Role of frozen section analysis of testicular/paratesticular fibrous pseudotumours: a five-case experience

An Unusual Case of Inflammatory Pseudotumor of Paratesticular Region

Inflammatory pseudotumors (IPT) are rare benign tumors that can develop in various regions of the body. Notably, IPTs have been uncommonly described in the Genitourinary system including occasional reports from the paratesticular region. This origin from this area is significant because of the ambiguity in differentiating this pathology from malignant lesions arising from the testis. We would like to report a case of a 32-year-old male who presented with a painless left scrotal mass for two years. Ultrasonography was done followed by a radical orchidectomy and histopathological examination of the excised lesion showed features suggestive of inflammatory pseudotumor from the paratesticular region. We feel this case merits reporting owing to the rarity of IPT occurring in the paratesticular region and the essential need for increased awareness and differentiation from the malignant counterparts.

Testicular-sparing excision for benign paratesticular IgG4-related disease

A 28-year-old male was referred by his local general practitioner due to recurrence of painful right scrotal mass, first noted 8 years prior. The mass was further characterised with ultrasound and then was locally excised via an inguinal approach, sparing the testicle, without any postoperative complication. Immunoperoxidase staining of the excised lesion confirmed paratesticular IgG4-related disease.

Intraoperative pathology consultation during urological surgery: Impact on final margin status and pitfalls of frozen section diagnosis

Despite recent improvements in diagnostic and surgical techniques in urological oncology, positive resection margin remains a significant concern for surgeons. Meanwhile, intraoperative pathology consultation with frozen section assessment (FSA), particularly for histological diagnosis of the lesions incidentally found or enlarged or sentinel lymph nodes, generally provides critical information which enables immediate decision making for optimal patient care. The intraoperative evaluation of surgical margins is also often requested, although there are some differences in its application between institutions and surgeons. Importantly, it remains to be determined whether intraoperative FSA indeed contributes to reducing the risk of final positive margins and thereby improving long-term patient outcomes. This review summarizes available data indicating the potential impact of FSA at the surgical margins during urological surgeries, including radical or partial cystectomy, partial nephrectomy, radical prostatectomy, penectomy, and orchiectomy. The accuracy and pitfalls of the intraoperative consultation/FSA diagnosis are also discussed.

Benign testicular neoplasm in a human immunodeficiency virus-positive patient masquerading as testicular cancer

Inflammatory myofibroblastic tumor (IMT) is a rare, benign neoplasm comprising spindle myoepithelial cells in the background of inflammatory cells. It can involve multiple anatomic sites in the body but rarely involves the testis. We report a case of 52-year-old male patient with a history of human immunodeficiency virus who presented with a painless, testicular mass for 2 months. Despite being treated with prolonged antibiotics and nonsteroidal anti-inflammatory drugs, scrotal ultrasound demonstrated an increase in the size of the lesion. With a presumed diagnosis of testicular germ cell tumor, a right radical inguinal orchiectomy was performed. Microscopic and immunohistochemical features were consistent with testicular IMT, a benign neoplastic process.

Clinical benefits of frozen section assessment during urological surgery: Does it contribute to improving surgical margin status and patient outcomes as previously thought?

Despite significant advances in patient selection as well as surgical technique over the past few decades, it is still not uncommon for patients with urological malignancy and positive surgical margins to be observed. Meanwhile, intraoperative pathology consultation with frozen section assessment, which generally provides useful information for the optimal procedure, has been widely utilized for the assessment of surgical margins during urological surgeries. Thus, it remains unanswered whether intraoperative frozen section assessment has an impact on final surgical margin status as well as long-term oncological outcomes. The present review summarizes and discusses available data assessing the utility of frozen section assessment of the surgical margins during urological surgeries, such as radical prostatectomy, partial nephrectomy and radical cystectomy. The current findings suggest that select patients might benefit from the routine frozen section assessment.

Pediatric fibrous pseudotumor of the tunica vaginalis testis

We describe a 16-year-old male with ultrasound evidence of a 1.3 cm right paratesticular nodule, which was managed by intraoperative frozen section and excisional biopsy. The pathologic findings were consistent with benign fibrous pseudotumor of the tunica vaginalis testis, which is a very rare lesion in the pediatric population. Consideration of fibrous pseudotumor in the differential diagnosis of pediatric paratesticular masses may help prevent unnecessarily aggressive therapy.

Paratesticular fibrous pseudotumour: Intraoperative frozen section analysis can help prevent unnecessary orchiectomy

Paratesticular fibrous pseudotumours are rare intrascrotal lesions, most frequently affecting the testicular tunics. They are benign in nature; however, their pathogenesis is not completely understood. Presenting features are similar to testicular malignancy, which may result in unnecessary radical surgery. It has been suggested that additional diagnostic imaging combined with frozen section analysis may help prevent orchiectomy in these patients. We describe a case of paratesticular fibrous pseudotumour in a 40-year-old male treated with testicle-sparing surgery aided by intraoperative frozen section analysis.

Paratesticular fibrous pseudotumor: a report of five cases and literature review

Paratesticular fibrous pseudotumor is a rare benign tumor that originates from intrascrotal tissue, such as tunica vaginalis, epididymis, or spermatic cord. Five cases of fibrous pseudotumor in our hospital were reviewed retrospectively, and the clinical manifestations were analyzed. Three cases of unilateral nodules, comprising one case located in the tunica vaginalis and two cases located in the epididymis, underwent local excision of the unilateral nodule. Two cases of diffuse incrassation in the tunica vaginalis underwent right radical orchiectomy. Postoperative pathological examination showed that all were fibrous pseudotumors. An average follow-up of 26 months showed uneventful results without recurrence for all patients. Fibrous pseudotumor is not a neoplasm but a reactive fibrous inflammatory hyperplasia. Definitive diagnosis requires pathological examination. Radical orchiectomy should be avoided when possible, and local excision should be performed because of the lack of obvious evidence of potential malignancy.

Paratesticular fibrous pseudotumor in young males presenting with histological features of IgG4-related disease: two case reports

Introduction

Paratesticular fibrous pseudotumors represent benign new growths confined to intrascrotal structures. Both pathogenesis and clinical management are little understood due to the rarity of the lesion, with less than 200 cases reported to date. Recently, paratesticular fibrous pseudotumors have been postulated to be immunoglobulin G4-related, pathogenetically. Here we report two cases of patients with paratesticular fibrous pseudotumor to highlight the clinical features of this rare disease and we report the immunohistochemical examinations to support the theory of paratesticular fibrous pseudotumor being an immunoglobulin G4-related disease.

Case presentations

A 28-year-old white man presented with a painless intrascrotal mass. After a clinical examination, a malignant growth was suspected. His ultrasound results revealed a well-demarcated hypoechoic lesion of 1.5cm in diameter at the spermatic cord. Our patient underwent local excision. His follow-up has been uneventful for 12 years. The second case was an 18-year-old white man who presented with a painless scrotal mass suspicious of testicular tumor. A magnetic resonance imaging scan revealed a 3cm mass at the spermatic cord with very low signal density on T2-weighted imaging and a low and inhomogeneous uptake of gadolinium contrast agent on T1-weighted, fat-suppressed imaging. Following local excision, our patient has been well for 18 months.

On histological examination, both of the lesions consisted of collagen-rich hyalinized fibrotic tissue with storiform features. There were lymphofollicular infiltrates and, sporadically, also venulitis. The immunoglobulin G4 staining (in case 2) showed an infiltrate of 10 to 15 positive cells per high-power field on average, corresponding to a proportion of 40% in evaluable hot spots. The two patients with paratesticular fibrous pseudotumor presented within a time span of 15 years. During that time, 400 patients with testicular germ cell tumors had been treated in our institution.

Conclusions

The specific histological features documented in our case lend support to the theory of paratesticular fibrous pseudotumor being an immunoglobulin G4-related sclerosing disorder. Paratesticular fibrous pseudotumors usually occur in young adulthood. Clinically, paratesticular fibrous pseudotumor can mimic testicular malignancy. Ultrasonographic findings are largely unspecific, however, scrotal magnetic resonance imaging may aid in discriminating the lesion from malignant tumors. Local excision, whenever technically feasible, is the preferred treatment of paratesticular fibrous pseudotumor.