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| Year : 2008 | Volume
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| Issue : 4 | Page : 534-535 |
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| Microlithiasis of the epididymis: A case report and review of literature |
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Mary Mathew1, Joseph Thomas2
1 Department of Pathology, Kasturba Medical College, Manipal, Karnataka, India
2 Department of Urology, Kasturba Medical College, Manipal, Karnataka, India
Click here for correspondence address and email
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 Abstract | | |
Microlithiasis of the epididymis, which is not associated with epididymal inflammation, is a rare entity that has been infrequently published in the literature. We report, one such case that was incidentally detected in association with prostatic adenocarcinoma. Keywords: Epididymis, microlithiasis
How to cite this article:
Mathew M, Thomas J. Microlithiasis of the epididymis: A case report and review of literature. Indian J Pathol Microbiol 2008;51:534-5 |
| Introduction | |  |
Testicular microlithiasis is a common entity documented in the literature. However, microlithiasis of the epididymis has been rarely described and remains as a curious phenomenon, the pathology of which has not been well documented. To date, only a single study has reported the presence of epididymal microliths in 8 surgical and 6 autopsy specimens. No cases have been documented in the Indian literature.
| Case Report | | |
A 77-year-old male presented to the outpatient department with history of obstructive voiding symptoms. A biopsy of the prostate was taken which showed prostatic adenocarcinoma. Bilateral orchidectomy was performed and both the testes were sent for histopathological examination.
Pathological findings
Gross : Both the testes showed normal parenchyma. The right and left epididymis were cystically dilated and contained a straw-colored fluid.
Microscopy
Sections from both the testes showed age-related changes of the seminiferous tubules. Sections from both the epididymis showed dilated lumen with atrophied epithelial stereocilia, thickened muscular layers and numerous intraluminal calcific, laminated, concentric, target structures. [Figure 1] and [Figure 2].
| Discussion | | |
Microlithiasis of the epididymis is a rarely documented entity. In a study conducted by Nistal et al. , [1] microlithiasis of the epididymis was observed in 8 surgical and 6 autopsy specimens. These microliths were observed within the lumen, subepithelial and interstitium of the epididymis. Those found in infants and young adults were frequently associated with developmental alterations of the proximal spermatic way. In older adults, it was usually related to obstruction and ischemia. The pathogenesis of microlith formation has been attributed to lipid saponification following sperm cell degeneration secondary to obstruction. An important differential diagnosis is Liesegang rings that are usually formed as precipitations in supersaturated solutions. They are laminated eosinophilic bodies [2] measuring approximately 10-800 µm and are characterized by concentric laminations with radial striations. These radial striations are typically absent in microliths. Other structures that must be considered in the differential diagnosis of microliths include Michaelis-Gutmann bodies, calcium deposits and ova/larvae of parasites, especially the giant kidney worm. Michaelis-Gutmann bodies which are of malakoplakia are intracytoplasmic basophilic bodies that are PAS and Oil red O negative, von Kossa-positive and variably positive with Prussian blue. They contain calcium, iron and phosphorous. Calcium apatite deposits are seen as amorphous or needle-shaped crystals or multi/unilaminated or targetoid forms. The giant kidney worm, Dioctophyma renale can be distinguished by its lack of radial striations and variations in size and shape. [3]
To the best of our knowledge, no other studies on epididymal microliths have been documented in the literature.
| References | | |
| 1. | Nistal M, Garcia-Cabezas MA, Ragadera J, Castillo MC. Microlithiasis of the epididymis. Am J Surg Pathol 2004;28:514-22.  |
| 2. | Raso DS, Greene WB, Finley JL, Silverman JF. Morphology and pathogenesis of Liesegang rings in cyst aspirates: Report of two cases with ancillary studies. Diagn Cytopatho 1998;19:116-9. |
| 3. | Chikkamuniyappa S, Kadri SM. Liesegang's rings: A morphologic mystery: Report of a Case and Review of the Literature. Ind J Practising Doctor 2006; 3. |
Correspondence Address:
Mary Mathew
Department of Pathology, Kasturba Medical College, Manipal, Karnataka
India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/0377-4929.43752
[Figure 1], [Figure 2] |
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| This article has been cited by | | 1 |
Perspectives in Pediatric Pathology, Chapter 13. Calcifications in the Testis and Paratesticular Structures |
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| Manuel Nistal,Ricardo Paniagua,Pilar González-Peramato,Miguel Reyes-Múgica | | Pediatric and Developmental Pathology. 2016; 19(3): 173 | | [Pubmed] | [DOI] | |
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