Journal of Integrative Nephrology and Andrology

CASE REPORT
Year
: 2015  |  Volume : 2  |  Issue : 4  |  Page : 135--138

Adenomatoid Tumor of the Testis: One Case Report


Chun-Feng He1, Qing-Chuan Zhang1, Fang Huang2, Yang Wu3, Wan-Jun Yu1,  
1 Department of Urology, Putuo Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
2 Department of Pathology, Putuo Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
3 Department of Imaging, Putuo Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China

Correspondence Address:
Qing-Chuan Zhang
Department of Urology, Putuo District Center Hospital, Shanghai University of Traditional Chinese Medicine, Putuo, Shanghai 200062
China

Abstract

Adenomatoid tumor is a rare neoplasm of mesothelial origin commonly seen in male and female genital tract. In this case report, the authors present a case of adenomatoid tumor in a 36-year-old male who presented with a 1-year history of scrotal swelling. A clinical diagnosis of testicular neoplasm was made, but the final diagnosis of adenomatoid tumor was made after testicular cancer radical.



How to cite this article:
He CF, Zhang QC, Huang F, Wu Y, Yu WJ. Adenomatoid Tumor of the Testis: One Case Report.J Integr Nephrol Androl 2015;2:135-138


How to cite this URL:
He CF, Zhang QC, Huang F, Wu Y, Yu WJ. Adenomatoid Tumor of the Testis: One Case Report. J Integr Nephrol Androl [serial online] 2015 [cited 2019 Aug 20 ];2:135-138
Available from: http://www.journal-ina.com/text.asp?2015/2/4/135/168545


Full Text

 Introduction



Adenomatoid tumor is a kind of rare benign tumor [1] which occurs in the reproductive system of male or female. [2],[3] It is originally found in testis. Recently, our hospital has received one case. Now, the authors will take a retrospective analysis of the case and discuss it with literature reviews.

 Case Report



The patient is a 36-year-old male. He is hospitalized for the progressive enlargement of a lump in the left scrotum for 1-year, and the aggravating condition within 1-week. One year ago, before the hospitalization, the patient felt scrotal pain in the left scrotum frequently. Considering the possibility of epididymitis, he took antibiotics and the symptom was gradually relieved. One week ago, for the pain on the left scrotum, the patient sought medical treatment in our hospital. After taking antibiotics, the pain was relieved slightly but the lump didn't decrease significantly. Besides, this patient has a son. Physical examination: Palpable lump size 25 mm ×25 mm ×25 mm in the left testis, glabrous surface, hard texture, fixing position, pain with light pressure. The right side is normal. Tumor marker check: Alpha Feto Protein (AFP) and β-human chorionic gonadotropin (β-HCG) are all within normal limits.

Ultrasonic tips [Figure 1]: Upper pole low echo area of the left testis is 25 mm × 25 mm, unclear boundary, inhomogeneous echo. Color Doppler flow imaging (CDFI) appears as fascicular and colorful bloodstream. Ultrasonic contrast: Injecting 2.4 ml Sono Vue through elbow vein method, the focus starts to enhance quickly and unequally at the 30 th s, earlier than peripheral testicular tissues. At the 36 s, the focus is enhanced to peak with high speed; a small part of nonenhancement area appears. At the 43 s, it disappears quickly, earlier than peripheral testicular tissues. Lesion contrast takes on the characteristic of quick in and out. Diagnosis: Left testis substantial lump (testicular cancer cannot exclude). Computed tomography (CT) tips [Figure 2]: The manifestations of the plain scan are nodular low-density shadow in the left testis and inhomogeneous enhancement of the enhanced scanning lesion. There is no significant lymph gland swelling in the groin. Magnetic resonance imaging (MRI) tips [Figure 3]: The front part of the left testis and its epididymis take on as circle shaped abnormal focus, with the size 23 mm × 32 mm. Most T2-weighted imaging fat suppression sequences of the focus appear with the slightly low signal. TI-weighted imaging emerges with low signal. Obvious enhancement occurs in the edge if it is enhanced, and nonenhancing area appears in the inner. Diffusion weighted imaging in the upper part has a low signal with glabrous and smooth boundary, clear realm. Partial enhancement takes on if it is enhanced. Diagnosis: Enclosed mass appear in the front part of the left testis and the left epididymis, and left testicular cancer may invade left epididymis. Considering the possibility of a left testicular malignant tumor, left testicular tumor radical operation is carried out. [Figure 4] and [Figure 5] show the testicular tumor specimen and pathological section. Specimen: The tumor is located in the inner part of the testis, near epididymis, taking invasive growth. It has no clear boundary to acroteric testis and epididymis tissue. The plane section is hard with the color of ashen and gray yellow. Under the microscope: The tumor doesn't have the envelope, the tumor cell is cubical, and the cytoplasm is red. The karyon takes the shape of circle or orbicular-ovate with the clear nucleolus. Its arrangement follows the shape of the glandular cavity, tubule, and real rope, with invasive growth. It has no clear boundary with the normal parts, epididymis, and surrounding tissue. Ischemic infarction appears in the center of the tumor. Interstitial fibrous tissue hyperplasia and inflammatory cell infiltration are also found. Cytokeratin, calretinin, and WT-1 show a strong positive reaction. Pathological diagnosis: Left testis adenomatoid tumor.{Figure 1}{Figure 2}{Figure 3}{Figure 4}{Figure 5}

 Discussion



Most of the testicular tumors are malignant with high degree, so radical orchectomy is often regarded as the routine operation principle to a testicular tumor. In recent years, researches show that benign tumor is not uncommon. In 1966, Mackay reported the percentage of the benign tumor was 1%. Elert announced the percentage was 10-20% through testicular frozen section examination. [4],[5] Moreover, the data came to 31% and 17.1%, respectively, according to Haas and Chang. The domestic data ranged from 10-23%. Therefore, new recognition of testicular benign tumor morbidity should be made. [6],[7] As for the treatment, orchectomy will bring adverse effect to patients (especially to unmarried patients) both in mentality and appearance, including quality and quantity reduction of semen. In this condition, testicular benign tumor operation attracts doctors' concern, and testis reserved tumorectomy is preferred.

Orchic adenomatoid tumor is a kind of specific and rare benign tumor. [8],[9] It is the commonest benign tumor in testis adjacent tissues, sustentacular tissues, envelopes, epididymides, spermatic cords, and subsidiary tissues, accounting for 30% among all paradidymal lumps. [10],[11],[12] There is no clear explanation for the origin of the adenomatoid tumor, and the following contents are four theories at present: Mesonephric origin, vascular endothelial origin, mesothelial origin, and mullerian tube origin. [13] Currently, more and more immunohistochemical and electron microscope research materials support the mesothelial origin, but it still has no final conclusion. In the case we receive, through iconography examination, we find the tumor is located in parenchyma testis and links to the envelope, so, we judge, it belongs to the envelope.

In general, the onset aging of orchic adenomatoid tumor ranges from the age of 20 to 60, and from 30 to 40 of male patients. Due to the slow growth, patients cannot feel overt symptoms and often find it in physical examination. The main clinical manifestations are scrotal pain and testicular lump, with the long course, often more than 1-year. It has slow disease progression and normal index of blood AFP and β-HCG.

The ultrasonic manifestations of orchic adenomatoid tumor are partial solid lesion (0.5-5 cm), more unilateral side less bilateral sides, unclear boundary, and homogeneous echo in the inner area of the tumor performing as strong echo, low echo, or surrounding tissues echo. Color Doppler flow shows increased, decreased or normal blood supply, no enlarged lymph node in the pelvic cavity, and groin. [14] The ultrasonic examination can provide some important information to the orchic benign tumor. [15] For example, some phenomena, such as a single lesion, echoless, clear boundary, and nonblood supply, illustrate the possibility of a benign tumor. The iconography manifestations of orchic benign tumor are unilateral single solid nodule, unclear boundary, high-density plain scan, homogeneous density, non-calcification, non-necrosis, small focus (diameter <2 cm), and unclear strengthening of enhancement scanning. MRI can clearly show the condition between tumor's edge and surrounding tissues. CT has important meaning to identify the testicular property and judge retroperitoneal lymphatic metastasis. And MRI has significant diagnostic and differential values. The correct diagnosis relies on pathological examination. If the possibility of the testicular benign tumor is considered before the operation, the frozen section pathological examination should be conducted in operation. The main pathological characteristics are: Physalides structure appears in the epithelioid cell. [16] Under the light microscope, the adenomatoid tumor has diverse shapes, including two components, epithelioid cell, and interstitial fibrosis. Tumor cell is cuboidal, flat, or ring-shaped. The cytoplasm of oncocyte is red with the shape of circle or oval, and it has a rare mitotic figure. Through electron microscope, tumor cell has obvious microvilli, bridge corpuscle, and stress fiber. Its intercellular space is ecstatic.

The operation modus of orchioncus relies on preoperative diagnosis and antidiastole. The intraoperative frozen section pathological examination is the reliable and gold standard to identify tumor's property, which has high sensitivity and specificity. [5] The testicular benign tumor needs to be conformed before the operation with standardized diagnosis and handling process. The conventional method includes testicular exploration of inguinal incision spermatic cord block. The concrete procedures are: Dissociate and block spermatic cord, at the same time, cool and protect testis in the ice particles, then expose testis at scrotum incision, and conduct frozen pathological tumor biopsy. In operation, if the pathological result belongs to benign, spermatic cord blocking should be removed, and testis reserved tumor resection should be implemented. If the pathological result is malignant or unclear, radical orchectomy should be carried out in the case of testis exposing and spermatic cord blocking. To preserve spermatogenesis function, warm ischemia time should be shortened to the full. If the time is more than 30 min, the spermatogenesis function will derogate. If the time is more than 2 h, the spermatogenesis function will stop. Therefore, intraoperative cohesion and the coordination between departments are very important. [17]

To avoid unnecessary testicular resection, the recognition of testicular benign lesion and its high morbidity should be improved. Of course, full assessment of the preoperative diagnostic data, active examination to high suspicious case, and decisive partial benign tumor resection all give great protection to testicular excision, which plays an important role in patients' fertility, sexual function, and psychology.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

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