Presentation
Non-tender right scrotal mass for 5 years. Slowly increasing in size. No urinary symptoms.
Patient Data
Well-defined nodule measuring about 1.1 x 1.3 x 1.5 cm seen adjacent to the inferior pole of right testis. It is separate from the right testis and is likely arising from the tail of the right epididymis. It is isoechoic to the testis and shows minimal internal vascularity. This is likely an adenomatoid tumor of the scrotum arising from the tail of the right epididymis.
An interval increase is seen in the size of right epidydimal tail lesion; it now measures 1.9 x 2.3 x 1.8 cm as compared to the previous measurement of 1.1 x 1.3 x 1.5 cm. Re-demonstration of mild intralesional vascularity on the color Doppler ultrasound examination. Small left epididymal head cyst measuring 6 x 7 mm.
Findings: A well-defined lesion measuring approximately 1.9 x 2.3 cm is seen in right hemiscrotum along the posterior inferior aspect of the testicle. It is clearly separable from the right testicle and is likely related to/arising from the tail of the epididymis. The lesion is partially hypointense on T2W sequence, shows no diffusion restriction and mild enhancement on the post-contrast study, which is however less than the normal testicular enhancement. Minimal bilateral hydroceles. Small left epidydimal head cyst measuring 4 x 6 mm.
Impression: Small well defined extratesticular nodular lesion in the right hemiscrotum which is likely an adenomatoid tumor of the right epididymal tail.
Case Discussion
Procedure: Right epididymis mass excision.
Gross: Specimen submitted in formalin container (labeled right epididymis mass) consists of a very well-circumscribed encapsulated, spherical firm mass measuring 2.5 cm in maximum diameter. On sectioning, the tumor is whitish, whorled and homogenous.
Diagnosis: Leiomyo-adenomatoid tumor. Presence of fragment of normal epidydimal tissue. Margins are free. The immunostains: Calretinin: +++, h-caldesmon: +++, CK (AE1/AE3): +++