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 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.