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Adenomatoid tumors of the scrotum

Last revised by Dr Jeremy Jones on 20 Sep 2021

Adenomatoid tumors of the scrotum are benign, solid extratesticular lesions that can originate from the epididymis, tunica vaginalis, or spermatic cord (90% derived from the funiculus).

They are the most common extratesticular neoplasm, and most common tumor of the epididymis, and occur more often in the lower pole than in the upper pole by a ratio of 4:1.

Usually an incidental finding, adenomatoid tumors manifest as a small (usually under 2 cm), painless scrotal mass, with the majority diagnosed in patients aged 20-50 years. They are typically unilateral and occur more frequently on the left side.

When they grow non-invasively into the testicular parenchyma, they can simulate intratesticular disease.

  • well-defined, usually oval extratesticular mass with variable echogenicity although most are isoechoic to the epididymis 6
  • usually solid although can be completely cystic 6
  • range in size from a few millimeters to a few centimeters

MR imaging can aid in determining the paratesticular origin of the lesion.

  • T2: low signal intensity relative to the testicular parenchyma
  • T1 C+ (Gd): show enhancement

They are benign with no reports of recurrence or metastatic disease after excision 5,6.

General imaging differential considerations include:

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Cases and figures

  • Figure 1: gross pathology
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  • Case 1: T2
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  • Figure 2: histology - low power
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  •  Case 2: ultrasound
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  • Figure 3: histology - high power
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  • Case 3: T2
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  • Case 4
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  • Case 5: extra-testicular adenomatoid tumor
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