Paratesticular Tumors Research Articles

Testicular and Paratesticular Neoplasms in Pediatrics: Report of 5 Cases with Atypical Presentation and Literature Review

This study presents 5 atypical cases of testicular and paratesticular neoplasms in pediatrics, highlighting the importance of a high level of clinical suspicion and accurate diagnostic approach. Although rare, these neoplasms can present a variety of clinical and histological manifestations, complicating their diagnosis. Early recognition and proper classification are crucial to ensure effective treatment and a favorable prognosis. Multidisciplinary collaboration, including oncology, pediatric surgery, and endocrinology, is essential to address the oncological and developmental needs of patients. The study concludes that rigorous clinical vigilance and a multidisciplinary approach are fundamental in addressing these challenges in pediatric care for patients with testicular and paratesticular neoplasms.

Adenomatoid tumor of ovary – A rare case

Adenomatoid tumors are benign tumors of mesothelium and rare tumors found in male and female genital tract. They are more common in males than females. They account for 30% of all paratesticular neoplasm in males and 1.2% tumors of uterus. There are very few cases reported in ovaries. A 62 year old female presented with complaints of vague abdominal pain. Ultrasonography showed a unilateral tumor with of neoplastic etiology. The diagnosis of adenomatoid tumor of ovary postulated based on the distinct features numerous small vacuoles and cystic spaces of the neoplasm.

Role of Fine Needle Aspiration Cytology in Paratesticular Neoplasms-A Case Reports-Based Systematic Review.

The cytology features of neoplastic paratesticular lesions are mostly documented as case reports. Thus, we conducted a case report-based literature review to identify the characteristics of paratesticular neoplasms and tried to determine the significance of FNAC in these tumors. The studies were searched using PubMed and Scopus. The quality assessment was done using the JBI critical appraisal checklist for case reports. The articles that received an overall rating of "Include" underwent data extraction. The data were extracted from the articles and analyzed. We included 34 case reports from 33 published articles. The mean age of patients was 44.74 (13-85) years, and the most common clinical manifestation was scrotal swelling (70.59%, 24/34). Lesions were commonly observed on the right side (65.63%, 21/32), and the most common tumor site was epididymis (35.29%, 12/34). A total of 38.24% (13/34) cases were nonmalignant, and 61.76% (21/34) were malignant on the cytological diagnosis. The adenomatoid tumor (53.85, 7/13) was the most common nonmalignant tumor. Other entities were schwannoma, benign spindle cell neoplasm with atypia, nerve sheath tumor, lipoma, undifferentiated pleomorphic sarcoma, rhabdomyosarcoma, epithelioid sarcoma, liposarcoma, malignant rhabdoid tumor, pigmented neuroectodermal tumor of infancy and mesothelioma. Considering the malignant and nonmalignant groups, the sensitivity, specificity, and diagnostic accuracy of cytology were 95.00%, 84.62%, and 90.91%, respectively. Cytopathologists should be familiar with the cytological features of various malignant and nonmalignant paratesticular tumors to prevent unnecessarily invasive surgical management. The current systematic review emphasizes usefulness of FNAC in the preoperative cytological identification of paratesticular tumors.

Malignant Testicular and Paratesticular Tumors in Children

Malignant Testicular and Paratesticular Tumors in Children

Adult genitourinary sarcomas: A single-centre experience over 25 years.

e23532 Background: Genitourinary sarcomas are a rare entity. This study is a retrospective review of the patient characteristics, types of adult GU sarcomas, treatments and outcomes in a single institution over the past 25 years. Methods: Survival probabilities were estimated and plotted using the Kaplan-Meier method. Estimates along with 95% pointwise confidence intervals were reported. Recurrence-free survival (RFS) is defined as time from when the patient was disease-free to recurrence. Otherwise, patients were censored at last disease evaluation. OS was defined as time from when the patient was disease-free to death due to any cause. Patients still alive were censored at last known alive. Results: 29 patients presented with various types of GU sarcomas, with the majority being paratesticular tumors (n = 22, 75.9%). Others included bladder leiomyosarcomas (n = 5), prostatic leiomyosarcoma (n = 1), renal leiomyosarcoma (n = 1). Median age for diagnosis was 51 years (range: 21-79) for leiomyosarcoma vs 61 (range: 36-89) for liposarcoma. Among the paratesticular tumors majority were (n = 16) were liposarcoma, remaining 5 being leiomyosarcoma and 1 being rhabdomyosarcoma. Majority tumors were stage III and above (n = 16, 55.17%), high and intermediate grade (65.51%). All tumors were resected ± adjuvant therapy (n = 4). Leiomyosarcomas had a higher stage (66%) and grade (83%) at diagnosis, recurrence rate was also higher at 37.5% (vs 6.6% for liposarcoma) along with a higher mortality (41.6%). Commonest site of recurrence for leiomyosarcoma was the lungs (n = 3, 100%). Treatment for recurrence commonly involved radiotherapy, pembrolizumab etc. Paratesticular liposarcomas were found to be associated with a lipomatosis syndrome with n = 5 (31.25%) having lipomas elsewhere in the body and n = 2 (12.5%) patients having had previously resected spermatic cord lipoma. Paratesticular sarcomas often required (n = 15, 68%) revision surgery due to being initially diagnosed as a hernia, cord lipoma or hydrocele and requiring high ligation of the cord with hemiscrotectomy and radical orchiectomy ± LND on revision surgery, which often demonstrated a focus of residual tumor in liposarcomas (n = 5, 31%). N = 4 patients (25%) had positive margins in spite of revision surgery. Majority of these were MDM2+ positive on FISH (n = 9, 56%). Overall, GU sarcomas had an RFS of 63% (53-94%) and OS of 82% (53-94%) at 36 months since NED was achieved. The median length of follow-up was 19.9 months for leiomyosarcoma, 33.8 months for liposarcoma. Conclusions: Leiomyosarcomas in adults have worse outcomes compared to other GU sarcomas especially if it originates in the bladder. [Table: see text]

Familial syndromes associated with testicular and paratesticular neoplasms: a comprehensive review.

A syndromic association between a subset of testicular/paratesticular neoplasms is well established. Such examples include Carney complex and large cell calcifying Sertoli cell tumor, Peutz-Jeghers syndrome and intratubular large cell hyalinizing Sertoli cell neoplasia, and VHL syndrome and clear cell papillary cystadenoma of the epididymis.However, recent studies proposed potential novel links between some testicular and paratesticular neoplasms with certain tumor syndromes. While more studies are still needed to solidify these associations, recent research suggests that a subset of Leydig cell tumors may arise in patients with hereditary leiomyomatosis and renal cell carcinoma syndrome or that some seminomas may occur in Lynch syndrome patients. Additionally, an association between testicular sex cord stromal tumors and paratesticular sarcomas with Familial adenomatous polyposis syndrome and DICER1 syndrome, respectively, has been proposed as well. This review provides a comprehensive overview of the intricate relationship between familial syndromes and associated testicular and paratesticular tumors, shedding light on their clinicopathological and molecular characteristics.

Robotic-assisted Pediatric Thoracic and Abdominal Tumor Resection: An Initial Multi-center Review

IntroductionRobotic-assisted minimally invasive surgery (RA-MIS) for tumor resection is an emerging technology in the pediatric population with significant promise but unproven safety and feasibility. MethodsA multi-center retrospective review of patients ≤18 years undergoing RA-MIS tumor resection from December 2015–March 2023 was performed. Patient demographics, perioperative variables, and complication rates were analyzed. ResultsThirty-nine procedures were performed on 38 patients (17 thoracic, 22 abdominal); 37% female and 68% non-Hispanic White. Median age at surgery was 8.3 years (IQR 5.7, 15.7); the youngest was 1.7 years-old. Thoracic operations included resections of neuroblastic tumors (n = 16) and a single paraganglioma. The most common abdominal operations included resections of neuroblastic tumors (n = 5), pheochromocytomas (n = 3), and angiomyolipomas (n = 3). Six patients underwent retroperitoneal lymph node dissection (RPLND) for paratesticular tumors. Median operating time for the cohort was 2:52 h (IQR 2:04, 4:31). Two thoracic cases required open conversion due to poor visualization and lack of working domain. All patients underwent complete tumor resection; one had tumor spillage from a positive margin (Wilms tumor). Median LOS was 1.5 days (IQR 1.1, 3.0). Postoperatively, one patient developed a chyle leak requiring interventional radiology drainage, but none required a return to the operating room. ConclusionsRobotic-assisted surgery is safe and feasible for tumor resection in carefully selected pediatric patients, achieving complete resection with minimal morbidity and short LOS. Resection should be performed by those with robotic expertise for optimal outcomes. Level of EvidenceIV. Type of StudyOriginal Clinical Research.

CARCINOMA TESTIS PROFILE IN TERTIARY HOSPITAL

Objective: This study was undertaken to estimate the epidemiological characteristics, histological types, and subtypes of testicular neoplasm according to the WHO classification in our patient group. Material & Methods: This was a retrospective study done over a period of ten years from January 2010 - December 2020 in our institution. Histopathological slides were retrieved and reviewed for tumour. Testicular Neoplasm patients who underwent orchidectomy and chemotherapy clinical data including the patient’s age, tumor location, tumor side, pathological finding, tumor marker, chemotherapy regiment, prognosis, chemotherapy response, and side effect were observed. All the data were analyzed descriptively and using SPSS 17.0. Results: A total of 31 cases of testicular and paratesticular neoplasm were encountered in our study with a mean age of 32.516.2 years. The highest incidence was 15-35 years old (48.3). Scrotum mass was the most frequent clinical presentation (70.96%) and left side became the predominant area (52%). Most of the patients come in late stage T3 (51.61%) and N3 (67.74%) with no metastatic process (70.96). The major pathological finding was Seminoma (64.51%), Teratoma (16.12), Yolk Sac (12.9%), Embryonal, and Mixed (3.22%). AFP, B-HCG, and LDH were elevated in some Seminoma, Teratoma, and Yolk Sac groups. The most wide chemotherapy used was 4 series BEP (87.09%). Patient prognosis highest incidence were Intermediate (70.96%). Most of the patients showed complete response (67.74) of chemotherapy. Nausea, vomiting, alopecia, and mucositis were observed as chemotherapy side effect in all patients. Conclusion: Testicular neoplasm peak incidence appears in young male. Most patients come to health care service in late stage. Seminoma become the highest testicular neoplasm incidence in our study. Elevated tumor markers were found in some patients. Four cycle BEP chemotherapy regiment showed great outcome for these patients.
 Keywords: Epidemiological, histological, testicular neoplasm.

Management of Metastatic Paratesticular Tumour in a Resource-Poor Setting

Abstract Paratesticular tumours are tumours that arise from the testicular tunics, spermatic cord, epididymis, or vestigial remnants. The tumours are rare and account for approximately 5% of intrascrotal neoplasms. About 75% of these tumours arise from the spermatic cord. Paratesticular tumours most commonly manifest as painless scrotal masses. Alternatively, the tumour may be incidentally noticed when a scrotal ultrasound scan is done for another intrascrotal pathology such as hydrocele, inguinoscrotal hernia, epididymo-orchitis, or suspected testicular tumour. We present a case of metastatic paratesticular tumour in a 21-year-old Nigerian male, who presented at the University of Nigeria Teaching Hospital, Ituku-Ozalla, Enugu, in September 2018 at the age of 19 years with a painless right hemiscrotal mass. The patient was clinically evaluated with scrotal ultrasonography, testicular tumour markers, and liver function test. Biopsy specimen obtained was ignorantly discarded by the patient who was subsequently lost to follow-up. Histologic diagnosis of mesenchymal tumour (myxoid liposarcoma) was made two years after his initial presentation when he developed both inguinal and retroperitoneal lymph node metastasis at the age of 21 years. He was evaluated as clinical stage IV disease and then commenced on chemotherapy after baseline investigations. Our objective of presenting this report is to highlight the effect of delayed diagnosis in the management outcome, challenges in the provision of resources in low- and middle-income countries, and to emphasise the rarity of the tumour in our subregion.

A Panorama of the Urological Diseases at the Former Military Teaching Hospital of Cotonou

Background: Urological care has been advancing quickly over the last ten years in Benin. In order to conveniently support that trend towards better urological care standards, decision-makers need sound data on urological diseases in the country. Objective: To determine the prevalence of urological diseases in the former Military Teaching Hospital of Cotonou. Patients and Method: We retrospectively collected the urological diseases that the institution had managed from January 2012 to December 2020. We used Excel© 2010 and SPSS© to analyze the collected data. Results: 4244 patients, i.e. 3717 males (87.58%) and 527 females (12.42%) were managed during the study period. The main diseases diagnosed were benign prostatic hyperplasia (32.61%, n = 1384), erectile dysfunction (10.44%, n = 443), chronic prostatitis (5.94%, n = 252), prostate cancer (4.03%, n = 171), and ejaculatory disorders (3.44%, n = 146). In patients ≤ 15 years, predominant diseases were peritoneal vaginal canal (15.9%, n = 43), circumcision (15.6%, n = 42), testicular dystopia (10.7%, n = 29), hydrocele (7.8%, n = 21), and hypospadias (5.6%, n = 15). Wilms tumor (1.9%, n = 5) was the first cancer, testicular (0.4%, n = 1) and para-testicular (0.4%, n = 1) tumors were the next. In patients > 15 and ≤40 years, the main diseases were infertility (14.1%, n = 189), chronic prostatitis (12.9%, n = 173), erectile dysfunction (10.1%, n = 135), ejaculatory disorders (6.2%, n = 83), genital infections (6.2%, n = 83) and urinary stone (4.9%, n = 66). The first cancer was kidney cancer (0.97%, n = 13) followed by bladder cancer (0.3%, n = 4) and testicular tumor (0.3%, n = 4). In patients >40 years, the most prevalent diseases were BPH (52.0%, n = 1370), erectile dysfunction (11.7%, n = 308), prostate cancer (6.5%, n = 171), inguinal hernia (5.1%, n = 134), and urinary stone (3.9%, n = 102). Prostate cancer is the first cancer; the next were bladder (0.95%, n = 25) and kidney (0.68%, n = 18) cancers. Conclusion: Benign prostatic hyperplasia and urological cancers (prostate, bladder and kidney cancers) were the main urological diseases at the former Military Teaching Hospital of Cotonou. Urological malformations and Wilms tumor were the main diseases in the children.

Local Control for Large Unresectable Intermediate Risk Pediatric Rhabdomyosarcomas

<h3>Purpose/Objective(s)</h3> Despite general improvement in progression-free survival (PFS) for non-metastatic pediatric rhabdomyosarcoma (RMS), patients with large, unresectable RMS in unfavorable sites with incomplete response to induction chemotherapy (CT) demonstrated inferior local control (LC) on D9803 and ARST0531. This study provides single-institution data on disease control, patterns of failure, and toxicity following proton therapy for these children at highest risk of local failure. <h3>Materials/Methods</h3> All intermediate-risk group III RMS (IR-RMS) patients ≤21 years old with >5 cm tumors treated on a prospective outcome tracking protocol between April 2007 and June 2021 were included. Patients were excluded if they had paratesticular or orbital tumors, delayed primary excision with gross tumor resection, or complete response to induction CT. Prior to 2013, all patients received ≤50.4 Gy. The cumulative incidence method provided estimates of time-dependent endpoints; the Fine-Gray test statistic assessed the level of statistical significance between predetermined strata of known prognostic factors. <h3>Results</h3> For the 91 patients included, median age at diagnosis was 4.5 years. Most tumors were stage III (84.6%), embryonal/FOX01 fusion negative (68.1%), and located in unfavorable sites (95.6%). Median primary tumor diameter at diagnosis was 7.4 cm (range, 5.2-17.6, including 37% of tumors ≥8 cm). Most patients (75%) received high-dose alkylating CT regimens. Median total dose to PTV2, defined by postinduction CT residual disease, was 50.4 Gy, and 40% received doses between 54 and 59 Gy. All patients underwent proton therapy. With a median follow-up of 7 years (range, 0.7-14.9), 5-year LC, PFS, and overall survival were 74%, 57%, and 66%, respectively. There were 23 in-field recurrences, 3 marginal recurrences, and 17 distant metastases. Significant predictors of improved PFS and OS were age 3-10 at diagnosis and embryonal histology/FOX01 fusion negative status. There were 3 acute grade 3 toxicities (diarrhea, laryngeal edema, and urinary tract obstruction) and 10% started enteral nutrition during radiotherapy due to mucositis. Nineteen patients experienced 23 late toxicities requiring surgical or serious medical intervention, primarily cataracts (n=7), hearing loss (n=5), TIA/stroke (n=3), and dental caries (n=2). No acute or late grade ≥4 toxicities were observed, nor any secondary malignancies. <h3>Conclusion</h3> Compared to historic data, the 74% 5-year LC observed in our cohort suggests that dose escalation of a postinduction tumor volume with proton therapy may partially mitigate negative risk factors in patients with large group III IR-RMS arising in unfavorable sites without increasing major toxicity. This single-institution experience serves as a benchmark and validates ongoing cooperative group pursuits within COG and SIOP to better characterize the therapeutic ratio of radiation dose escalation in children with IR-RMS.

Paratesticular Desmoplastic Tumor: Case Report and Review of Literature

Paratesticular Desmoplastic Tumor: Case Report and Review of Literature

A diagnostic approach to paratesticular lesions with tubulopapillary architecture: a series of 16 serous borderline tumors/low-grade serous carcinoma and 14 well-differentiated papillary mesothelial tumors and mesothelioma

As there is limited literature on paratesticular tumors of müllerian and mesothelial origin, we reviewed archived cases of serous borderline tumors (n=15), low-grade serous carcinoma (n=1), well-differentiated papillary mesothelial tumors (WDPMTs; n=2), and mesothelioma (n=12), for relevant clinicopathologic features. Molecular profiling data from the American Association for Cancer Research (AACR) GENIE registry was accessed for 8 additional patients with testicular mesothelioma. For tumors of mesothelial origin, the median age at surgical excision was 62 years, the median size was 4.5cm, and they consistently exhibited positivity for mesothelial markers (CK5/6, calretinin, WT1, and D2-40). Recurrent alterations of the NF2 gene were identified in 3 of 8patients (38%), and alterations of BAP1 and CDKN2A were relatively infrequent. While one patient with WDPMT had a recurrence, a second patient with WDPMT progressed to a biphasic mesothelioma 2 years after initial resection. For tumors of müllerian origin, the median age at surgical excision was 45 years, the median size was 2.5cm, and these exhibited consistent positivity for ER, WT1, and PAX8. Although no recurrences were documented in patients with serous borderline tumors, a single patient with a low-grade serous carcinoma developed widely metastatic disease and died of disease-related complications. Our study emphasizes the need for close clinical follow-up in patients with WDPMT and highlights the prognostic significance of documenting invasive behavior in tumors of müllerian origin as they can have an aggressive clinical course. Finally, our results suggest that NF2 alterations may play an important role in the pathogenesis of testicular mesothelioma.

Imaging of Pediatric Testicular and Para-Testicular Tumors: A Pictural Review.

Simple SummaryPediatric testicular tumors are rare and represent 1% to 2% of all solid tumors in children. Germ-cell tumors are the most frequent etiology; most are benign in the pre-pubertal population, whereas post-pubertal testicular tumors are similar to those that occur in adults, with potential malignancy. The development of testis-sparing surgery for presumed benign lesions enhances the need for better pre-operative tumor characterization by imaging, among other tools. Ultrasonography (US) remains the first-line examination for scrotal pathology assessment, but other techniques such as contrast-enhanced US, elastography, or scrotal MRI are emerging modalities for scrotal evaluation both in children and adults. This review provides an overview of imaging features of the most frequent testicular and para-testicular tumor types in children and discusses the role of imaging in disease staging and monitoring children with testicular tumors or risk factors for testicular tumors.Pre- and post-pubertal testicular tumors are two distinct entities in terms of epidemiology, diagnosis and treatment. Most pre-pubertal tumors are benign; the most frequent are teratomas, and the most common malignant tumors are yolk-sac tumors. Post-pubertal tumors are similar to those found in adults and are more likely to be malignant. Imaging plays a pivotal role in the diagnosis, staging and follow-up. The appearance on ultrasonography (US) is especially helpful to differentiate benign lesions that could be candidates for testis-sparing surgery from malignant ones that require radical orchidectomy. Some specific imaging patterns are described for benign lesions: epidermoid cysts, mature cystic teratomas and Leydig-cell tumors. Benign tumors tend to be well-circumscribed, with decreased Doppler flow on US, but malignancy should be suspected when US shows an inhomogeneous, not-well-described lesion with internal blood flow. Imaging features should always be interpreted in combination with clinical and biological data including serum levels of tumor markers and even intra-operative frozen sections in case of conservative surgery to raise any concerns of malignity. This review provides an overview of imaging features of the most frequent testicular and para-testicular tumor types in children and the value of imaging in disease staging and monitoring children with testicular tumors or risk factors for testicular tumors.

Leiomyosarcoma of the spermatic cord: a rare paratesticular neoplasm case report

BackgroundPrimary soft tissue sarcomas contribute to only 2% of all malignancies arising from the male genitourinary tract. Leiomyosarcoma (LMS) is a malignant soft tissue neoplasm which originates from the mesenchyme and has a characteristic smooth muscle differentiation. Usually, it presents as a painless, firm, slow-growing unilateral scrotal mass. Investigations include imaging, tumor markers, and histopathology.Case presentationA 65-year-old gentleman known diabetic and beta-thalassemic trait was referred to the Urology OPD at Letterkenny University Hospital. His presenting complaint was a left groin lump that appeared 1 year ago and was growing larger in size gradually. According to the patient, his lump was slightly painful (localized) initially that later became painless. He did not report any testicular trauma/infection or UTI. There was no significant history of malignancies running through his family. Clinical examination revealed a soft and lax abdomen, normal testes. There was a non-tender 2cm x 2cm well-circumscribed, mobile, firm to cystic irreducible left inguinoscrotal mass and appeared to be attached to the spermatic cord. Cough impulse was indiscernible. Ultrasound left groin showed 1.8 cm transverse x 1.4 cm AP x 1.9 cm sagittal) well-circumscribed ovoid nodular subcutaneous lesion present in the upper left inguinal area just lateral to the left pubic tubercle that appeared solid with heterogeneous internal echotexture and no internal calcification. Some internal vascularity is demonstrated with color Doppler assessment.ConclusionBecause of its rareness, LMS represents a management conundrum. There is no standard protocol for treatment. We present a case and discuss the available evidence from the literature to date to help identify LMS of the spermatic cord that is highly unusual.

Rare intrascrotal tumors in a tertiary cancer center: A retrospective case series.

415 Background: Given their rarity, the literature on non-germ cell testicular tumors and paratesticular malignancies is still scarce. The objective of this study is to describe clinical and pathological features, as well as treatment patterns and outcomes, of patients with non-germ cell intrascrotal malignancies. Methods: Patients (pts) with benign or malignant non-germ cell intrascrotal tumors who were older than 18 years-old were deemed eligible. Electronic health records (EHR) were reviewed to assess pts clinical features, and disease characteristics and outcomes. Descriptive statistics was used to report data. RECIST 1.1 was used to determine radiological response to treatment. Time-to-event variables were estimated by the Kaplan-Meier method. Results: EHR of 885 pts with a primary diagnosis of ICD-10 C62 treated in a tertiary cancer center from January 2009 to June 2020 were reviewed for eligibility. 29 pts fulfilled eligibility criteria (Sertoli cell tumors, N = 3; Leydig cell tumors, N = 6; granulosa cell tumor, N = 1; testicular tumor of the androgenital syndrome, N = 1; mesotheliomas, N = 3; liposarcomas, N = 3; leiomyosarcomas N = 2; rhabdomyosarcomas, N = 3; spindle cell sarcomas, N = 3; lymphomas, N = 2; carcinoma of the rete testis, N = 1; primary neuroendocrine tumor of the testis, N = 1). The majority of pts (N = 25) had non-metastatic disease at diagnosis, and underwent upfront orchiectomy. The remaining four patients had metastatic disease at diagnosis (lymphoma, N = 1; sarcomas, N = 3), all positive for lymph node (LN) involvement; one with concurrent visceral metastasis. Six other pts posteriorly developed metastatic disease after a median follow-up of 13 months (IQR: 5.8–33.1 months) (Leydig tumor, N = 1; mesothelioma, N = 2; sarcomas, N = 3). The most common metastatic sites were LN (N = 8, 80%), lung (N = 4, 40%), bone (N = 3, 30%), adrenal gland (N = 2, 20%), peritoneum (N = 1, 10%), and skin (N = 1, 10%). Nine pts (90%) received systemic treatment: vincristine, doxorubicin and cyclophosphamide for rhabdomyosarcomas (N = 3), cisplatin plus pemetrexed for mesotheliomas (N = 2), doxorubicin for liposarcomas (N = 2), doxorubicin plus ifosfamide for liposarcoma (N = 1) and doxorubicin, vincristine, cyclophosphamide, and prednisone plus rituximab for lymphoma (N = 1). Of those, 2 pts achieved partial response and 2 had stable disease. Metastasectomy of a single lung metastasis was performed in a patient with metastatic Leydig cell tumor. Median overall survival was 51.2 and 24.5 months for patients with localized and metastatic disease, respectively. Conclusions: Paratesticular and non-germ cell testicular tumors are extremely rare entities with relatively good prognosis if treated at early stages depending on the underlying histology. Most metastatic disease cases were due to paratesticular sarcomas.

A Rare Case of Bilateral Paratesticular Malignant Mesothelioma of Tunica Vaginalis with Bilateral Hydrocele

Paratesticular region is an indeterminate anatomical region including the spermatic cord with its contents- tunica vaginalis of the testes, epididymis and its appendices and testis. Paratesticular tumours may mimic testicular tumours and is clinically indistinguishable. Paratesticular malignant mesothelioma is an extremely rare tumour, representing only 0.3-5% of all mesotheliomas. There is not a specific clinical presentation however, it may present as a mass which is painless or as a hydrocele, having a wide age distribution. Lack of specific tumour markers presents a challenge in its diagnosis and management. Extreme diagnostic difficulty arises preoperatively in distinguishing malignant and benign tumour. Most of the cases are diagnosed intraoperatively or postoperatively when found on biopsy. Pleural and peritoneal mesotheliomas are known to occur in individuals exposed to asbestos. The case reported here is of a 32-year-old male who reported in the Out Patient Department (OPD) with the complaint of painless bilateral enlarged scrotum without history of exposure to asbestos. Bilateral orchidectomy followed by biopsy reported paratesticular malignant mesothelioma. Bilateral malignant mesothelioma of tunica vaginalis with bilateral hydrocele occurrence is rare, and it has an aggressive clinical progression, so clinical presentation and histopathology features are being presented to emphasise on the fact that it is critical for the urologists to be aware of such potentially rare entity. A mandatory high index of clinical suspicion is required, as lack of knowledge would result in an unnecessary radical orchidectomy as happened in present case.

Diagnosis and Treatment of Paratesticular Tumors: A 10-Year Experience with 19 Cases of Single Center

Diagnosis and Treatment of Paratesticular Tumors: A 10-Year Experience with 19 Cases of Single Center

Testicular and Paratesticular Tumors in Children

Testicular and Paratesticular Tumors in Children

Paratesticular fibrous pseudotumour in a 26-year-old Nigerian man: A case report.

Introduction and importanceBenign fibroblastic proliferation located within the scrotum are uncommon. They are also identified as fibrous pseudotumour and usually arise from the paratesticular region. Their pathogenesis is unknown. These tumours are difficult to diagnose pre-operatively and resemble intra-scrotal malignancy.Case presentationWe managed a 26-year-old Nigerian man with a five-year history of left sided hemiscrotal swelling. The mass was excised, and histology showed benign fibroblastic proliferation.DiscussionMost paratesticular tumours are benign. Imaging studies that show the mass as separate from the testis, normal levels of tumour markers and clinical features not suggestive of malignancy make the case for organ-sparing mass excision, in the treatment of paratesticular fibrous pseudotumour, very strong.ConclusionIntra-scrotal benign fibrous proliferation is a challenge to diagnose pre-operatively but excision of this benign mass without an orchidectomy is practicable when pre-operative assessment suggests a benign disease.