Adenomatoid tumor of the tunica albuginea

Abstract

Adenomatoid tumors are benign mesothelial tumors most commonly found in the paratesticular structures, especially the epididymis. Herein, we report a case of adenomatoid tumor originating in the tunica albuginea and mimicking an intratesticular neoplasm. We review the ultrasonographic presentation and literature regarding adenomatoid tumors originating in the tunica albuginea and testicular parenchyma.Key words adenomatoid, case report, review, testes, tumor, tunica albuginea. Case reportA 44-year-old African-American male presented with a 1 year history of a right midtesticular mass which had progressively enlarged over the last 3 months. He denied having any urinary or constitutional symptoms. On physical examination, his testicles were descended bilaterally with a nodule noted in the midposterior aspect of the right testicle. His physical examination was otherwise unremarkable. Serum tumor markers including b -human chorionic gonadotropin, a -fetoprotein and lactate dehydrogenase were normal. Scrotal ultrasonography was performed, revealing a right testicular mass (Fig. 1).The patient underwent exploration via a right inguinal approach. After isolating the spermatic cord, an excisional biopsy was sent for intraoperative frozen section analysis (Fig. 2). These sections were suggestive of an epithelial neoplasm, though malignancy could not be excluded. A right radical orchiectomy with high ligation of the cord was therefore performed. Final pathological analysis showed mesothelioid cell invasion from the tunica albuginea into the testicular parenchyma. The tumor cells were positive for CK7 and tumor cell nuclei stained darkly with calretinin (typical of mesotheloid subtype adenomatoid tumors). The tumor itself measured 0.7 ¥ 0.6 ¥ 0.5 cm with clear margins (Figs 3,4).

Adenomatoid paratesticular tumour – Rare presentation in a child

“…There are many theories about their histogenesis: mesothelial, Müllerian, mesonephric and endothelial origin, but the most accepted is the mesothelial origin, supported by electron microscopy and immunohistochemistry findings 2 , 4 …”

“…Scrotal ultrasound is the preoperative imaging method of choice 4 but the findings are nonspecific 1 . It can distinguish testicular from paratesticular and cystic from solid lesions 4 but can present as isoechoic, hypoechoic or hyperechoic (most commonly the latter) 1 , 5 .…”

“…It can distinguish testicular from paratesticular and cystic from solid lesions 4 but can present as isoechoic, hypoechoic or hyperechoic (most commonly the latter) 1 , 5 . Adenomatoid tumours of the tunic are typically benign but can invade the testicule, making it difficult to differentiate from intratesticular tumours 4 .…”

Tumor adenomatoide paratesticular: una serie de nueve casos

“…Queremos destacar la gran plasticidad morfológica del mesotelio, tanto a nivel citológico como estructural; y señalar la ausencia de estructuras papilares en este tumor, que son frecuentes en las proliferaciones reactivas y neoplásicas del tejido mesotelial en la pleura y el peritoneo 12,13 .…”

Tumor adenomatoide de túnica albugínea: Caso clínico

“…Entre las pruebas de imagen la ecografía escrotal es útil para identificar el origen de la lesión, pues diferencia claramente las lesiones testiculares de las paratesticulares 7 . No obstante, esta técnica pierde eficacia a la hora de filiar el origen exacto de la lesión.…”