A 16-year-old male with free medical history presented as an outpatient requesting for consultation regarding a small lump that he palpated two months ago in his right hemiscrotum during self-examination. He did not report any trauma or inflammation of the area neither at the referred period nor in the past. Except for mild discomfort in the hemiscrotum during exercise that subsided after its discontinuation, no other symptoms were reported. Importantly, the size of the lump did not change significantly during this two-month period.\nPhysical examination revealed a small, round, hazelnut-sized, painless mass in the right hemiscrotum, localized in the tail of the epididymis. No other pathological signs were detected at the rest of the scrotum, testicles, or groin.\nU/S examination of the scrotum documented the presence of a solid hypoperfused, hyperechoic, well-demarcated, without invasive behavior mass, localized at the tail of the epididymis, 1.3 × 1.1 cm in size, and including 2 small hypoechoic lesions inside the mass (arrows, ).\nThe typical preoperative laboratory examination (blood routine and coagulation profile) and the values of the specific tumor markers AFP, LDH, CEA, and b-HCG were normal. Surgical treatment was decided and a right scrotal exploration was performed. Macroscopic examination revealed a yellowish uncapsulated mass with maximum diameter of 13 mm located next to the tail of the epididymis ().\nAfter meticulous dissection, the mass was totally dissociated from the epididymis and was excised en-block without any damage to adjacent structures.\nHistological examination of the mass revealed the presence of cuboidal epithelial cells in tubular clusters into a fibrous stroma (). Immunohistochemical evaluation was positive for tumor markers HMBE1 and calretinin, which documented the diagnosis of adenomatoid tumor and its mesothelial origin.\nPostoperative course was uneventful. After a 24-month follow-up period, the patient remains asymptomatic without signs of recurrence.
A 12-year-old boy presented to the andrology department in June 2013 with left testicular pain that he had had for 6 months. There was no history of recent trauma, infection, hydrocele, or undescended testis. He denied having any urinary or constitutional symptoms. Physical examination revealed a hard, tender, 10 mm × 10 mm × 8 mm testicular nodule in the superior aspect of the left testis. The contralateral testicle was normal.\nScrotal ultrasonography (8 to 12 linear array transducer, LOGIQ P5, GE Healthcare, New York, New York State, USA) revealed 8 mm × 10 mm, hypoechoic homogeneous solid mass with unclear margin at the junction of the epididymis and left testis (). Serum tumor markers, including alpha-fetoprotein, beta-human chorionic gonadotropin, and lactate dehydrogenase, were all within normal limits. All preoperative laboratory tests, including complete blood count, biochemistry, and chest X-ray, were normal. A pelvic computerized tomography (CT) scan was negative for retroperitoneal metastasis. The provisional diagnosis was paratesticular tumor, with the possibility of benign nature.\nThe patient was then referred to our institution for surgical treatment. The left inguinal approach was established and the left spermatic cord was identified. On visual inspection, the tumor arose from the tunica albuginea protruding into the testis parenchyma. Intraoperative frozen-section biopsy showed benign tumor from tunica albuginea. Subsequently, a right tumor resection including removing a portion of tunica albuginea was performed.\nFinal histological examination confirmed the diagnosis of AT from the tunica albuginea (). Immunohistochemical analysis revealed the tumor cells were positive for calretinin, cytokeratin, and vimentin (). The postoperative course was uneventful. After 12 months of follow-up, the patient was asymptomatic without any evidence of local recurrence.