Case 136

Case 136. Chlamydia trachomatis epididymitis (33 y-o M)


		Surgical resection for left epididymal tumor without provoking active inflammatory host response


		Key words : Chlamydia trachomatis, epididymitis, salpingitis


		sexually transmitted infection




Marked mononuclear infiltration is seen among and around the ductal epithelial cells (HE, low power). Ductal cells are not destroyed, and lymphoepithelial lesions are commonly formed. The lumen contains neutrophils.		In the duct-lining columnar cells, a few intracytoplasmic vacuoles containing fine granular substances are observed (HE, high power).



The granulated cytoplasmic inclusions are immunoreactive for Chlamydia trachomatis antigen. Immunostaining is essential for making the diagnosis of chlamydial inflammation (immunostaining using a monoclonal antibody).		Immunoelectron micrograph of the chlamydial cytoplasmic inclusion using a routine paraffin section (pre-embedding method). Chlamydial particles are positively stained. N = nucleus. Bar = 2 μm.



Reference case 136A Surgically resected chlamydial salpingitis in a 33 y-o female, showing sausage-like swelling due to pyosalpinx (gross findings).　Infirtility due to salpingitis is a problematic complication of sexually transmitted disorders, such as chlamydiosis and gonorrhea.		Reference case 136A The inner surface of the sausage-like dilated oviduct (gross findings).　Marked dilatation of the oviduct lumen is demonstrated. The circumferential folds are evident.



Reference case 136A Histologic features of chlamydial salpingitis (HE).　Marked lymphoplasmacytic infiltration in the stroma and neutrophilic exudation into the lumen are seen. Some columnar epithelial cells possess a granulated cytoplasmic inclusion body.		Reference case 136A Chlamydia trachomatis antigen in chlamydial salpingitis (immunostaining).　C. trachomatis antigen is located within the cytoplasmic inclusion formed in the columnar epithelial cells.