Presentation
Painless left scrotal swelling for 8 months. No history of trauma, fever or any urinary symptoms.
Patient Data
A well-defined, oval solid nodule is seen in the left hemiscrotum, adjacent to the left epididymal head. It is isoechoic to the adjacent testis and has mild internal vascularity. Its exact origin cannot be determined confidently. Possible imaging differential diagnosis of this lesion is adenomatoid tumor of the scrotum or supernumerary testis.
Findings: A small well-defined rounded nodule measuring ~ 1 x 1 cm is seen in the left hemiscrotum, adjacent to but separable from the head of the epididymis. It is of intermediate signal intensity on T1, low signal intensity on T2-weighted images, and shows no diffusion restriction. It shows moderate heterogeneous enhancement in the post-contrast study. No evidence of infiltration is seen into the surrounding structures. Minimal bilateral hydroceles. Both testes are normal.
Conclusion: Small benign looking non-epididymal and non-testicular nodule in the left hemiscrotum. Possible differential diagnoses include fibrous pseudotumor of the scrotum and adenomatoid tumor of the scrotum.
Case Discussion
Pre-operative diagnosis: Left scrotal mass.
Procedure: Left scrotal mass excision. Normal looking left testis and epididymis intraoperatively.
Diagnosis: Benign paratesticular fibrous pseudotumor. Associated reactive mesothelial hyperplasia of the surface is noted. There is no evidence of malignancy.
Gross description: Specimen is submitted in one container in formalin and consists of a polypoid grey to yellow lesion measuring 10 x 8 x 5 mm showing grey and homogenous cut surface.
Microscopic description: Sections show a lesion composed of hypocellular fibrous and sclerotic tissue, associated with a moderate chronic inflammatory cell infiltrate, and scattered hemosiderin-laden macrophages. The surface of the lesion shows small broad papillary formations lined by a single layer of benign mesothelial cells.
Immunohistochemistry confirms the mesothelial nature of the papillary formations, with the lining cells positive for CK7, CK 5/6, calretinin, and WT1 and negative for CEA and EMA.
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