Congenital testicular lymphangiectasis in children with otherwise normal testes

Perspectives in Pediatric Pathology, Chapter 11. Testicular Pathology of Hamartomatous Origin

The term hamartoma was coined by Albrecht in 1904 from the Greek μαρτ-άνω, to go wrong [ 1 ]. Hamartoma is currently used to name nonneoplastic lesions composed of disorganized tissue indigenous to the site where it is found. In the testis, this refers to abnormal/excessive development of structures that usually form part of the gonadal parenchyma, epididymis, or spermatic cord. We include the following as hamartomatous lesions of the testis and sperm excretory ducts: cystic dysplasia of the rete testis, rete testis hamartomas, fetal gonadoblastoid testicular dysplasia (FGTD), Sertoli cell nodules, tubular hamartomas, congenital testicular and epididymal lymphangiectasis, and smooth muscle hyperplasia of paratesticular structures. These hamartomas are always benign, but their importance resides in their association with specific disorders, or as markers of complex syndromes.

Bilateral lymphangiomatous testicular lesions in a lamb

Bilateral testicular enlargement was recognized in a young lamb; both gonads were largely replaced by a mass composed of multiple cystic spaces. Positive immunohistochemical staining for factor VIII-related protein indicated that the cysts were lined by endothelial cells. The precise nature and origin of the lesions is unclear; they might represent hamartomas or benign tumours or may be a result of lymphatic obstruction.

Testicular biopsy. Contemporary interpretation

Biopsy of the testis is not universally accepted in contrast with biopsies of other organs. The pathologist studies and reports on the pathophysiology of the testicular biopsy specimen. Methodology requires the inclusion of qualitative and quantitative studies, the evaluation of the lesion's evolution (prognosis), and, often, therapeutic advice regarding treatment. Cooperation between pathologists and clinicians optimizes the utility of the biopsy for the patient.

Epididymal lymphangiectasis

We report on a 59-year-old man with epididymal lymphangiectasis. The patient had noticed somewhat intermittent intrascrotal painless swelling. The interstitium of the right caput epididymis exhibited a number of large, dilated lymphatic vessels forming irregular channels among and around the epididymal ducts. The afferent epididymal ducts showed dilatation similar to that of the lymphatic vessels except for focal cuboid epithelial linings. Spermatogenesis in the right testis was preserved. Lymphangiectasis in the epididymis is infrequent and needs to be differentiated from other intrascrotal lesions.