Angiomyofibroblastoma férfiban – egy ritka paratesticularis eltérés és irodalmi áttekintés

Összefoglaló. A scrotum képalkotó vizsgálóeljárásai közül elsőnek választandó az ultrahang, mivel könnyen hozzáférhető, szenzitivitása és specificitása magas. Szerepe kiemelendő mind az intratesticularis eltérések differenciáldiagnózisában, mind pedig a kevésbé ismert paratesticularis eltérések esetében. Az urológiai ambulancián egy 56 éves férfi jelentkezett kivizsgálásra tapintható terime miatt. Ultrahangvizsgálattal paratesticularis elváltozás látszódott, mely a vizsgálat során az inguinalis csatorna irányába többször elmozdult. A laesio dignitása nem volt meghatározható, ezért műtéti eltávolításra került sor. A szövettani vizsgálat a férfiak körében ritkán előforduló angiomyofibroblastoma diagnózisát véleményezte. A paratesticularis elváltozások ugyan ritkán fordulnak elő, de a gyakoribb entitások és azok ultrahangos sajátosságainak ismerete elengedhetetlen a terápia tervezése szempontjából. Orv Hetil. 2021; 162(34): 1376–1382. Summary. Ultrasonography is the basic imaging technique for the evaluation of testicular structures because it is easily accessible and has high sensitivity and specificity. It plays a significant role in the differential diagnosis of intratesticular changes, in addition, its role should be emphasised in rare paratesticular abnormalities. A 56-year-old male presented in the urology department complaining of a palpable inguinal mass and was referred to ultrasonography for further evaluation. A scrotal ultrasound was performed, and it described a mobile paratesticular mass without any specific characterizations. Therefore the lesion was removed, and the histological analysis established the diagnosis of angiomyofibroblastoma. Paratesticular lesions are rare, but it is essential to know the frequent abnormalities and the corresponding ultrasound findings for planning of treatment. Orv Hetil. 2021; 162(34): 1376–1382.

The fate of paratesticular masses: 13 years’ experience in a tertiary referral centre

Objective Paratesticular neoplasms exhibit different behaviours, depending on the embryological tissue of origin. Treatment modalities can depend on the differential diagnosis. The aim of this study is to present the clinical, morphological and histopathological features of patients with paratesticular masses and their follow-ups and is intended to increase awareness of the issues. Methodology We included 31 excisions of paratesticular masses, after radiological diagnosis as paratesticular mass in our hospital between 2007–2020. Information on treatment modalities, tumour recurrence, metastasis, and survival rates were obtained from hospital archives. All patients were evaluated by taking patients’ history, physical examination, scrotal ultrasound, chest radiography, and serum tumour markers. Treatment modality was selected according to intraoperative findings. Haematoxylin-eosin sections were examined, and immunohistochemical analyses were performed for smooth muscle actin, desmin, Ki67, CD34, S100, and myogenin. Ten high-power fields were counted to document Ki67 and p53 nuclear positivity rates. Results A total of 31 operations were performed with recurrence in three patients. Histomorphological and immunohistochemical examination revealed eleven malignant masses; eight rhabdomyosarcomas, a leiomyosarcoma, a liposarcoma and a large B cell lymphoma. Other excised masses were benign and infective lesions. Conclusion Paratesticular masses are heterogeneous tumours that follow different clinical courses. Clinicians must be aware of this histological diversity in order to plan a treatment pathway. This study is one of the largest published series, with a long follow-up period. It shows that the most critical features in determining prognosis are histopathological subtype and tumour grade.

Multiple Paratesticular Fibrous Pseudotumors in an Adult Patient: Case Report

Abstract- Paratesticular fibrous pseudotumors (PFP) are relatively rare benign spindle cell tumors. These tumors usually are originated from testicularis tunics and grow into the epididymis and spermatic cord. PFP is a consequent of a reactive proliferation of inflammatory tissue. We report a case of PFP with simultaneous multiple tunica albuginea and tunica vaginalis lesions. A 33-year-old man presented with painless right scrotal lump, normal serum tumor markers, and one centimeter paratesticular mass in ultra-sonography that underwent testis-sparing surgery due to a benign microscopic appearance in frozen section evaluation. Testis sparing surgery can be considered as the preferred management because of the lack of obvious evidence of potential malignancy in this tumor

Splenogonadal fusion: A rare paratesticular lesion and how to recognise it on ultrasound

Introduction Splenogonadal fusion is a rare developmental disorder that results in a gonadal or paragonadal mass due to the close proximity of the developing spleen and gonad. Case report We describe a case of splenogonadal fusion presenting as a paratesticular mass in a 25-year-old male. This was ultimately diagnosed on surgical biopsy. Discussion Splenogonadal fusion is a rare abnormality but can be managed conservatively. The sonographic features and the differential diagnosis are highlighted. Conclusion Through this case, we highlight the clinical and sonographic features of splenogonadal fusion. Awareness amongst ultrasound practitioners is important, given that it can be managed conservatively, and means of a non-invasive diagnosis are highlighted.

Benign Scrotal Tumor in a Pediatric Patient: Epididymal Cyst

A pediatric patient of 12 years consulted for a left scrotal mass of 2 months of evolution. After suspecting a cystic content due to positive transillumination, on ultrasonography a scrotal cyst separated from the testis, of 5 cm in its maximum length, was confirmed. Due to size, parental anxiety, and the referred short evolution, excision was decided. Given the clinical radiological findings, a scrotal incision was chosen, obtaining complete excision. Biopsy confirmed the diagnosis of simple epididymal cyst (EC). ECs usually present as painless, scrotal swelling in adolescents as a result of dilatation of the efferent epididymal tubules. Many cases (up to 60%) regress spontaneously. In these, average time to involute ranges from 4 to 50 months. Although cases of cyst torsion have been described (with pain derived from ischemia and inflammation), conservative management has been suggested in the majority, both in pediatric and in adult series. Surgery is recommended in some patients, due to testicular pain or increased paratesticular mass, as was our case.

Long-standing aggressive angiomyxoma as a paratesticular mass: A case report and review of literature

Objectives: Aggressive angiomyxoma is known as a mesenchymal tumor of premenopausal women and it is extremely rare in men. Methods: Herein, we report a 66-year-old male with a firm scrotal mass that had gradually enlarged over 20 years. Results: Radiological studies revealed 10 x 15 cm mass lesion confined to right scrotum with neither local invasion nor distant metastasis. Inguinal orchiectomy was performed and histopathology showed characteristic features of an aggressive angiomyxoma occupying paratesticular region, which was a challenging diagnosis due to its unexpected occurrence in the male gender. Conclusion: Aggressive angiomyxoma is mostly considered as a benign tumor in females despite its propensity for local recurrence. Whether it may show a divergent biological behavior in men is unknown as the reported cases are too few.