Xanthogranulomatous orchitis: a rare cause of testicular swelling

Abstract

Xanthogranulomatous orchitis (XGO) is a rare, nonneoplastic inflammatory condition of the testis that typically presents as a mass-forming lesion and can closely mimic testicular malignancy on clinical and radiologic evaluation. Owing to its rarity and nonspecific presentation, establishing a preoperative diagnosis is often difficult, making histopathologic confirmation essential. We report the case of a 34-year-old male patient who presented with unilateral scrotal pain, swelling, and recurrent febrile episodes lasting 1 month. Orchidectomy was performed due to persistent symptoms and clinical suspicion of malignancy. Gross examination revealed focal hemorrhagic areas and diffuse, gray-yellow, solid areas. Microscopic evaluation revealed near-total replacement of the testicular parenchyma by sheets of foamy histiocytes, accompanied by a dense mixed inflammatory infiltrate consisting of neutrophils, eosinophils, lymphocytes, and plasma cells. Peri-epididymal lymphocytic infiltration and focal areas of ischemic necrosis were also noted. These histopathological features were diagnostic of XGO. This case underscores the critical role of careful histopathological assessment in distinguishing XGO from neoplastic conditions. It highlights the need to consider this rare entity in the differential diagnosis of chronic scrotal swelling.