80 Document heading doi: 10.1016/S2305-0500(14)60007-5 Tuberculous orchitis mimicking a testicular tumor: A diagnostic dilemma Seema Dayal 1 , Alok Kumar 2 * , SP Singh 3 , Archana Verma 4 1 Department of Pathology, U.P. RIMS & R. Saifai Etawah, 206130 (U.P.), India 2 Department of Forensic Medicine & Toxicology, U.P. RIMS & R. Saifai Etawah, 206130 (U.P.), India 3 Department of Surgery, U.P. RIMS & R. Saifai Etawah, 206130 (U.P.), India 4 Department of Neurology, U.P. RIMS & R. Saifai Etawah, 206130 (U.P.), India ARTICLE INFO ABSTRACT Article history: Received 22 October 2013 Received in revised form 10 November 2013 Accepted 10 November 2013 Available online 20 January 2014 Keywords: Tuberculosis Orchitis Seminoma Ultrasound Cytology *Corresponding author: Dr. Alok Kumar, Additional Professor & Head, Department of Forensic Medicine & Toxicology, Faculty In-charge, Research Cell & Telemedicine Unit, Member Secretary of Research & Ethical Committee, UP Rural Institute of Medical Sciences and Research, Saifai, Etawah. -206130 (U.P.), India. E-mail: drsalok@rediffmail.com 1. Introduction Tuberculosis is one of the most important infection and ancient disease. It is estimated that about one third of the world population is infected with mycobacterium tuberculosis and most of the cases occur in Asia( 55%) and Africa (31%) and rest in others [1] . Death in adult due to tuberculosis is more than any infectious disease [2] . With the background of very high prevalence, tubercular orchitis is not uncommon in developing country like I ndia. Clinically, this condition may resemble epididymo–orchitis, sarcoidosis and malignancy [3] . As testicular biopsy is contraindicated in suspected case of malignancy. The diagnosis of tubercular orchitis can be achieved only on histopathological examination of resected testis and some time it comes with surprise. T uberculous epididymo-orchitis is an important manifestation of genitourinary tuberculosis ( GUTB) [4] , which is the second most common form of extra pulmonary tuberculosis [5] . Genital tuberculosis other than tuberculous ( TB) epididymitis is rare. I solated TB orchitis without epididymal involvement is even more rare [6] . Many cases coexist with pulmonary TB or tuberculosis of other parts of lower genitourinary system including bladder, ureter and prostate [7] . I solated instances of tuberculous epididymitis or epididymo-orchitis is rare but when it occurs, a comprehensive assessment of the patient is mandatory [8] . Recent surge in the prevalence of TB worldwide linked to human immunodeficiency virus (HIV) pandemic has resulted in a concomitant increase in extrapulmonary TB of which GUTB accounts for up to 20% in endemic areas [9] . Isolated tuberculous orchitis is a rare entity and may mimic testicular tumours particularly in apparently healthy patients with no other clinical symptoms or signs, as in our case that presented as a testicular tumor. The following case is being presented on account of its rarity. 2. Case report A 37 year old hetro sexual married male presented with a history of left scrotal mass of 4 months duration and Asian Pacific Journal of Reproduction 2014; 3(1): 80-82 Asian Pacific Journal of Reproduction Journal homepage: www.apjr.net A 37-year old man presented with 5 months history of left scrotal mass and had underwent left orchidectomy following a presumptive diagnosis of testicular tumour. Histopathological diagnosis of testicular tuberculosis was subsequently made, which revealed a case of isolated TB orchitis. It signifies that the careful evaluation of patients with testicular mass is extremely significant for diagnostic accuracy, optimal treatment and avoiding unnecessary surgery in case of testicular tuberculosis. Simultaneously it will also help in early detection of testicular malignancies and vital for the clinicians to avoid negligence charges.