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Aksakalli T, Cinislioglu AE, Demirdogen SO, Utlu A, Celik F, Karabulut I, Akkus MC, Sulukoglu E, Oflas D, Sener E, Ozbey I. The Clinical Management of Intrascrotal Extratesticular Masses With Evaluation of Histopathologic Findings. Urology 2024:S0090-4295(24)00339-X. [PMID: 38719111 DOI: 10.1016/j.urology.2024.04.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2024] [Revised: 04/23/2024] [Accepted: 04/24/2024] [Indexed: 05/24/2024]
Abstract
OBJECTIVE To contribute to the literature by sharing the clinical presentation, surgical approach, postoperative complications management, and follow-up protocols of the patients we operated on due to intrascrotal extratesticular mass. METHODS Thirty-two patients admitted due to intrascrotal extratesticular mass were included in the study. Demographic and clinical characteristics of the patients such as age, initial clinical presentation, physical examination, radiological imaging findings, such as scrotal Doppler ultrasonography and magnetic resonance imaging, mass size, and characteristics, surgical treatment procedures, operation notes, and patient follow-up visits were retrospectively examined and evaluated from the patient files. RESULTS The median age of the 32 individuals included in the study was 52 (interquartile range: [45.0-60.5]) years. The primary reason for initial presentation was a palpable mass in 25 (78.1%) patients, pain in 13 (40.6%) patients, and scrotal swelling in 8 (25%) patients. The median mass diameter was 4.4 (interquartile range: [3.1-5.7]) cm. Surgical treatment involved inguinal excision in 29 cases (90.6%) and inguinoscrotal excision in 3 cases (9.4%). All patients were treated with testicle-sparing surgery. The most common tumor location, observed in 27 cases (84.3%), was the epididymis. The most frequent histopathological diagnosis was epididymal cyst, identified in 13 patients (40.6%). Pathology results showed that the mass was removed with negative margins in all patients. CONCLUSION Testicular-sparing surgery through the inguinal approach is one of the surgical methods that can be preferred for intrascrotal extratesticular masses. This approach can both preserve the testicle and achieve successful surgical results. Studies with larger samples are needed on this subject. TRIAL REGISTRATION This study was approved by the Erzurum Medicine Faculty University Local Ethics Committee (approval number: BAEK 2023/08-105).
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Affiliation(s)
- Tugay Aksakalli
- University of Health Sciences, Erzurum Regional Training and Research Hospital, Department of Urology, Erzurum, Turkey.
| | - Ahmet Emre Cinislioglu
- University of Health Sciences, Erzurum Regional Training and Research Hospital, Department of Urology, Erzurum, Turkey.
| | | | - Adem Utlu
- University of Health Sciences, Erzurum Regional Training and Research Hospital, Department of Urology, Erzurum, Turkey.
| | - Feyzullah Celik
- University of Health Sciences, Erzurum Regional Training and Research Hospital, Department of Urology, Erzurum, Turkey.
| | - Ibrahim Karabulut
- University of Health Sciences, Erzurum Regional Training and Research Hospital, Department of Urology, Erzurum, Turkey.
| | - Muhammed Cagrı Akkus
- University of Health Sciences, Erzurum Regional Training and Research Hospital, Department of Urology, Erzurum, Turkey.
| | - Emre Sulukoglu
- Ataturk University Medical Faculty, Department of Urology, Erzurum, Turkey.
| | - Damla Oflas
- University of Health Sciences, Erzurum Regional Training and Research Hospital, Department of Pathology, Erzurum, Turkey.
| | - Ebru Sener
- Ataturk University Medical Faculty, Department of Pathology, Erzurum, Turkey.
| | - Isa Ozbey
- Ataturk University Medical Faculty, Department of Urology, Erzurum, Turkey.
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Farah M, Song M, Mahmalji W. Epididymal Adenomatoid Tumour: A Case Report. Cureus 2023; 15:e47505. [PMID: 37908693 PMCID: PMC10614083 DOI: 10.7759/cureus.47505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/23/2023] [Indexed: 11/02/2023] Open
Abstract
Adenomatoid tumours are rare benign neoplasm involving the para testicular region, mostly the tail of the epididymis. They are typically small, firm and asymptomatic masses in the scrotal region and often discovered incidentally during physical examination or imaging studies. It is very challenging to differentiate them clinically and radiologically from malignant intratesticular solid tumours, which may lead to unnecessary orchidectomies. This case report presents the clinical management of a 57-year-old male patient with adenomatoid tumour of the epididymis, highlighting the diagnostic workup, surgical approach and postoperative outcomes. In addition, a comprehensive literature review was conducted to discuss the morphological and immunohistochemical features to improve understanding of these rare lesions and assist in accurate diagnosis and appropriate management.
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Affiliation(s)
| | - Mosea Song
- Urology, Wye Valley NHS Trust, Hereford, GBR
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Alhusainan D, Bubishate S, Alharmi A, Elabd A, Almahmid M. Adenomatoid tumor in a young male case report. Urol Case Rep 2023; 50:102486. [PMID: 37455783 PMCID: PMC10344655 DOI: 10.1016/j.eucr.2023.102486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 06/22/2023] [Accepted: 06/25/2023] [Indexed: 07/18/2023] Open
Abstract
Adenomatoid tumors are benign para-testicular tumors and account for about 30% of all paratesticular neoplasms in males. The most common presentation is scrotal swelling between the third and fifth decades. We reported an epididymal adenomatoid tumor in a 28-year-old patient.
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Corvino A, Catalano O, Faggian G, Delli Pizzi A, Tafuri D, Corvino F, Borzelli A, Picchi SG, Lassandro G, Boccatonda A, Schips L, Cocco G. Multiparametric Ultrasound Diagnostic Approach to Malignancy-Mimicking Adenomatoid Tumors of the Scrotum: Is Strain Elastography Enough? MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1261. [PMID: 37512071 PMCID: PMC10384894 DOI: 10.3390/medicina59071261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 06/28/2023] [Accepted: 07/04/2023] [Indexed: 07/30/2023]
Abstract
Background: Paratesticular tumors (PTs) are very uncommon, accounting for almost 5% of intrascrotal tumors. Of these, adenomatoid tumors (ATs) represent about 30% and most frequently arise in the tail of the epididymis. Ultrasound (US) examination is the first-choice imaging method employed for the evaluation of the scrotum. Unfortunately, there are no specific US-imaging features useful for distinguishing an AT from a malignant lesion. To increase diagnostic accuracy and confidence, new sonographic techniques have incorporated real-time tissue elastography (RTE) under the assumption that malignant lesions are "harder" than benign lesions. Case report: In our paper, we describe a very rare case of a 60-year-old patient with a giant paratesticular mass mimicking malignancy when examined using RTE, i.e., it was stiffer than the surrounding tissue (a hard pattern), which, upon histologic examination, was identified as an AT. Discussion: Our case underscores that there is also a significant overlap between different types of scrotal lesions when RTE is used for examination. Thus, if a PT is found, the imaging approach should always be supplemented with more definitive diagnostic methods, such as FNAC or FNAB, which are the only diagnostic methods capable of leading to a certain diagnosis. Conclusions: Alongside underlining the importance of pre-operative imaging for making correct diagnoses and selecting the correct therapy, we wish to draw our readers' attention to this report in order to demonstrate the clinical implications of a giant AT presenting as stiff lesions when examined using SE.
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Affiliation(s)
- Antonio Corvino
- Movement Sciences and Wellbeing Department, University of Naples "Parthenope", Via Medina 40, I-80133 Naples, Italy
| | - Orlando Catalano
- Radiology Unit, Istituto Diagnostico Varelli, I-80126 Naples, Italy
| | - Guido Faggian
- Advanced Biomedical Sciences Department, University Federico II of Naples, I-80131 Naples, Italy
| | - Andrea Delli Pizzi
- Department of Innovative Technologies in Medicine and Dentistry, University "G. D'Annunzio", I-6610 Chieti, Italy
| | - Domenico Tafuri
- Movement Sciences and Wellbeing Department, University of Naples "Parthenope", Via Medina 40, I-80133 Naples, Italy
| | - Fabio Corvino
- Vascular and Interventional Radiology Department, Cardarelli Hospital, I-80131 Naples, Italy
| | - Antonio Borzelli
- Vascular and Interventional Radiology Department, Cardarelli Hospital, I-80131 Naples, Italy
| | | | - Giulia Lassandro
- Radiology Department, Ospedale del Mare, ASL NA1 Centro, I-80147 Naples, Italy
| | - Andrea Boccatonda
- Internal Medicine, Bentivoglio Hospital, AUSL Bologna, I-40010 Bologna, Italy
| | - Luigi Schips
- Department of Medical, Oral and Biotechnological Sciences, "G. D'Annunzio" University, Urology Unit, SS Annunziata Hospital, I-6610 Chieti, Italy
| | - Giulio Cocco
- Department of Neuroscience, Imaging and Clinical Sciences, "G. D'Annunzio" University, I-6610 Chieti, Italy
- Unit of Ultrasound in Internal Medicine, Department of Medicine and Science of Aging, "G. D'Annunzio" University, I-6610 Chieti, Italy
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Song R, Xi J, Shi H, Xue Z, Li H, Yu X. Ultrasonographic manifestations and the effective diagnosis of epididymal leiomyosarcoma: Case report and systematic literature review. Front Oncol 2023; 13:1101801. [PMID: 36845710 PMCID: PMC9950396 DOI: 10.3389/fonc.2023.1101801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 01/30/2023] [Indexed: 02/12/2023] Open
Abstract
Background Epididymal leiomyosarcoma is an extremely rare tumor. In this study, we describe the sonographic features of this uncommon tumor. Methods A case of epididymal leiomyosarcoma diagnosed at our institute was retrospectively analyzed. Ultrasonic images, noted clinical manifestations, treatment procedures, and pathology results were collected for this patient. The same information was collected from a systematic literature search on epididymal leiomyosarcoma, including the PUBMED, Web of Science and Google Scholar databases. Results The literature search resulted in 12 articles; we were able to extract data from 13 cases of epididymal leiomyosarcomatosis. The median patient age was 66 (35-78) years, and the average tumor diameter was 2-7 cm. All patients had unilateral epididymal involvement. The lesions were all solid, irregular-shaped in almost half of the cases, featured clear borders in six cases, and had unclear borders in four cases. The internal echogenicity was heterogeneous in the majority of lesions: six cases were hypoechoic (7/11) and three cases moderately echoic (3/10). Information on blood flow within the mass was provided in four cases, but all were noted with significant vascularity. Surrounding tissue invasion was discussed in 11 cases, with 4 featuring peripheral invasion or metastasis. Conclusion Epididymal Leiomyosarcoma demonstrates sonographic characteristics common to many malignant tumors, such as increased density, irregular shape, heterogeneous internal echogenicity, and hypervascular. Ultrasonography is helpful to differentiate benign epididymal lesions, and can provide some reference for clinical diagnosis and treatment. However, compared with other malignant tumors of the epididymis, it has no characteristic sonographic features,and pathological confirmation is required.
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Affiliation(s)
- Ruixiao Song
- Department of Ultrasonics, Wujin Hospital Affiliated with Jiangsu University, Changzhou, Jiangsu, China,Science and Education Section, The Wujin Clinical College of Xuzhou Medical University, Changzhou, Jiangsu, China
| | - Jing Xi
- Department of Ultrasonics, Wujin Hospital Affiliated with Jiangsu University, Changzhou, Jiangsu, China
| | - Honglei Shi
- Department of Urology, Wujin Hospital Affiliated with Jiangsu University, Changzhou, Jiangsu, China
| | - Zhixin Xue
- Department of Pathology, Wujin Hospital Affiliated with Jiangsu University, Changzhou, Jiangsu, China
| | - Huifang Li
- Department of Urology, Wujin Hospital Affiliated with Jiangsu University, Changzhou, Jiangsu, China
| | - Xiaolong Yu
- Department of Ultrasonics, Wujin Hospital Affiliated with Jiangsu University, Changzhou, Jiangsu, China,Science and Education Section, The Wujin Clinical College of Xuzhou Medical University, Changzhou, Jiangsu, China,*Correspondence: Xiaolong Yu,
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Keles A, Arikan O, Keser F, Yildirim ANT, Yildirim A. Paratesticular Dedifferentiated Liposarcoma with Rhabdomyoblastic Differentiation: A Case Report and Review of the Literature. Prague Med Rep 2023; 124:449-455. [PMID: 38069650 DOI: 10.14712/23362936.2023.35] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2023] Open
Abstract
Liposarcomas of the paratesticular tissue is a rare pathological entity. The symptoms are similar to inguinal hernias or hydroceles. We present the case of an 84-year-old man with a rare paratesticular liposarcoma that manifested as painless right hemiscrotal swelling. Testicular tumour markers were negative. Imaging revealed a heterogeneous mass with a fat component. He underwent a radical orchiectomy on the left side to remove the associated mass. This revealed dedifferentiated liposarcoma (DDLS) with rhabdomyoblastic differentiation and MDM2 amplification. The surgical margins were negative, and the patient had a metastatic workup that included magnetic resonance imaging (MRI) of the abdomen and pelvis. Because of the disease's rarity, there is no clear agreement on radiotherapy and chemotherapy roles.
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Affiliation(s)
- Ahmet Keles
- Department of Urology, Istanbul Medeniyet University, Istanbul, Turkey
| | - Ozgur Arikan
- Department of Urology, Istanbul Medeniyet University, Istanbul, Turkey
| | - Ferhat Keser
- Department of Urology, Hakkari Yuksekova State Hospital, Hakkari, Turkey.
| | | | - Asif Yildirim
- Department of Urology, Istanbul Medeniyet University, Istanbul, Turkey
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Efared B, Boubacar I, Soumana D, Bako ABA, Coulibaly IS, Koura HH, Boureima HS, Nouhou H. Epididymal adenomatoid tumor: a case report and literature review. AFRICAN JOURNAL OF UROLOGY 2022. [DOI: 10.1186/s12301-022-00329-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Abstract
Background
Adenomatoid tumor is a very rare benign neoplasm of mesothelial origin affecting mainly female and male genital tracts. The diagnosis is challenging as this tumor mimics many differential diagnoses. The current literature offers only some case reports and short series of adenomatoid tumors.
Case presentation
A 47-year-old patient with unremarkable medical history presented for chronic mild pain of the right testis evolving for months. The physical examination shows a palpable right intrascrotal nodule of 10 mm in greatest diameter. The nodule was painful, mobile with firm consistency. The laboratory investigations were within normal limits, the scrotal ultrasonography showed a well-circumscribed predominantly hyperechoic intrascrotal nodule in the right epididymal head with heterogeneous echostructure. Excisional biopsy of the lesion was performed and the histopathological analysis showed a well-circumscribed tumor with microcystic and trabecular architecture made of small interconnected tubules and cysts lined by flattened cells with prominent vacuolization and thread-like bridging strands, consistent with an epididymal adenomatoid tumor. The postoperative course was uneventful and the patient was discharged. Four months after surgical treatment, the patient has no sign of the disease.
Conclusion
Testicular adenomatoid tumors are uncommon benign neoplasms with diagnostic challenge. Adenomatoid tumors arising in epididymis are managed by excisional biopsy with testis-sparing surgery avoiding unnecessary orchidectomy.
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Li YH, Huang ZM, Yu JK, Lin YS, Hsu CY, Tung MC. Misdiagnosis of vasitis: a potential diagnostic pitfall with computed tomography. Basic Clin Androl 2022; 32:19. [PMID: 36217112 PMCID: PMC9552416 DOI: 10.1186/s12610-022-00168-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Accepted: 07/24/2022] [Indexed: 11/10/2022] Open
Abstract
Background Vasitis is a rare condition that may be challenging for the clinical practitioner. Sometimes it is misdiagnosed as incarcerated inguinal hernia; thus, patients end up receiving unnecessary surgery. Compared with the traditional approach with only sonography, the more recent introduction of computed tomography in the diagnostic process has provided higher quality imaging and more detailed anatomy. Consequently, some urologists advocate the efficacy of computed tomography in the differential diagnosis of difficult cases. Case presentation We present the case of a 23-year-old male who suffered from right inguinal pain and swelling. His scrotum ultrasound showed multiple tubular structure dilatation within the subinguinal area and no testis torsion. The initial diagnosis was a right inguinal hernia. Computed tomography supported that initial diagnosis, and we presumed the lesion represented a herniation of the omentum with mesenteric vessels. Since there was a suspicion of hernia incarceration, the patient underwent diagnostic laparoscopy, which did not reveal herniation, but only erythematous reaction and swelling over the right spermatic cord. Following a final diagnosis of vasitis, he received empirical antibiotic treatment and his symptoms entirely resolved. Conclusions Even though computed tomography can provide thorough imaging of the urogenital system, the contrast enhancement within vessels and inflammatory organs can still be misleading in the diagnostic process.
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Castro AA, Utrilla VS, Antón BR, Carmona LER, Ruiz LP. MULTIPLE LESIONS IN SCROTAL TUNICA VAGINALIS. Urology 2022; 166:e12-e14. [DOI: 10.1016/j.urology.2022.04.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 04/03/2022] [Accepted: 04/18/2022] [Indexed: 11/30/2022]
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Isidori AM, Dogra VS, Sidhu PS. Imaging andrology of the future: Where functional imaging embraces the clinic. Andrology 2021; 9:1287-1289. [PMID: 34708931 DOI: 10.1111/andr.13054] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 05/25/2021] [Indexed: 12/18/2022]
Affiliation(s)
- Andrea M Isidori
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - Vikram S Dogra
- Department of Imaging Science in Rochester, University of Rochester Medical Center, New York, USA
| | - Paul S Sidhu
- Department of Radiology, King's College Hospital, London, UK
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