精索結核の1例

Abstract

70歳男.左陰嚢内の無痛性腫瘤が増大した.腫瘤は精巣, 精巣上体とは連続性がなく, 石様硬で, 内容の透光性試験は陰性であった.MRIでは15×20×15mmで, 精巣, 精巣上体より頭側で精索部に位置していた.T1強調像で等～やや高信号, T2強調像で軽度高信号を呈し, 造影MRIでほぼ均一に濃染した.ツベルクリン反応が強陽性で, 全身検索で異常は認めなかった.精索結核を疑ったが悪性疾患の可能性も否定できず, 摘除術を行った.病理組織所見で, 腫瘤部には類上皮細胞とラングハンス型巨細胞を主体とする肉芽組織を認め, 一部に乾酪壊死巣も認めた.Ziehl-Neelsen染色で結核菌の存在は確認できなかった.術後経過は良好で, 抗結核療法を6ヵ月間行い, 2年3ヵ月経過して再発はない

Genital tuberculosis occurring in the spermatic cord is a rare disease. A 70-year-old man presented with a mass on the left side of the scrotum which had been painless and had gradually enlarged over the previous 4 months. Surgical excision was performed. The tumorous mass was located in the spermatic cord but did not connect with the testis or epididymis. The removed specimen was 15 x 20 x 15 mm in size and weighed 6 g. Histopathological diagnosis was tuberculosis. At present, 27 months after surgery, recurrence has not been found.