Studies on Tuberculosis of the Epididymis: 2. Influence of Chemotherapy on tuberculous lesions of the Epididymis

Lee, Jhy Bok; Lee, Hak Song; Lee, Chae Koo

Abstract

Forty five cases of tuberculosis of the epididymis were classified according to grade of invasion and length of antituberculous chemotherapy and the histopathological response to chemotherapy was evaluated as follows: 1) Tuberculosis of the epididymis is graded according to the size and extent of invasion. Grade I (mild) A single nodule in size of small finger tip or smaller in the head, body or tail is palpable. Differentiation with nonspecific lesion is very difficult. Grade II (moderate): A single nodule in size of index finger tip or smaller ie palpable. No adhesion is noticeable. Grade III (advanced): One or two nodules in size of thumb or smaller are palpable. Adhesion is present or absent and the vas shows thickening. Grade IV (far advanced): Tow or more nodules in size of thumb or larger are palpable and scrotal fistula or abscess present. Adhesion is usually present and the beaded vas is palpable. 2) Histopathological response to chemotherapy are as follows: a) Caseation: the longer the duration of chemotherapy the less the caseation is present. b) Epitheloid cells show degeneration, atrophy and decrease. c) Giant cells show degeneration, atrophy, vacuolization and decrease. d) Perifocal reaction is reduced gradually upon chemotherapy. e) Fibrosis is very significant in the group of treatment and vacuolization readily occurred early in the chemotherapy with longer chemotherapy. Hyalinization of fibrous tissue is prominent f) Lymphocytic infiltration and vacuolization are observed both in treated and untreated groups, more significant in the first. g) Almost same grade of reticulosis is observed both in the treated and untreated groups. h) It was observable that among the testis, epididymis and the vas deferens, somewhat faster response to the chemotherapy vas obtained in the vas than in the epididymis and the testis showed the slowest response to the chemotherapy. i) Significant histopathological response is obtained in the group of two months or longer chemotherapy, j) From these observations, the author is of belief that extensive chemotherapy is only indicated for epididymal tuberculosis of grades I and II without surgery. However, the grades III and IV lesions require surgical intervention following a trial with chemotherapy for 2 months or longer.