appearance with specks of calcification.

Figure 2: H &E cyst like space lined by homogeneous eosinophilic material with calcified concretions and collections of lymphocytes, eosinophils and histiocytes (10x).

Figure 3: Eosinophilic material with calcified concretions (40x).

Discussion

Filariasis usually affects lymph nodes and lymphatic system. Culex, Aedes, Anopheles genera acts as intermediate hosts in transmission of W. bancrofti, B. malayi filariasis [1-3]. Filariasis affects male genitals especially lymphatics of the spermatic cord. Suppurative and granulomatous reaction induced by the dead filarial worm mimics neoplasm [4]. Filarial manifestation in male genitals include orchitis, filarial abscess, funiculoepidymitis, hydrocoele, lymphvarix, Filarial granuloma, chyluria, filarial penis, inguinal lymphadenitis, elephantiasis of genitalia or filarial granuloma [3-7]. Our case presented as painful mass in the testis, clinically thought to be pyocoele.

When a person acquires filarial infection during childhood, he may remain asymptomatic or it may progress to infect male genitalia [6, 8]. When we find eosinophils in any tissue it gives clue that person has parasitic or fungal infection. When we find more eosinophilic infiltrates in testis filariasis may be considered in differential diagnosis.

Microfilaria apart from lymph nodes and lymphatics can be found in lesions from breast mass, thyroid mass, pleural fluid, ascitic fluid, pericardial fluid, bronchial aspirates, urine, nipple secretion, joint fluid aspirates and hydrocoele fluid [9]. Adult worms had been found in subcutaneous tissue, peritoneal and pleural cavity, heart, brain, breast and scrotum [9]. Enzyme linked immunosorbent assay (ELISA) is considered as gold standard test for diagnosing filarial infection. Identifying microfilaria in peripheral blood midnight smear is necessary for diagnosis of filariasis [9].

On ultrasonography following diethylcarabamazine treatment, intrascrotal calcified deadworms can be seen as specks of calcification. Undulating movements of live adult worms can be seen as “filarial dance sign” [10, 11].

Conclusion

Filariasis responds very well to treatment if it is diagnosed early. Filarial orchitis can resemble neoplastic, non-neoplastic testicular and paratesticular leisons. Here we present this case to consider filarial infection as differential diagnosis when dealing with testicular swelling for accurate diagnosis, conservative management and evade unnecessary orchidectomy if possible.

Conflicts of interest

Authors declare no conflicts of interest.