A 35 year-old male presented with a right-sided, scrotal swelling of three days’ duration associated with acute scrotal pain of increasing severity. His past medical history was not significant and there was no history of trauma. Clinical examination revealed an enlarged, firm, tender nodule, three cm in diameter, while the contralateral testis was normal. A clinical diagnosis of torsion testis/testicular neoplasm was made. All routine investigations gave normal results. An emergency scrotal ultrasonography (USG) revealed a 2.5 cm, single, ovoid, well-defined, hypoechoic, solitary mass in the right testis. Guided aspiration was done under local anesthesia using a 10 mL syringe and a 24 gauge needle to obtain a scanty, grey-white aspirate. The smears were stained with hematoxylin-eosin (H and E), Papanicolaou, and May-Grünwald-Giemsa (MGG) stains. The smears were moderately cellular, consisting of tumor cells arranged in sheets and clusters. The cells were round to oval, having eccentric, vesicular nuclei with a fine granular chromatin along with a pale/vacuolated cytoplasm []. A cytological diagnosis of adenomatoid tumor was made. The patient underwent orchidectomy as the mass was firmly adherent to the tunica albugenia making conservative surgery unfeasible. The specimen showed the testis with a well circumscribed, encapsulated mass measuring 2.5 × 2 cm [] and its cut section was gray white. Histopathological examination (HPE) showed cuboidal to flat epithelial cells in solid cords, some lining the cystic spaces. Some of these epithelial cells showed prominent cytoplasmic vacuolation. Intervening stroma showed fibrocollagenous tissue with sparse lymphocytic infiltrates []. These features were consistent with those of an adenomatoid tumor.
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.