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 52-year-old male presented with complaints of a painless nodule in right scrotal sac for last 2-years that was gradually but very slowly increasing in size. There was no history suggestive of urinary infection, genitor-urinary tuberculosis or epididymo-orchitis. Examination revealed a pea-sized firm, well-marginated, smooth swelling present at the lower pole of testis but that could not be separated with epididymis. Testicular sensation was normal and cord and rest of the epididymis was normal. Serum level of α-fetoprotein and β-HCG were normal. Scrotal ultrasonography revealed a solid mass at the lower pole of right testis that was relatively hyperechoic as compared to the testicular parenchyma []. Scrotal MRI revealed a well-defined lenticular lesion at lower part of right testis. The lesion displayed signals isointense to slightly hypointense on both T1- and T2-weighted images with adjacent hypointense band. The interface with the testis was maintained []. Fine-needle aspiration from the mass revealed absence of malignant cells. In view of long clinical history, negative tumor markers, findings typical of adenomatoid tumor on sonography and MRI, as reported previously,[] and absence of malignant cells on cytology local excision was performed under local anesthesia through inguinal incision. At exploration, there was a hard mass on the lower pole separate from the epididymis. Histopathology confirmed it to be an adenomatoid tumor.