Table of Contents  
CASE REPORT
Year : 2014  |  Volume : 7  |  Issue : 4  |  Page : 522-524  

The giant paratesticular tumor in elderly


Department of Urology, Padmashree Dr. D.Y. Patil Medical College, Hospital and Research Centre, Dr. D.Y. Patil Vidyapeeth, Pimpri, Pune, India

Date of Web Publication25-Jun-2014

Correspondence Address:
Parag S Bhirud
Bhirud Hospital, Bhusawal, Jalgaon, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0975-2870.135298

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  Abstract 

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.

Keywords: e0 lderly, giant, paratesticular tumor


How to cite this article:
Bhirud PS, Kankalia S. The giant paratesticular tumor in elderly. Med J DY Patil Univ 2014;7:522-4

How to cite this URL:
Bhirud PS, Kankalia S. The giant paratesticular tumor in elderly. Med J DY Patil Univ [serial online] 2014 [cited 2021 Sep 29];7:522-4. Available from: https://www.mjdrdypu.org/text.asp?2014/7/4/522/135298


  Introduction Top


Giant localized paratesticular tumor in an elderly is an extremely rare case. We present a case of giant benign paratesticular mass treated by local excision. The diagnosis may be challenging and is of clinical importance because these lesions may mimic a teratoma and teratomas in post-pubertal males carry a malignant potential regardless of the degree of maturation. [1]


  Case Report Top


An 84-year-old male presented with painless intrascrotal mass on the left side [Figure 1]. Patient noticed swelling 12 years back, which was slowly growing. No cough impulse was present and swelling was irreducible. On examination, swelling was hard in consistency and testis was palpable separately from mass except on posterior aspect, where clinically mass was inseparable from testis. Ultrasonography was carried out, which showed normal testis and mass behind the testis and minimal hydrocele. For completion of staging abdominal computed tomography scan and chest X-ray were carried out and were normal. Surgery was planned and inguinoscrotal incision was taken to perform high orchidectomy. Cord was isolated and ligated at deep ring [Figure 2]. Orchidectomy was done [Figure 3] and scrotal reduction procedure performed to remove excess of scrotal skin. Specimen was sent for histopathology examination - which subsequently came as serous cystadenoma [Figure 4]. Post-operative period was uneventful.
Figure 1: Pre-operative paratesticular tumor extending up to knee

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Figure 2: Intra-operative testis with paratesicular tumor

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Figure 3: Post-operative specimen of testis with paratesticular tumor

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Figure 4: Histopathology showing serous cystadenoma

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  Discussion Top


Primary tumors of epididymis are rare and are most commonly benign. Adenomatoid tumors of the epididymis are the most common and typically occur in the third and fourth decade of life. They are generally asymptomatic solid lesions that arise from any portion of the epididymis.

Cystadenomas are benign lesions of the epididymis that are bilateral in 30% of cases and are frequently seen in association with von Hippel-Lindau disease. [2] A few case reports and reviews of testicular and paratesticular mucinous neoplasms resembling ovarian tumors have suggested the possibility of a müllerian origin of these tumors. However, no histologic evidence has been found to support such a histogenesis. [1] Tumors reminiscent of müllerian epithelial tumors of the ovary have been reported outside of the ovary, including in the pancreas and paratesticular region. The latter are most commonly serous tumors of borderline malignant potential and involve the tunicae. [3] Benign epididymal epithelial tumors are very uncommon. Their frequency rating is as follows: adenomatoid tumor, leiomyoma and papilliferous cystadenoma. [4] Epididymal nodules are frequently encountered in the epididymis. Their differential diagnosis includes chronic granulomatous epididymitis, adenomatoidtumor and benign paratesticular neoplasms. Singh et al. consider that it is important to distinguish epididymal nodules from benign inflammatory lesions and the threshold for a surgical excision should be low as it is therapeutic and provides a definite diagnosis. Whilst the fine needle aspiration cytology alone may not be always adequate to confirm diagnosis, an epididymectomy may be curative-as well as diagnostic in selected cases. [5]

Although its etiopathogenesis remains unclear, the mesothelial hypothesis is the most widely accepted. [6]

Diagnosis of müllerian type tumors - serous or mucinous adenocarcinomas, adenomas or borderline tumors, have been identified in the epididymis. [7],[8] Adenomatoidtumor of epididymis, when suspected, conservative surgery must be performed. [9] Romero Pérez et al., performed simple local excision safely for epididymal tumors. [4] Although benign in nature, but because they are difficult to differentiate from testicular malignancy these men are often subjected to radical orchiectomy. [10] A practical problem faced by clinicians is to differentiate this condition pre-operatively from the much commoner testicular malignancy so as to avoid high inguinal orchiectomy especially in younger men. Because of its rarity radiological features are still not well-defined. The adenomatoid tumor does not produce any characteristic pattern on ultrasound that would allow it to be distinguished from malignant testicular tumors because they can be hypo, hyper or even isoechoic as regards the adjacent parenchyma. [11] The finding on contrast-enhanced magnetic resonance imaging (MRI) are more useful in diagnosing this condition. [12] It provides additional morphological evidence to allow precise localization of the origin of the mass, may also show contrast-enhancement features that enable further confidence of a benign diagnosis and may allow conservative management. [13] Goel et al. have used such MRI findings for conservative approach for such clinical condition and could save the testis. [14]

 
  References Top

1.Uschuplich V, Hilsenbeck JR, Velasco CR. Paratesticular mucinous cystadenoma arising from an oviduct-like müllerian remnant: A case report and review of the literature. Arch Pathol Lab Med 2006;130:1715-7.  Back to cited text no. 1
    
2.Joseph CP. Genital tumors. In: Tanagho EA, McAninch JW, editors. Smith's General Urology. 16 th ed. New York: Lange; 2004. p. 394.  Back to cited text no. 2
    
3.Talmon GA, Johannson SL. Serous cystadenoma of the epididymis. Urology 2007;70:372.e7-8.  Back to cited text no. 3
    
4.Romero Pérez P, Amat Cecilia M, Rafie Mazketli W, Merenciano Cortina FJ, Laforga Canales JB. Epididymal adenomatoid tumor. Review of the national literature and report of a case. Actas Urol Esp 1996;20:839-43.  Back to cited text no. 4
    
5.Singh I, Dev G, Singh N. Chronic epididymitis (epididymal nodule) mimicking an adenomatoid tumor - Case report with review of literature. Int Urol Nephrol 2002;34:219-22.  Back to cited text no. 5
    
6.Sánchez Gómez E, Huesa Martínez JI, Pérez Pérez M, Campoy Moreno JR. Adenomatoid tumor of the epididymis: Report of a new case. Arch Esp Urol 1995;48:643-5.  Back to cited text no. 6
    
7.De Nictolis M, Tommasoni S, Fabris G, Prat J. Intratesticular serous cystadenoma of borderline malignancy. A pathological, histochemical and DNA content study of a case with long-term follow-up. Virchows Arch A Pathol Anat Histopathol 1993;423:221-5.  Back to cited text no. 7
    
8.Young RH, Scully RE. Testicular and paratesticular tumors and tumor-like lesions of ovarian common epithelial and müllerian types: A report of four cases and review of the literature. Am J Clin Pathol 1986;86:146-52.  Back to cited text no. 8
    
9.Moyano Calvo JL, Giraldez Puig J, Sánchez de la Vega J, Dávalos Casanova G, Morales López A. Adenomatoid tumor of the epididymis. Actas Urol Esp 2007;31:417-9.  Back to cited text no. 9
    
10.Horstman WG, Sands JP, Hooper DG. Adenomatoid tumor of testicle. Urology 1992;40:359-61.  Back to cited text no. 10
    
11.Pacheco AJ, Torres JL, de la Guardia FV, Arrabal Polo MA, Gómez AZ. Intraparenchymatous adenomatoid tumor dependent on the rete testis: A case report and review of literature. Indian J Urol 2009;25:126-8.  Back to cited text no. 11
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12.Watanabe Y, Dohke M, Ohkubo K, Ishimori T, Amoh Y, Okumura A, et al. Scrotal disorders: Evaluation of testicular enhancement patterns at dynamic contrast-enhanced subtraction MR imaging. Radiology 2000;217:219-27.  Back to cited text no. 12
    
13.Patel MD, Silva AC. MRI of an adenomatoid tumor of the tunica albuginea. AJR Am J Roentgenol 2004;182:415-7.  Back to cited text no. 13
    
14.Goel A, Jain A, Dalela D. Can radical orchiectomy be avoided for paratesticular adenomatoid tumor? Indian J Urol 2011;27:556-7.  Back to cited text no. 14
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  [Figure 1], [Figure 2], [Figure 3], [Figure 4]



 

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