A 41 years old man referred to our department for painless enlargement in the left hemiscrotum. Personal and familial history were unremarkable, without epididymitis, torsion or trauma. On physical examination, a hard, painless, firm, intrascrotal mass at the lower pole of the left testis was revealed, apparently distinct from the testis and arising directly from the surface of the left epididymis. Scrotal skin epididymis, spermatic cord, inguinal region and right testis were normal.\nUltrasonography confirmed a solid isoechoic lesion lying on the border between epididymal tail and lower pole of the left testis, without any disruption of the architecture of the testical parenchyma. The testicular parenchyma immediately adjacent to the mass showed slightly degreased echogenity compared with the parenchyma elsewhere. Preoperative laboratory investigation, including hemogram, blood chemistry studies were within normal limits. Plasma levels of β-hCG (β-subunit human chronic gonadotropin), α-fetoprotein (AFP), lactic dehydrogenase (LDH) were within normal ranges. The first clinical impression was a probable germ cell neoplasm.\nThe patient subsequently underwent a total left orchiectomy-epididymectomy, which revealed a white, crescent-shaped, well circumscribed tumor, about 1,5 cm, without involvement of the testicular parenchyma.\nHistological appearance of this paratesticular tumor is represented by cuboidal cells, with vacuolated cytoplasm and with gaping spaces (Fig. ). The neoplasmatic cells had lymphoplasmacytic and eosinophilic infiltration, which varied in intensity, from scan to moderate dense, and especially the presence of prominent lymphoid aggregates, particularly towards the periphery of the neoplasm, is a helpful clue to the diagnosis of the adenomatoid tumor (Fig. ). The cellular vacuoles had a signet ring-like appearance in some fields but epithelial type mucin was not present There was no mitotic activity and no suspicious neoplasmatic areas in testicular parenchyma was been detected.\nImmunohistochemical positivity for mesothelial marker HMBE1 (mouse anti-human antigen mesothelial cell) and calretinin confirm the mesothelial origin of the tumor (Fig. , ). This tumor was diagnosed as an adenomatoid tumor in the epididymis and the patient underwent no additional treatment.
A 41 year old male presented to our department with left sided scrotal swelling and pain for fifteen days. There was no history of trauma or surgery. Local examination revealed a firm, tender nodule 2.5 cm in diameter. The contralateral testis was normal. Clinical diagnosis of testicular neoplasm/epididymal cyst was made. Investigations revealed normal serum α-fetal protein, human chorionic gonadotropin and lactate dehydrogenase levels. Scrotal ultrasonography revealed 2.5 cm well defined, heterogeneous, hypo echoic solitary mass in the left testis. Guided aspiration was done using 10 mL syringe and 24 gauge needle. Scanty, grayish white aspirate was obtained. Smears were stained with hematoxylin and eosin (H and E), Papanicolaou and May–Grόnwald-Giemsa (MGG) stains.\nModerately cellular smears consisted of tumor cells arranged in monolayered sheets and loosely cohesive clusters. Cells were round to oval with indistinct cell borders and moderate to abundant pale vacuolated cytoplasm. The monomorphic nuclei were eccentrically placed with fine granular chromatin and small inconspicuous nucleoli. Occasional binucleated cells were seen. Background showed pink amorphous material along with bare nuclei and few lymphocytes []. These cytological features suggested the diagnosis of AT. The patient underwent conservative testis sparing surgery, with excision of nodule.\nGrossly, an encapsulated grayish white mass measuring 2.5 × 2 × 1.8 cm was obtained. Microscopic examination revealed cuboidal to flat epithelial cells in solid cords, tubules and cystic spaces, some showing cytoplasmic vacuolation. Intervening stroma showed fibrocollagenous tissue with sparse lymphocytic infiltrate. Epithelial cells showed periodic acid schiff (PAS) positivity, the features consistent with adenomatoid tumor.