Paratesticular Mass Research Articles

Liposarcoma del cordón espermático

Introduction: liposarcoma of the spermatic cord (LSC) is a rare condition and accounts for about 3 to 7% of all paratesticular sarcomas. A case is presented in an 80-year-old patient who consulted for a left inguinoscrotal painless swelling, that had been present for several years. Physical examination revealed a soft left hemiscrotal tumor that appeared not to be adherent to the testicle. Ultrasonography showed a solid, heterogeneous hyperschoic paratesticular mass with central calcifications and peripheral hypervascularity. During surgery, a diffuse lipomatous tumor was found in the spermatic cord on the superior pole of the left testicle, separated from it. Anatomopathological examination revealed a well-differentiated liposarcoma of the spermatic cord. Discussion: this neoplasm features a slow-growing palpable paratesticular mass. This site of occurrence is rare and represents 7 to 10% of all scrotal tumors. Imaging differentiation between LSC and benign lesions is sometimes challenging. Surgical treatment should include radical orchiectomy wide local excision, and spermatic cord and inguinal ring surrounding soft tissue resection. Conclusion: spermatic cord liposarcoma is a rare and unusual mesenchymal tumor and should be considered among the differential diagnoses of scrotal tumors.

Paratesticular cellular angiofibroma: a case report.

Paratesticular cellular angiofibroma is a rare benign mesenchymal tumor. The optimal management is surgical resection due to the difficulty of preoperative accurate diagnosis. A 51-year-old Japanese male visited our hospital complaining of asymptomatic left scrotal swelling. Physical examination revealed a nontender elastic paratesticular mass (5.5cm in diameter). Although testicular germ cell tumor was ruled out clinically, the possibility of malignant potential remained for the tumor. Since the patient consented to complete resection, a transinguinal radical orchiectomy was performed. The pathological diagnosis revealed cellular angiofibroma. The patient recovered without perioperative complications, and no apparent recurrence was observed at 5years after surgery. The pathological findings were compatible for cellular angiofibroma. The tumor was successfully resected, and no apparent recurrence was observed at 5years after surgery.

Left paratesticular mass mimicking polyorchidism: A case report

We report a rare case of primary scrotal lipoma in a 20-year-old patient which clinically mimics a left triorchidism. The patients presented with the left testicular swelling and the ultrasonography of the scrotum revealed an inhomogeneous hyperechoic mass with an inconclusive report. The left scrotal hemi exploration was planned, and intraoperatively, it was found to be a paratesticular mass with an equivalent size corresponding to the left testicle, separate from the left testicle. The histopathology confirms the lipomatous swelling. The post-operative period remains uneventful and the patient has been on follow-up for the past 1 year with no relapse.

Malignant Para-Testicular Mesothelioma: A Rare Presentation in the Tunica Vaginalis of an Elderly Male With No Prior Asbestos Exposure.

Malignant mesothelioma of the tunica vaginalis is an extremely rare and aggressive tumor that is frequently encountered in elderly patients. The diagnosis of malignant mesothelioma of the tunica vaginalis poses a diagnostic challenge due to its infrequency and nonspecific clinical presentation. Histopathological examination and immunohistochemical staining are essential in differentiating this tumor from other para-testicular masses and establishing a definitive diagnosis. Early detection and comprehensive treatment planning are crucial for improving the prognosis and overall outcomes for patients with this rare malignancy. We present a report of malignant mesothelioma of the tunica vaginalis in a 78-year-old male patient with no history of asbestos exposure who presented with a large infiltrative left para-testicular mass. Histopathological examination revealed a biphasic proliferation composed of epithelioid and spindle cells with infiltrative features, foci of necrosis, and increased mitotic figures. Immunohistochemical staining exhibited positive staining for WT1, D2-40, and calretinin, supporting the mesothelial origin of the tumor. Notably, BerEP4 staining was negative, arguing against carcinoma. Immunostaining for keratin 5 was positive, supporting the mesothelial differentiation. The Ki67 proliferation index was high. The differential diagnosis included adenomatoid tumors, germ cell tumors, and pleomorphic sarcoma. We aim to discuss the clinical presentation, diagnostic approach, and therapeutic approaches of this rare entity.

SMARCB1/INI1-deficient epithelioid and myxoid neoplasms in paratesticular region: Expanding the clinicopathologic and molecular spectrum

SMARCB1/INI1-deficient soft tissue tumors with epithelioid and myxoid features are diverse and mainly include soft tissue myoepithelial tumor, extraskeletal myxoid chondrosarcoma, and the recently described myoepithelioma-like tumor of the vulvar region and myxoepithelioid tumor with chordoid features. Because of their overlapping features, the accurate diagnosis and classification of these tumors are often challenging. Herein, we report two unique cases of SMARCB1/INI1-deficient soft tissue neoplasm with epithelioid and myxoid features occurring in male paratesticular region. The first case was a 52-year-old man presented with an intermittent painful left paratesticular mass for 1 year. The second case was a 41-year-old man presented with a painless paratesticular mass on the right side for 3 months. Both patients underwent an orchiectomy. After 6 and 26 months of follow-up, both were alive with no evidence of recurrence or metastasis. In both cases, the tumor was relatively well-demarcated and showed monomorphic round to epithelioid cells arranged in a nested, trabecular, reticular, and corded pattern, setting in a myxohyalinized and vascularized matrix. The tumor cells showed relatively uniform round nuclei with vesicular chromatin and variably prominent nucleoli. No rhabdoid cells were identified. Mitoses numbered 3 and 2 per 10 high-power fields. Tumor necrosis or lymphovascular invasion was absent. Immunohistochemically, both tumors expressed epithelial membrane antigen (focal), calponin (focal), and CD99. SMARCB1/INI1 expression was deficient in both cases. In addition, case 1 diffusely expressed pan-cytokeratin, and case 2 diffusely expressed CD34 and synaptophysin. Molecular genetically, case 1 showed SMARCB1 homozygous deletion as detected by fluorescence in-situ hybridization (FISH), and case 2 demonstrated SMARCB1 copy number deletions by next-generation sequencing and SMARCB1 monoallelic deletion by FISH. Both cases lacked EWSR1 rearrangements by FISH. The overall clinicopathologic profiles of the two cases made it difficult to classify them as one of the established categories of SMARCB1/INI1-deficient mesenchymal tumors. Our study further expands the clinicopathologic and molecular spectrum of SMARCB1/INI1-deficient epithelioid and myxoid neoplasms and highlights the challenges to diagnose these tumors.

Adenomatoid tumor with extensive reactive smooth muscle: a diagnostic dilemma

Abstract Introduction/Objective Adenomatoid tumors are slow-growing benign tumors of mesothelial origin. They comprise 30% of all tumors of the paratesticular area. In this location, they commonly involve the epididymis, spermatic cord, ejaculatory duct and rarely testicular parenchyma. Histologically, a spectrum of growth patterns can be seen, such as adenoid, tubular, glandular, solid, or cystic. In some cases, a smooth muscle component can also be present. The purpose of this report is to describe a case of adenomatoid tumor with exuberant smooth muscle component, mimicking leiomyoma. Methods/Case Report A 28-year-old male presented with painless left inguinal bulge. He noticed it five years prior, and it had been slowly growing since then. Examination revealed a paratesticular mass which was subsequently excised. Grossly, the tumor was firm with smooth, white-tan cut surfaces. Microscopically, the tumor was well- circumscribed, showing predominance of smooth muscle bundles and rare cuboidal to ovoid cells in tubular growth pattern. In the background there was little intervening stroma. Immunohistochemical stains showed the cuboidal cells to be positive for WT1 and calretinin, confirming the mesothelial origin. Diagnosis of adenomatoid tumor was rendered. In contrast to adenomatoid tumors, leiomyomas are whiter and firmer on gross examination and lack the characteristic tubules or cystic spaces lined by mesothelial cells. Results (if a Case Study enter NA) N/A Conclusion Exuberant smooth muscle differentiation in adenomatoid tumor can mislead to diagnosis of leiomyoma. Careful inspection for tubules of mesothelial origin and appropriate immunohistochemical stains are key to accurate diagnosis. Pathologists need to be aware of this potential pitfall.

Paratesticular Mass in Childhood a 13-Year-Old Boy: A Case Report and Literature Review.

Paratesticular Mass in Childhood a 13-Year-Old Boy: A Case Report and Literature Review.

Well-differentiated “lipoma-like” giant paratesticular liposar-coma: a case report

Few cases of paratesticular liposarcomas have been described in literature and they are considered as rare tumors, especially when they are larger than 10 cm, called giant tumors. We describe the case of a 52-year-old patient diagnosed with a painless mass in the scrotum, initially submitted to magnetic resonance imaging, which revealed a large paratesticular mass. Subsequently, he underwent left radical orchiectomy, which revealed a well-differentiated, “lipoma-like,” “giant” paratesticular liposarcoma. We discussed the workup and current management of this pathology.

A Rare Case of Paratesticular Cystadenoma with Ovarian Stroma Found by Scrotal Ultrasound on a Cirrhotic Patient with Elevated Alpha-fetoprotein

Abstract Introduction/Objective Paratesticular cystadenoma with ovarian stroma is a rare benign cyst-forming neoplasm with less than 10 cases reported in the literature. Typically, it presents in men aged 11 to 68 years (average 30) and is asymptomatic. The tumor is hypothesized to represent the efferent ductulus undergoing metaplastic change, the vestigial remnants of Mullerian duct, or mesothelium of the tunica vaginalis. Most tumors are considered benign, but a few cases of malignant transformation have been reported. Methods/Case Report We present a case of a 54-year-old male with a history of cirrhosis and elevated alpha-fetoprotein (17.85 ng/ML) who was found to have a paratesticular mass by scrotal ultrasound. Clinical history was obtained from review of electronic medical record. CD10 (Novocastra Clone 56C6) and progesterone receptor (PR) (Leica Clone 16) Immunoperoxidase stains were performed following the vendor recommendations. Surgical excision revealed a 0.6-cm polypoid nodule on tunica albuginea that was entirely submitted. Microscopically, the tumor was comprised of cystic spaces lined by cuboidal epithelium identical to that of the Fallopian tubes. There was a sparse spindle-shaped stroma underlying the epithelium similar to ovarian stroma. No nuclear atypia or mitosis was found. Immunoperoxidase stains showed the epithelium was positive for PR, and the stroma was positive for CD10. No evidence of germ cell tumor was identified. Results (if a Case Study enter NA) NA. Conclusion Characteristic histologic and immunophenotypic findings can aid in the diagnosis of paratesticular cystadenoma with ovarian stroma. Surgical resection for histological confirmation and long-term monitoring for the potential recurrence and metastatic spread are required.

Ewing’s sarcoma of the male external genitalia: a case report and review of the literature

BackgroundEwing’s sarcoma (ES) within the genitourinary tract are relatively unheard of and those within the external male genitalia are even rarer. To our knowledge, this is the first known case of primary ES within the paratesticular region in an adult.Case presentationWe present a case of a 24-year-old man with a right sided testicular mass on examination that was initially characterized as an adenomatoid tumor on ultrasound. After the patient was lost to follow up over the course of 9 months, the testicular mass grew significantly and was excised with pathology revealing primary paratesticular Ewing’s sarcoma. This rare case emphasizes the importance of elucidating between the broad differentials of paratesticular masses, including the rare presentation of primary ES and adds a review of the literature of ES in the external male genitalia.ConclusionsRare differentials such as this case should be considered in patients with paratesticular masses. Further diagnostic and management algorithms for extraosseous Ewing Sarcoma, particularly in the adult population, are warranted.

Shapeshifters in Pathology: Paratesticular Solitary Fibrous Tumor Mimicking Leiomyoma.

Solitary fibrous tumors are mesenchymal fibroblastic tumors that were originally described as intrathoracic lesions but have since been found to occur in many other locations. They may rarely occur as paratesticular masses. Here we present a peculiar case of a solitary fibrous tumor arising in the paratesticular region and exhibiting leiomyoma-like morphology. Confirmation of the tumor as a solitary fibrous tumor was achieved by RNA sequencing showing NAB2::STAT6 fusion. Possible explanations for the unusual tumor morphology include entrapment of normal smooth muscle elements and tumor differentiation into smooth muscle type cells.

PARATESTICULAR INVOLVEMENT IN NEUROBLASTOMA

Neuroblastoma is 7-10% of all pediatric cancer cases. Primary testicular and paratesticular neuroblastoma is very rare in the literature. We aimed to present our experience with a 4-year-old patient with an abdominal and right paratesticular mass. The patient's imaging revealed extensive lung and bone metastases. In the diagnostic biopsy, the primary tumour consistent with poorly differentiated neuroblastoma and the right paratesticular mass biopsy revealed neuroblastoma metastasis.

Paratesticular fibrous pseudotumour: case report of a rare manifestation of IgG4-related disease

BackgroundParatesticular fibrous pseudotumour is a rare benign growth with unclear pathogenesis and clinical management. It has been linked to Serum IgG4-related disease. This mass can notoriously masquerade around as a malignancy; however, a conservative (testis sparing) approach is sufficient as surgical management.Case presentationWe present the case of a 35-year-old gentleman who presented with a slow growing paratesticular mass, raising the suspicion of a malignancy. However, normal tumour markers and benign appearance on imaging modalities compelled us to give trial of local excision with intra-operative frozen section analysis. After confirmation of benign pathology of the mass, the incision was closed. Final histopathology confirmed the diagnosis of benign paratesticular fibrous pseudotumour, and serum IgG levels were noted to be elevated.ConclusionThus, using tumour markers, radiological imaging and intraoperative frozen section, a potential radical resection can be avoided, testis sparing surgery, employed.

A RARE CASE REPORT OF PARATESTICULAR RHABDOMYOSARCOMA IN AN ADULT PATIENT

Rhabdomyosarcoma is a malignancy of mesenchymal tissue origin typically occurring in childhood and adolescence, with an incidence rate of of 4.3 patients per million population per anum. Primary rhabdomyosarcoma of para-testicular origin is an infrequent condition, making up to 7% of all the cases of rhabdomyosarcoma tumors in children and adolescents. Here we describe a case of a 25 years old man with left paratesticular solid mass. He underwent left sided orchiectomy with histopathology revealing paratesticuler embryonal rhabdomyosarcoma. He underwent definitive chemo-radiotherapy and orchidopexy with complete remission and is on active surveillance for 4 years.

Supernumerary Testis Discovered Upon Workup of a Paratesticular Mass

A supernumerary testis is a rare finding with limited description in the literature. Presentations of supernumerary testes vary and often involve initial discovery intraoperatively or in association with a separate condition. In this case report, we describe our experience of a patient with ultrasound imaging concerning for a left paratesticular mass. The patient was taken to the operating room where the mass was found to be an atrophic, supernumerary testis. We also address the specific anatomy encountered in our case and discuss both the intraoperative and post-operative management that resulted, in addition to reviewing relevant literature.

The fate of paratesticular masses: 13 years' experience in a tertiary referral centre.

Paratesticular neoplasms exhibit different behaviours, depending on the embryological tissue of origin. Treatment modalities can depend on the differential diagnosis. The aim of this study is to present the clinical, morphological and histopathological features of patients with paratesticular masses and their follow-ups and is intended to increase awareness of the issues. We included 31 excisions of paratesticular masses, after radiological diagnosis as paratesticular mass in our hospital between 2007-2020. Information on treatment modalities, tumour recurrence, metastasis, and survival rates were obtained from hospital archives. All patients were evaluated by taking patients' history, physical examination, scrotal ultrasound, chest radiography, and serum tumour markers. Treatment modality was selected according to intraoperative findings. Haematoxylin-eosin sections were examined, and immunohistochemical analyses were performed for smooth muscle actin, desmin, Ki67, CD34, S100, and myogenin. Ten high-power fields were counted to document Ki67 and p53 nuclear positivity rates. A total of 31 operations were performed with recurrence in three patients. Histomorphological and immunohistochemical examination revealed eleven malignant masses; eight rhabdomyosarcomas, a leiomyosarcoma, a liposarcoma and a large B cell lymphoma. Other excised masses were benign and infective lesions. Paratesticular masses are heterogeneous tumours that follow different clinical courses. Clinicians must be aware of this histological diversity in order to plan a treatment pathway. This study is one of the largest published series, with a long follow-up period. It shows that the most critical features in determining prognosis are histopathological subtype and tumour grade.

Paratesticular Papillary Cystadenoma of the Epididymis in the Setting of von Hippel-Lindau

An individual with von Hippel-Lindau disease presented with bilateral paratesticular masses. Prior germline testing had revealed the presence of a pathogenic VHL c.620T>C alteration. His past medical history was significant for right cerebellar hemangioblastoma, laser photocoagulation procedures for bilateral retinal hemangioblastomas, as well as multiple partial nephrectomies for clear cell renal cell carcinoma. In addition, he had also undergone a distal pancreatectomy for a well-differentiated neuroendocrine tumor. He was evaluated for worsening bilateral scrotal pain and a bilateral epididymectomy was performed for a 3.0-cm mass on the left and a 3.6-cm mass on the right. Representative images of the tumor arising within the epididymis (A) have been depicted. Specifically, this tumor exhibited papillary architecture (B) and was comprised of cells with clear cytoplasm that exhibited reverse polarity (ie, oriented away from the basement membrane; C). Immunohistochemistry for carbonic anhydrase IX, which is upregulated secondary to hypoxia-dependent signaling in tumors that have loss of function alterations of VHL, demonstrated a constitutive pattern of expression characterized by diffuse membranous localization (D). What is the most likely diagnosis?a. Metastatic clear cell renal cell carcinoma involving the epididymisb. Primary papillary cystadenoma of the epididymisc. Metastatic clear cell (tubulo-) papillary renal cell carcinoma involving the epididymisd. Primary adenocarcinoma of the epididymis Answer: b. Primary papillary cystadenoma of the epididymis. Papillary cystadenomas are benign tumors and are thought to arise from epididymal ducts.1Odrzywolski K.J. Mukhopadhyay S. Papillary cystadenoma of the epididymis.Arch Pathol Lab Med. 2010; 134: 630-633Crossref PubMed Google Scholar The mean age at presentation is approximately 35 years, and these tumors range in size from 0.5 to 8.0 cm.1Odrzywolski K.J. Mukhopadhyay S. Papillary cystadenoma of the epididymis.Arch Pathol Lab Med. 2010; 134: 630-633Crossref PubMed Google Scholar Although solitary tumors are identified more frequently, the presence of bilateral tumors should raise the possibility of von Hippel-Lindau disease.1Odrzywolski K.J. Mukhopadhyay S. Papillary cystadenoma of the epididymis.Arch Pathol Lab Med. 2010; 134: 630-633Crossref PubMed Google Scholar These tumors have significant morphologic and immunophenotypic overlap with both clear cell renal cell carcinoma as well as clear cell (tubulo-) papillary renal cell carcinoma.2Cox R. Vang R. Epstein J.I. Papillary cystadenoma of the epididymis and broad ligament: morphologic and immunohistochemical overlap with clear cell papillary renal cell carcinoma.Am J Surg Pathol. 2014; 38: 713-718Crossref PubMed Scopus (20) Google Scholar For instance, neither the expression of PAX8 or diffuse membranous localization of carbonic anhydrase IX (a surrogate marker of hypoxia-dependent signaling in tumors that have loss of function alterations of VHL) can be used to reliably distinguish clear cell type renal cell carcinoma from primary papillary cystadenoma of the epididymis.2Cox R. Vang R. Epstein J.I. Papillary cystadenoma of the epididymis and broad ligament: morphologic and immunohistochemical overlap with clear cell papillary renal cell carcinoma.Am J Surg Pathol. 2014; 38: 713-718Crossref PubMed Scopus (20) Google Scholar The diagnosis of papillary cystadenoma of the epididymis is therefore established based on a combination of histopathologic examination as well as the clinical context, including tumor site.

Paratestiküler Kitlelerin Güncel Tanı, Tedavi ve Takip Prosedürleri

Objective :The pre-op differentiation of testicular tumors from paratesticular masses cannot be made clearly. Generally, radical orchiectomy is performed with pre-diagnosis of testicular tumor and a clinical approach is planned according to the final pathological result.When clinicians diagnose a scrotal mass, they should considered that this mass may be originated from epididymidis, tunica vaginalis, spermatic cord, fat-muscle-connective tissue, and embryonic remnants and should determine the treatment management accordingly. Materials and Methods :The pathology results of 140 patients, who were admitted to our center between 2008 and 2018 presenting scrotal mass and underwent inguinal radical orchiectomy considering as testicular tumor, were retrospectively analyzed. Preoperative and postoperative data, clinical course, and treatment management of the cases reported to be paratesticular mass by pathology were discussed in the light of the literature. Results :Paratesticular mass(PTM)was detected in 13 cases of our retrospectively analyzed series. Of these, 10 patients were found to have adenomatoid tumors(AT) 2 patients have rhabdomyosarcoma(RMS), and 1 patient angiomyxoma(AM). Conclusion :The differential diagnosis of whether intrascrotal masses are originating from testicular tissues or paratesticular structures is usually cannot be made. Therefore, radical orchiectomy is performed in the same way as testicular tumors and a definite diagnosis can be made by pathological examination. The paratesticular masses, 2-3% of the scrotal masses, should be considered in the differential diagnosis. In this regard, there is a need for studies with a higher number of series.

Polyorquidism: case report comparing ultrasonography and magnetic resonance imaging

Abstract Introduction: polyorchidism is an unusual pathology, about 200 cases in the world literature. Case report: we reported a case of polyorchidism in a 16-year-old male patient diagnosed by ultrasound and confirmed by magnetic resonance imaging. Discussion: most of the cases presented, there is a supernumerary testis, but there are reports on more than three, up to five testicles with supranumerical gonads on both sides of the scrotum. The diagnosis is usually performed in late puberty, incidentally, with a painless scrotal mass or at the emergency room, presenting a testicular torsion of the whole hemiscrotum or supernumerary testisalone, and the differential diagnosis should be made with epididymal cyst and spermatocele, besides other extra-testicular masses (hydroceles, varicoceles, lipomas, tumors.) and para-testicular masses (hernias, scrotal calculi). After the initial clinical evaluation, ultrasound is the first line subsidiary exam. Magnetic Resonance Imaging is very helpful, just in case the ultrasound diagnosis is uncertain. The supernumerary testishave the same Magnetic Resonance Imaging characteristics as the normal testes (intermediate signal intensity on T1- weighted images and high signal intensity on T2-weighted images).

Acute Scrotum Secondary to Torsion of a Tunica Vaginalis Cyst

This is a case of an 8-year-old boy with a chief complaint of left-lower-quadrate abdominal pain for 3 days. Examination revealed swollen left hemi-scrotum and scrotal ultrasound showed a para-testicular cystic mass, which was later proven to be a torsion of a benign scrotal tunica cyst during emergent scrotal exploration. Torsion of the tunica vaginalis cyst is a rare cause of acute scrotum, and we present this case to share our experience of diagnosis and management of this peculiar disease.