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.
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.