Fibrous pseudotumor of the scrotum

Fibrous pseudotumor of the scrotum is a relatively rare, non-neoplastic extratesticular non-epididymal lesion.

Epidemiology

It affects any age. Although rare, it is considered the third most common extra testicular mass after a scrotal lipoma and an epididymal adenomatoid tumor. 

Risk factors

Certain factors increases the risk of fibrous pseudotumor of the scrotum ⁵:

• inflammatory hydrocele
• trauma
• surgery
• infection 

Pathology

It is characterized by usually nodular, probably reactive proliferation of fibrous tissue and inflammatory cells. It occurs due to prior inflammation, infection, or trauma. 

Location

It most often involves the tunica vaginalis.

Radiographic features

Ultrasound

Sonographic appearances can be widely variable. They are typically seen as one or more solid paratesticular or tunica nodules or masses with variable echogenicity.

MRI

• T1: uniformly low signal intensity: due to the presence of fibrosis ⁴
• T2: uniformly low signal intensity: due to the presence of fibrosis ⁴
• T1 (C+) Gd: generally show slow but persistent enhancement, as is typical of fibrous tissue, although enhancement can be variable ⁴

Differential diagnosis

Clinically, it can mimic testicular malignancy. 

See also

• paratesticular lesions