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 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.