慢性睾上体炎にその病理組織学的研究並びにその臨牀的観察

Abstract

The histological study on 135 cases of epidid y mis and 28 cases of testis with the clinical diagnosis of epididymitis tuberculosa, together with its clinical symptoms, was done at the Dermatological and Urological Department of the Keio University, School of Medicine, in 4 years between January 1949 to December 1952. A) By the histological classification, 72 cases of epididymitis tu berculosa with the characteristic tubercle, 41 cases of nonspecific inflammation, 10 cases of epididymitis with necrotizing angiitis as remarked finding, 9 cases of epididy mitis with cystic dilatation of the canal of epididymis, 1 case of f ilarial funiculitis, 1 case of epididymitis sclero--atrophicans and 1 case of embr y onal adeno-carcinoma of epididymis was obtained. B) Except 2 cases of the tuberculous, 3 cases of the nonspecific and 1 case of the filarial, the characteristic changes in all cases were at the globus mino r (or tail) of the epididymis. C) 1. The patholog ical changes of epididymitis tuberculosa are the remarked tendency towards caseation, while the tendency towards fibrosis w e r e not remarkable. 2. T h ere were 2 cases of the so-called epididymitis tuberculosa without tubercle, in which tubercle bacilli are possitiv, in spite of the n e g ativ findings of tubercle formation. According to these findings, it co u l d be hypothesize that the sudden spread of disease lacked the time of tubercle formation, depending on the sensitivity of the individual and viru l e n t of the bacilli. 3. Excep t the 1 case of obstruction due to connective tissue, tuberculous changes were found at the vas deferens in 39 cases with remar k e d find248 ings especially at the lamina propria but among these cases the beaded vas could be recognised clinically in only 16 cases. 4. Among the 28 cases of the tuberculous, 22 ca s es of tuberculous orchitis were found including the 8 cases with tubercle only at the linea a l b a . 5. Among the clinically diagnosed cases, the age incidence were m o st remarkable in the twenties and gradually decrease towards the sixtie s . Diagnosis depends on the presence of the following symptoms ; pr e e x i stent or coexistent of renal tuberculosis, fistula of the scrotal wall a n d the evidence of beaded vas. D) 1. The remarked histopathological changes of the nonspecific epididymitis are the diffuse cell infiltration of the stroma which cells are m o stly consisted of plasma cells accompanied with lymphocytes, eosinophilic a n d neutrophilic cells. There were remarked tendency towards the increa s e of fibrin (hyperfibrinosis) and the remarked changes at the ep i d e rmis are the metaplasia, destruction of epidermis and the papillar p r o liferation. 2. T ubercle bacilli was negative in all of these cases except one, in which gram positive cocci was found by histological bacterial stain. 3. The pathological changes of the vas deferens were mos t remarkable at the lamina propraia, which were seen in 26 cases and the findings wer e mostly the plasma cell infiltration. 4. Clinically, the age incide n ce is some what simillar to the group of tuberculous cases and complaining only the induration at the epididymis l a cking other symptoms of the epididymis or the vas deferens. E) 1. The cases with angiitis as cheif histological changes are the epididymits with the changes (angiitis), which should be called granulomato u s necrotizing angiitis at the lamina propria and stroma characterized b y the fibrinous necrosis at the media ad endothel surrounded by exsudative a n d productive findings, that is the so-called angiitis nodosa tuberculosa h a s appeared localized at the epididymis which are considered to be originat e d from the allergy in tuberculosis. 2. Clinically, the age in c idence are most remarkable in the twenties and shows a sudden decrease after them and are affected in 75W, before 2 9 years old. The clinical symptoms at status presens are fever and loca l tenderness (pain) with the coexistance or preeetence of active tubercul o u s focus somewhere. F) 1. The obstruction by calculation or connective tissue of vas deferens were seen in some cases among those with cystic dilatation at the canal of epididymis, which could be considered as the cause of such passage disorders. On the other hand, no inflammatous changes could b e seen in all the cases of this group. 2. Clinically, the age incid e nce were most remarkable in the twenties and forties and except the lack of inflammatous symptoms at status presens , the other local findings are most similar to the tubercular cases . Therefore the origin could be considered as the obstruction of the vas de f e r ens by the obsoleted inflammation, especially tuberculosis is suspecte d , but on the other hand the incompleted absence of vasa should be brought i n mind too. G) There were 72 cases of evident tubercular by histological examination, but even if there are no definite way of its demonstration, the increase in t h e number of cases caused by the so-called tuberculosis should be considere d to be larger than this, according to the viewpoint that just because tubercle bacilli was not demonstrated the cases of so-called epididymitis tube r c ulosa without tubercle might mingle into the nonspecific group, the c ases with angiitis as characteristic changes could be originated from allergy in tube r c ulosis and the cases showing cystic dilatation at the canal of epididymis could be originated from the obsolescence of tuberculous inflammation.