Testicular encasement by retroperitoneal fibrosis: a rare testicular mass

Abstract

A53-year-old black man presented with elevated serum creatinine and blood urea nitrogen levels, bilateral hydronephrosis, and an unremarkable physical examination (abdomen, flank, genitalia, rectum). Computed tomography (CT) of the abdomen/pelvis demonstrated a diffuse homogeneous mass encasing both ureters suggestive of retroperitoneal fibrosis (RF). The diagnosis was confirmed by biopsy (Fig. 1). He underwent bilateral percutaneous nephrostomy drainage and steroid administration. Bilateral ureterolysis with omental wraps was performed for persistent ureteral obstruction. Four years later, he returned with a painless left scrotal mass. Sonography demonstrated a solid homogeneous mass replacing the testicle. Serum tumor markers (HCG, AFP, LDH) were not elevated. A left radical orchiectomy was performed for a presumptive diagnosis of testicular malignancy (Fig. 2A). Pathologic examination revealed complete encasement of an atrophic testicle by a dense fibrous sheet involving the tunica vaginalis, which was histologically consistent with RF (Fig. 2B). There were no neoplastic features. CT of the abdomen/pelvis demonstrated residual RF without hydronephrosis.