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 51-year-old man was referred at the urological department due to the primary suspicion of a left testicular cancer. Staging computed tomography of the thorax, abdomen, and pelvis was negative for lymphatic or hematogeneous metastatic tumor spread. Moreover, testicular tumor markers such as α-fetoprotein (AFP) and beta-human chorionic gonadotropin (β-hCG), and preoperative hormone levels (testosterone, LH, FSH) were within normal ranges.\nTesticular ultrasound confirmed a 0.9 × 0.9 × 1.0 cm rounded, peripheral, and hyperechoic lesion of the lower pole of the left testicle (Fig. a) connected with the tunica albuginea, without pathological signs of the right testicle. No exact vascular signs or vascular flow within this lesion were reproducible on baseline color and power Doppler sonography (Fig. b). Contrast-enhanced ultrasound (LOGIQ E9 ultrasound machine by GE Healthcare, Fairfield, Connecticut, USA) was performed as an additional diagnostic tool to clarify the vascularization of the suspicious lesion. Interestingly, the lesion was contrast-absorbing after bolus contrast agent application of 2.4 cc (SonoVue, Bracco, Milan, Italy), Fig. c. Moreover, real-time elastography (RTE) of the left testis was performed to evaluate the tissue elasticity of the tumor mass, showing a hard lesion (Fig. d). In summary, multiparametric ultrasound confirmed a vascularized and hardened lesion, therefore being suspicious of testicular cancer.\nNext, inguinal exploration with organ-sparing surgery and tumor enucleation was performed without ischemia. Intraoperative frozen section analysis of the tumor and tumor bed biopsies was performed, providing no evidence of malignant germ cell tumor or testicular intraepithelial neoplasia (TIN). Final pathology report confirmed a completely removed adenomatoid tumor of the left testicle arising from the tunica albuginea.