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 30 year-old male presented with a right-sided, tender scrotal swelling of four days’ duration. He had no significant past medical history or history of trauma. On local examination, a firm, mobile, and tender mass measuring 2 × 2 cm was found; the contralateral testis was normal. A clinical diagnosis of tuberculous epididymitis or testicular neoplasm was made. Routine hematological and biochemical investigations, urine analysis, and a chest radiograph revealed no abnormalities. USG of the scrotum showed a well defined, hypoechoic mass measuring 2.5 × 2 cm in the region of the globus major of the right epididymis. Aspiration was done using a 10 mL syringe and a 24 gauge needle to yield a scanty, grey-white aspirate. The smears were stained with H and E, Papanicolaou, and MGG stains. The cytological features were similar as those of case 1 and a diagnosis of an adenomatoid tumor was made. The patient underwent a conservative testis-sparing surgery with the excision of the epididymal nodule. The nodule measured 2 × 2 cm and the cut section was grey-white with microcysts. The results of the histopathological investigation were consistent with features of an AT.