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 year old male presented to our department with left sided scrotal swelling and pain for fifteen days. There was no history of trauma or surgery. Local examination revealed a firm, tender nodule 2.5 cm in diameter. The contralateral testis was normal. Clinical diagnosis of testicular neoplasm/epididymal cyst was made. Investigations revealed normal serum α-fetal protein, human chorionic gonadotropin and lactate dehydrogenase levels. Scrotal ultrasonography revealed 2.5 cm well defined, heterogeneous, hypo echoic solitary mass in the left testis. Guided aspiration was done using 10 mL syringe and 24 gauge needle. Scanty, grayish white aspirate was obtained. Smears were stained with hematoxylin and eosin (H and E), Papanicolaou and May–Grόnwald-Giemsa (MGG) stains.\nModerately cellular smears consisted of tumor cells arranged in monolayered sheets and loosely cohesive clusters. Cells were round to oval with indistinct cell borders and moderate to abundant pale vacuolated cytoplasm. The monomorphic nuclei were eccentrically placed with fine granular chromatin and small inconspicuous nucleoli. Occasional binucleated cells were seen. Background showed pink amorphous material along with bare nuclei and few lymphocytes []. These cytological features suggested the diagnosis of AT. The patient underwent conservative testis sparing surgery, with excision of nodule.\nGrossly, an encapsulated grayish white mass measuring 2.5 × 2 × 1.8 cm was obtained. Microscopic examination revealed cuboidal to flat epithelial cells in solid cords, tubules and cystic spaces, some showing cytoplasmic vacuolation. Intervening stroma showed fibrocollagenous tissue with sparse lymphocytic infiltrate. Epithelial cells showed periodic acid schiff (PAS) positivity, the features consistent with adenomatoid tumor.