Paratesticular Tumors Research Articles

Histopathologic pattern of neoplastic testicular and paratesticular lesions in university of Maiduguri teaching hospital: A 10-year retrospective review

Objective: The present study is undertaken to describe the spectrum of histopathological features and age distribution of neoplastic testicular and paratesticular lesions in the University of Maiduguri Teaching Hospital.Materials and Methods: A retrospective descriptive study of 14 testicular and paratesticular neoplastic lesions was conducted over a period of 10 years; between January-2005 and December-2014 in the Department of Histopathology, University of Maiduguri Teaching Hospital. Histopathological examination was done after routine processing and staining with Haematoxylin & Eosin.Results: There were 14 cases of neoplastic testicular and paratesticular tumours of which 12cases (85.7%) were malignant lesions and 2 (14.3%) were benign. There were 7 cases (50.0%) of testicular germ cell tumours, 4 cases (28.6%) of paratesticular tumoursand 3 cases (21.4%) of metastasis to the testis. The testicular germ cell tumours also accounted for 100% of all primary testicular tumours. These included 3 cases (42.9%) of seminoma and teratoma each and a case (14.3%) of endodermal sinus tumour (yolk sac tumour). The age distribution of the testicular and paratesticular tumours in this study shows that the majority of malignant lesions were present in the third and sixth decades of life (66.6%), while the only two benign lesions have also one case each in the third and sixth decades of life. The study also shows thatonly 2 cases were seen in the second decade of life; a case of seminoma in a 14-year-old boy and rhabdomyosarcoma in 15 years old, while the oldest patient was a 61-year-old male whose diagnosis was yolk sac tumour.Conclusion: This study highlights the rarity of testicular tumours in Maiduguri, Northeastern Nigeria and correlates well with the histopathological spectrum of testicular tumours in other parts of the world. The relative higher percentage of up 21.4% of cases of metastasis to the testis also emphasizes the need for thorough evaluation of testicular specimens especially in cases of advanced carcinoma of the prostate.Keywords: testicular, neoplastic lesions, histopathology

Epididymal Adenomatoid Tumor: A Very Rare Paratesticular Tumor of Childhood.

Adenomatoid tumor is an uncommon benign mesothelial neoplasm, usually localized in the epididymis. It is the most common paratesticular tumor of middle-aged patients (average age of clinical presentation: 36 years). However, these tumors in pediatric and pubertal patients are extremely rare. Due to their rarity, we present a case of adenomatoid tumor of the tail of the epididymis in a 16-year-old patient. After systematic research of the current literature, we did not find another case report of epididymal adenomatoid tumor in a male patient aged 16 years old or less. This notice and our concern, as well, about the patient's surveillance protocol during the postoperative period were the motive for this case study.

Conservative Treatment of Serous Borderline Paratesticular Tumor in a Pediatric Patient

Serous borderline tumors are rare neoplasms. Herein we report our conservative approach, whose rationale is neoplasm low-malignant potential. Tumor was removed under general anesthesia, and frozen section ruled out a germinal malignancy or a stromal tumor such as rhabdomyosarcoma. Ultrasound evaluation was initially performed every 3 months during the first 2 years, every 6 months during the next 3 years, and annually thereafter. After 8 years, the patient has not experienced any relapse, either clinical or ultrasonographical. In our opinion, conservative approach, whose final decision relies on intraoperative frozen section, represents the best option and does not jeopardize long-term oncological outcome.

Paratesticular Tumors and Clinicopathologic Approach

Paratesticular Tumors and Clinicopathologic Approach

Commentary on “A Case of Paratesticular Leiomyosarcoma Successfully Treated with Orchiectomy and Chemotherapy”

Commentary on “A Case of Paratesticular Leiomyosarcoma Successfully Treated with Orchiectomy and Chemotherapy”

Rare case of paratesticular rhabdomyosarcoma

Extremities are the usual site of involvement in Rhabdomyosarcomas whereas paratesticular rhabdomyosarcoma is an extremely rare, which is known to be an aggressive variety of paratesticular tumors occurring in first and second decades of life. They usually develop from the tunica, epididymis or the spermatic cord. Precise preoperative diagnosis is seldom established. It can be mistaken as epididymitis, scrotal abscess, hydrocele, testicular tumors, tuberculosis of testis and strangulated or obstructed inguinal hernia, as in our case. Multidisciplinary approach is needed for the management and disease localized to the scrotum has a favorable outcome.

Testicular capillary hemangioma: Case report

Testicular capillary hemangioma: Case report

Paratesticular metastasis from colorectal adenocarcinoma

Paratesticular tumors are rare, especially when they are metastatic. Most of them originate in the prostate, kidney, gastrointestinal tract, lung, and breast. The most common site of metastasis from the gastrointestinal tract is the colon. A 75-year-old male presented with a painless and tense right scrotal mass. He underwent a radical right orchiectomy, and the pathology revealed mucinous cystadenocarcinoma of the paratesticular tissue. Computed tomography revealed focal wall thickening at the rectosigmoid junction and liver nodules. The colonoscopic biopsy of the mass showed adenocarcinoma. Immunohistochemical staining of both sites confirmed the diagnosis of colorectal adenocarcinoma metastatic to the scrotum.

Primary Paratesticular Mucinous “Ovarian-Type” Adenocarcinoma: A Rare Case of Scrotal Tumor in a Patient With History of Bilateral Cryptorchidism

Ovarian-type epithelial tumors are extremely rare in testis and paratestis, and in literature no cases of this tumor are reported in a patient with history of bilateral cryptorchidism. We describe a case of an 81-year-old man with a scrotal ulcerative lesion associated with signs of infection. After a skin biopsy showing tumor cells and mucin, we performed a surgical resection of this scrotal lesion and the final pathologic examination revealed a mucinous adenocarcinoma with medium grade of differentiation. The pathologist suggested performing additional tests of this tumor to differentiate it from mucinous “ovarian-type” paratesticular tumor and from a metastatic tumor. We did not find any tumor of different type. We discuss clinical presentation, differential diagnosis and treatment of this rare tumor. World J Nephrol Urol. 2015;4(4):260-263 doi: http://dx.doi.org/10.14740/wjnu235w

Adenomatoid Tumor of the Tunica Albuginea in a Boy: A Case Report and Literature Review.

Adenomatoid tumors (AT) are the most common paratesticular neoplasms and account for approximately 30% of all paratesticular masses. Most of them occur in the third or fourth decade and present as well-defined firm and painless masses. We report here a case of adenomatoid tumor from tunica albuginea. This patient is a 12-year-old boy with left testicular pain for 6 months. Scrotal ultrasonography revealed a solid mass of paratesticular origin. The histology and immunohistochemistry confirmed the final diagnosis. A right tumor resection was performed. Because of its rarity, the clinical and histopathologic appearance is seldom illustrated. Here we present a case report and a comprehensive literature review with the objective of providing useful information on this entity.

Shorter-Duration Therapy Using Vincristine, Dactinomycin, and Lower-Dose Cyclophosphamide With or Without Radiotherapy for Patients With Newly Diagnosed Low-Risk Rhabdomyosarcoma: A Report From the Soft Tissue Sarcoma Committee of the Children's Oncology Group

Intergroup Rhabdomyosarcoma Study Group (IRSG) studies III and IV showed improved failure-free survival (FFS) rates with vincristine, dactinomycin, and cyclophosphamide (VAC; total cumulative cyclophosphamide dose, 26.4 g/m(2)) compared with vincristine and dactinomycin (VA) for patients with subset-one low-risk embryonal rhabdomyosarcoma (ERMS; stage 1/2 group I/II ERMS or stage 1 group III orbit ERMS). The objective of Children's Oncology Group ARST0331 was to reduce the length of therapy without compromising FFS for this subset of low-risk patients by using VA in combination with lower-dose cyclophosphamide (total cumulative dose, 4.8 g/m(2)) plus radiotherapy (RT). This noninferiority prospective clinical trial enrolled newly diagnosed patients with subset-one clinical features. Therapy included four cycles of VAC followed by four cycles of VA over 22 weeks. Patients with microscopic or gross residual disease at study entry received RT. With a median follow-up of 4.3 years, we observed 35 failures among 271 eligible patients versus 48.4 expected failures, calculated using a fixed outcome based on the FFS expected for similar patients treated on the IRSG D9602 protocol. The estimated 3-year FFS rate was 89% (95% CI, 85% to 92%), and the overall survival rate was 98% (95% CI, 95% to 99%). Patients with paratesticular tumors had the most favorable outcome. Three-year cumulative incidence rates for any local, regional, or distant failures were 7.6%, 1.5%, and 3.4%, respectively. Shorter-duration therapy that included lower-dose cyclophosphamide and RT did not compromise FFS for patients with subset-one low-risk ERMS.

Testicular and paratesticular tumors and tumor-like lesions in the first 2 decades.

The spectrum of testicular tumors and tumor-like lesions that affect young patients (defined for purposes of this article as less than 20 years old) differs significantly from that in an older age group. Although germ cell tumors remain the single largest category, they are a smaller proportion than in adults. Furthermore the pathogenesis and behavior of comparably named germ cell tumors differ depending on whether or not they have developed in prepubertal or postpubertal patients. This is most apparent for the teratomas, which are almost uniformly benign in children but, with some notable exceptions, malignant in the older patients. But even the most common malignant tumor of the testis in children, the yolk sac tumor, despite its identical morphology, lacks the association with other germ cell tumor types, including intratubular germ cell neoplasia, and more aggressive behavior that typify the adult tumors. Among the sex cord-stromal tumors, the juvenile granulosa cell tumor predominates in children, mostly occurs in those under 1-year old, and, for all intents and purposes, is not seen in the postpubertal period. It has a distinctive morphology and, to date, a uniformly benign outcome. There are additional tumors in the sex cord-stromal group that are mostly seen in young patients, including the large cell calcifying Sertoli cell tumor and intratubular large cell hyalinizing Sertoli cell neoplasia. The former is sometimes associated with the Carney syndrome and, to date, all of the latter with the Peutz-Jeghers syndrome. The subtypes of lymphomas and leukemias that involve the testis in children are rare in older patients, and similar remarks pertain to the metastatic tumors, where neuroblastoma (especially) and Wilms׳ tumor are most common but may be mimicked by primary tumors originating in the paratestis. The pseudoneoplastic lesion, the testicular "tumor" of the adrenogenital syndrome, is usually found in young patients and bears a strong resemblance to the Leydig cell tumor, although there are features that allow its distinction, which is important given its frequently bilateral nature and amenability to medical management through glucocorticoid administration. One of the preferential sites for embryonal rhabdomyosarcoma is the paratestis of young patients, where the spindle cell variant predominates. The melanotic neuroectodermal tumor (retinal anlage tumor) usually occurs in the first year of life, typically involves the epididymis, and uncommonly metastasizes. Occasional cases of the desmoplastic small round cell tumor present in the paratestis of teenagers, and some distinctive tumor-like lesions of the paratestis may also be seen, including meconium periorchitis and splenic-gonadal fusion (occupying both testis and paratestis). These tumors and tumor-like lesions and many others are discussed in this review with the hope it will provide the diagnostic pathologist aid in recognizing the lesions and providing some insight into their clinical significance.

The large pediatric scrotum: ultrasound technique and differential considerations.

Scrotal enlargement in the pediatric population is caused by a variety of pathologic processes including hydroceles, hernias, varicoceles, testicular torsion, testicular or paratesticular infection, trauma, or neoplasm; adrenal rests; or scrotal skin edema. The clinical presentation of scrotal enlargement is often nonspecific, and ultrasound plays a key role in making the correct diagnosis. In this pictorial review, we review the ultrasound protocol for performing scrotal ultrasound in pediatric patients and illustrate the ultrasound appearance of conditions resulting in scrotal enlargement.

Rare case of intra-testicular adenomatoid tumour

Adenomatoid tumors are rare benign neoplasms considered of mesothelial origin. They are usually asymptomatic and slow growing masses. They account for 30% of paratesticular tumors and very rarely involve the testicular parenchyma. Only ten such cases have been reported in the literature so far. Ideal treatment should be excision of the tumor avoiding orchidectomy. Nevertheless, because of the rarity of the lesion and the difficulty of distinguishing it from malignancy, radical orchidectomy is often performed. We describe a case of a 31 years old caucasian man who presented with a moderately symptomatic left testicular mass, normal tumor markers and normal sex hormones levels. The ultrasound showed an hypoechoic intratesticular nodule of 0.8 cm in diameter. The patient underwent intraoperative frozen section of the nodule which could not exclude malignancy with certainty. A radical orchiectomy was therefore performed. Subsequent definitive histological and molecular report described an adenomatoid tumor involving the parenchyma of the testis.

Adenomatoid tumors of the testis: A report of two cases and review of the literature.

Adenomatoid tumors are rare benign neoplasms that normally occur in the scrotum. The clinical symptoms and routine examinations mean that it is difficult to distinguish adenomatoid tumors from malignant intratesticular solid tumors, which may result in unnecessary orchidectomies. The present report describes two adenomatoid tumor patients treated between 2006 and 2013 at the Peking University Shenzhen Hospital who presented with an asymptomatic mass in the scrotum. Based on thorough analysis of clinical features, blood, radiological images and intra-operative findings, limited local excisions were performed, revealing adenomatoid tumors of the testis on pathological examination. The patients were followed up and exhibit no recurrence at the time of writing. The present report also summarizes the morphological and immunohistochemical features of paratesticular tumors and reviews the literature to improve understanding of these rare lesions and assist in accurate diagnosis.

The giant paratesticular tumor in elderly

Paratesticular tumor is an extremely rare. We present a case of paratesticular tumor in an elderly person of 84-year-old, which was presented as very large localized intrascrotal mass. This required subsequently orchidectomy. Histopathology confirmed the diagnosis as serous cystadenoma. Such a giant paratesticular mass, which was localized, has not been described previously.

High grade myofibroblastic sarcoma of paratesticular soft tissues.

Tumors of the paratesticular region most often arise from the soft tissue surrounding the spermatic cord and the epididymis or from the soft tissue (dartos muscle) of the scrotal wall. Paratesticular tumors, despite their rarity, present a high incidence of malignancy (30%), and the therapeutic approach of choice is surgical resection with negative margin. The grade, the histology type, the presence of metastases during the diagnosis, the size of the tumor, the age of the patients, and the surgical margins are all important prognostic factors. We present a case report of a 86-year-old patient with a high grade paratesticular and scrotum sarcoma of soft tissues which was presented as a hard painful mass of the scrotum. The patient was subjected to high ligation of the spermatic cord and received no further treatment and 6 months after the operation no local or systematic recurrence was observed.

Paratesticular inflammatory myofibroblastic tumor in a pediatric patient.

Although rare, paratesticular inflammatory myofibroblastic tumor (IMT) represents the second most common paratesticular mass after adenomatoid tumor and comprises roughly 6% of such lesions. Only approximately four cases have been reported in patients younger than 18 years of age. We report an incidentally discovered paratesticular IMT in a 17-year-old male successfully treated with wide excision and testis sparing. To our knowledge, no recurrence has been reported after complete excision of paratesticular IMT; however, continued follow-up is recommended.

Prepubertal testicular tumours: Should testicular-sparing surgery be considered? A single-institution experience and review of the literature

ObjectivesTo review our 10-year experience with uncommon testicular tumours in children (prepubertal testicular and paratesticular), to review previous reports, and to determine the appropriate management of these rare tumours, specifically the role of testicular-sparing surgery. Patients and methodsWe retrospectively reviewed all cases of testicular tumours managed at our institution between 1999 and 2009. Boys aged <16years were included in the study. The patients’ characteristics, presentation, the diagnostic tools, tumour markers, mode of treatment, pathological findings and outcome were assessed. We reviewed previous reports that addressed testicular and paratesticular tumours in prepubertal boys, using a Medline/PubMed search. ResultsFrom 80 patients, 13 boys (median age 8.7years) presented with testicular tumours (16%) and were included in the study. Two boys presented with precocious puberty and one with gynaecomastia. The level of α-fetoprotein was high in three boys, and the human chorionic gonadotrophin level was elevated in one, and both markers were high in one. Testicular-sparing surgery was performed in three boys. Six of the 13 tumours were malignant and seven were benign. None of the patients developed a recurrence or testicular atrophy after testicular-sparing surgery. From the review of previous reports we devised an evidence-based algorithm for managing prepubertal testicular tumours. ConclusionsPaediatric testicular tumours are rare but they require an inguinal approach for either orchidectomy or testicular-sparing surgery; we recommend the latter option as long as frozen sections are analysed and a safety margin is maintained.

English

Paratesticular tumours are rare but generally benign neoplasms, of mesothelial in origin. Adenomatoid tumours of epididymis are uncommon and accounts for 30% of all paratesticular neoplasms. A case of Adenomatoid tumor arising from tail of right epididymis is presented with ultrasound imaging features and review of literature.