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 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.