A 16-year-old male with free medical history presented as an outpatient requesting for consultation regarding a small lump that he palpated two months ago in his right hemiscrotum during self-examination. He did not report any trauma or inflammation of the area neither at the referred period nor in the past. Except for mild discomfort in the hemiscrotum during exercise that subsided after its discontinuation, no other symptoms were reported. Importantly, the size of the lump did not change significantly during this two-month period.\nPhysical examination revealed a small, round, hazelnut-sized, painless mass in the right hemiscrotum, localized in the tail of the epididymis. No other pathological signs were detected at the rest of the scrotum, testicles, or groin.\nU/S examination of the scrotum documented the presence of a solid hypoperfused, hyperechoic, well-demarcated, without invasive behavior mass, localized at the tail of the epididymis, 1.3 × 1.1 cm in size, and including 2 small hypoechoic lesions inside the mass (arrows, ).\nThe typical preoperative laboratory examination (blood routine and coagulation profile) and the values of the specific tumor markers AFP, LDH, CEA, and b-HCG were normal. Surgical treatment was decided and a right scrotal exploration was performed. Macroscopic examination revealed a yellowish uncapsulated mass with maximum diameter of 13 mm located next to the tail of the epididymis ().\nAfter meticulous dissection, the mass was totally dissociated from the epididymis and was excised en-block without any damage to adjacent structures.\nHistological examination of the mass revealed the presence of cuboidal epithelial cells in tubular clusters into a fibrous stroma (). Immunohistochemical evaluation was positive for tumor markers HMBE1 and calretinin, which documented the diagnosis of adenomatoid tumor and its mesothelial origin.\nPostoperative course was uneventful. After a 24-month follow-up period, the patient remains asymptomatic without signs of recurrence.
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.