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.
A 41 years old man referred to our department for painless enlargement in the left hemiscrotum. Personal and familial history were unremarkable, without epididymitis, torsion or trauma. On physical examination, a hard, painless, firm, intrascrotal mass at the lower pole of the left testis was revealed, apparently distinct from the testis and arising directly from the surface of the left epididymis. Scrotal skin epididymis, spermatic cord, inguinal region and right testis were normal.\nUltrasonography confirmed a solid isoechoic lesion lying on the border between epididymal tail and lower pole of the left testis, without any disruption of the architecture of the testical parenchyma. The testicular parenchyma immediately adjacent to the mass showed slightly degreased echogenity compared with the parenchyma elsewhere. Preoperative laboratory investigation, including hemogram, blood chemistry studies were within normal limits. Plasma levels of β-hCG (β-subunit human chronic gonadotropin), α-fetoprotein (AFP), lactic dehydrogenase (LDH) were within normal ranges. The first clinical impression was a probable germ cell neoplasm.\nThe patient subsequently underwent a total left orchiectomy-epididymectomy, which revealed a white, crescent-shaped, well circumscribed tumor, about 1,5 cm, without involvement of the testicular parenchyma.\nHistological appearance of this paratesticular tumor is represented by cuboidal cells, with vacuolated cytoplasm and with gaping spaces (Fig. ). The neoplasmatic cells had lymphoplasmacytic and eosinophilic infiltration, which varied in intensity, from scan to moderate dense, and especially the presence of prominent lymphoid aggregates, particularly towards the periphery of the neoplasm, is a helpful clue to the diagnosis of the adenomatoid tumor (Fig. ). The cellular vacuoles had a signet ring-like appearance in some fields but epithelial type mucin was not present There was no mitotic activity and no suspicious neoplasmatic areas in testicular parenchyma was been detected.\nImmunohistochemical positivity for mesothelial marker HMBE1 (mouse anti-human antigen mesothelial cell) and calretinin confirm the mesothelial origin of the tumor (Fig. , ). This tumor was diagnosed as an adenomatoid tumor in the epididymis and the patient underwent no additional treatment.