A 32-year-old man form the Indian subcontinent presented to the emergency department 2 days after having been kicked in the scrotum during a football match with increasing pain and swelling of the right hemiscrotum. A firm discrete mass was noted at the lower pole of the right epididymis that was clinically inseparable from the otherwise unremarkable testicle. The right testicle was nontender and sat in a normal position with no signs of scrotal skin ecchymosis. The history suggested that the scrotal mass had been present for approximately 12 months, and a preliminary diagnosis of a haemorrhagic cyst caused by trauma was made. Initial management included scrotal support, analgesia, and a follow-up magnetic resonance imaging (MRI) scan. The MRI confirmed a 2.3 cm irregular lesion arising posterior to the lower pole of the right testis that enhanced peripherally with central necrosis and therefore could not rule out a potentially malignant lesion (). After informed consent, a scrotal exploration and epididymectomy was performed. Grossly, the specimen measured 25 mm in maximum diameter. Sectioning revealed a 20 mm yellow, partly necrotic tumour mass ().\nHistological examination (H+E) showed a central area of coagulative necrosis with surrounding reactive fibroblastic tissue and inflammation (). Irregular clusters and solid nests of viable epithelioid cells were present, partly obscured by the fibroblastic tissue reaction ().\nOn immunohistochemical staining, these epithelioid cells were positive for CAM5.2 and CK7 and also expressed the mesothelial markers calretinin and WT1 (). The H+E appearances and immunoprofile were consistent with a partly necrotic/infarcted adenomatoid tumour. No evidence of malignancy was seen. The tumour was well circumscribed and completely excised at all margins. The patient was informed of the results, reassured, and discharged from further followup.
A 30 year-old male presented with a right-sided, tender scrotal swelling of four days’ duration. He had no significant past medical history or history of trauma. On local examination, a firm, mobile, and tender mass measuring 2 × 2 cm was found; the contralateral testis was normal. A clinical diagnosis of tuberculous epididymitis or testicular neoplasm was made. Routine hematological and biochemical investigations, urine analysis, and a chest radiograph revealed no abnormalities. USG of the scrotum showed a well defined, hypoechoic mass measuring 2.5 × 2 cm in the region of the globus major of the right epididymis. Aspiration was done using a 10 mL syringe and a 24 gauge needle to yield a scanty, grey-white aspirate. The smears were stained with H and E, Papanicolaou, and MGG stains. The cytological features were similar as those of case 1 and a diagnosis of an adenomatoid tumor was made. The patient underwent a conservative testis-sparing surgery with the excision of the epididymal nodule. The nodule measured 2 × 2 cm and the cut section was grey-white with microcysts. The results of the histopathological investigation were consistent with features of an AT.