Leiomyo-adenomatoid Tumor of the Epididymis

Abstract

Primary tumors of the epididymis are rare. Adenomatoid tumors are the most frequently diagnosed benign tumors of the epididymis and are well known, while leiomyomas are uncommon. We report a case of combined leiomyo-adenomatoid tumor of the right epididymis, which was difficult to diagnose. CASE REPORT A 44-year-old white man presented with a painful right scrotal mass 2 months in duration. History was unremarkable and no other symptoms were reported. Physical examination revealed a 2 3 3 cm. mass at the lower pole of the right testicle. Ultrasound showed a 3 2 cm. combined hypodense and hyperdense mass of the right epididymal tail, which was not clearly separable from the testicle. The right testicle and contralateral scrotal contents were normal. Doppler ultrasound demonstrated enhanced signals of the right rete testis when compared to the contralateral testis. Blood studies, including the tumor markers -fetoprotein, human chorionic gonadotropin, placental alkaline phosphatase and lactate dehydrogenase, revealed normal parameters. Primarily, the patient was thought to have epididymitis and conservative treatment was started. After an initial decrease in symptoms, the patient was referred to our department with recurrent pain and unchanged clinical and sonographic findings 1 month later. Subsequently, right inguinal exploration was performed, during which a firm solid mass arising from the tail of the epididymis was found. Although the mass was firmly adherent to the testicle, epididymectomy was easy to perform. Fresh frozen sections of the tumor were interpreted as leiomyoma of the epididymis. Biopsies of the adjacent testicle were normal. Due to the histological findings, radical orchiectomy was not performed. However, after epididymectomy, routinely processed histological sections of different tumor sites showed a leiomyo-adenomatoid tumor of the epididymis. At 8-month followup the patient was well and without evidence of disease. DISCUSSION