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 39-year-old male presented with a palpable mass in the right side of the scrotum. There was no history suggestive of urinary infection, genito-urinary tuberculosis or epididymo-orchitis. On local examination, a mass was identified in the right testis which was 2×1.5 cm in size, firm in consistency and well-marginated with smooth swelling. The overlying skin and surrounding adenexa appeared normal. Serum levels of AFP and β-HCG were within normal limits. Scrotal ultrasound revealed a solid mass in the epididymal body of the right scrotum that was hypoechoic compared with the testicular parenchyma.