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Spindle cell rhabdomyosarcoma (RMS) is a rare variant of embryonal rhabdomyosarcoma. This tumor commonly involves paratesticular region of young males. Herein we report a case report of right paratesticular spindle cell rhabdomyosarcoma in a 16-year-old boy, who was referred to us for painless right scrotal mass. Staging computerized tomography (CT) showed no nodal or distant metastasis. The right radical inguinal orchidectomy was performed. Diagnosis of paratesticular spindle cell rhabdomyosarcoma was confirmed by histopathological and immunohistochemical examination. Paratesticular spindle cell RMS is a rare tumor and morphologically it may mimic other spindle cell neoplasms. Immunohistochemistry plays a pivotal role in its diagnosis. Making a correct diagnosis is crucial owing to the different treatment modalities available for this tumor.

Primary tumors of the paratesticular region are rare, with sarcomas constituting a major proportion, particularly in the old age. The paratesticular region consists of mesothelial, various epithelial, and mesenchymal cells and may therefore give rise to a variety of tumors. Epithelioid sarcoma usually occurs at the distal extremities of young adults. The proximal-type variant is characterized by a more aggressive course and resistance to treatment. We herein report a case of 32 years male with scrotal swelling diagnosed as proximal-type epithelioid sarcoma of paratesticular region after histopathological examination and immunohistochemistry. To the best of our knowledge, this is only the second case of proximal epithelioid sarcoma of paratesticular region in the English literature. As these tumors are rare, it has been difficult to establish their optimal treatment. Also, these can be easily misdiagnosed as other epithelioid lesions.

INTRODUCTION AND OBJECTIVE:Liposarcoma is one of the most common subtypes of soft tissue sarcoma. The tumor often develops in the lower extremities and the retroperitoneal or paratesticular region....

Introduction and importance Benign fibroblastic proliferation located within the scrotum are uncommon. They are also identified as fibrous pseudotumour and usually arise from the paratesticular region. Their pathogenesis is unknown. These tumours are difficult to diagnose pre-operatively and resemble intra-scrotal malignancy. Case presentation We managed a 26-year-old Nigerian man with a five-year history of left sided hemiscrotal swelling. The mass was excised, and histology showed benign fibroblastic proliferation. Discussion Most paratesticular tumours are benign. Imaging studies that show the mass as separate from the testis, normal levels of tumour markers and clinical features not suggestive of malignancy make the case for organ-sparing mass excision, in the treatment of paratesticular fibrous pseudotumour, very strong. Conclusion Intra-scrotal benign fibrous proliferation is a challenge to diagnose pre-operatively but excision of this benign mass without an orchidectomy is practicable when pre-operative assessment suggests a benign disease., Highlights • Paratesticular fibrous pseudotumours are benign and uncommon. • Pre-operative diagnosis of these tumours is difficult, and they resemble intra-scrotal malignancy. • Many cases are diagnosed post-operatively from orchidectomy specimen. • Organ-sparing mass excision is practicable with appropriate pre-operative evaluation.

Inflammatory pseudotumor is a soft-tissue lesion of unknown etiology, but likely of reactive nature. It is considered benign and treated by simple excision; however, pre-operative diagnosis is often challenging because of the ability of pseudoinflammatory pseudotumor to mimic numerous benign and malignant entities, both clinically and ultrasonographically. Herein, we present the case of a 56-year-old man with a paratesticular inflammatory pseudotumor with concerning clinical features which could not be identified clinically or intra-operatively and thus required an orchiectomy to reach the final diagnosis. In the paratesticular region, inflammatory pseudotumors are uncommon (6% of masses) but must be kept in mind due to their benign nature.

Objectives: Tumors and tumor-like lesions (TLL) of the paratesticular region are rare. Very few studies depicting the spectrum of lesions of this location are available in the literature. Malignant neoplasms arising in the paratesticular region represent only 7.0% of malignant tumors presenting as a scrotal mass. TLL and benign tumors are of great interest, because of their topography they can simulate a neoplasm in the paratesticular structures. We sought to study the incidence, nature, pattern, clinical, immune, and histopathological characteristics of tumors and TLL of the paratestis. Methods: In this six-year study, records of the cases were reviewed and the histopathology slides were reassessed. Blocks were retrieved and stained immunohistochemically for relevant markers. Results: A total of 47 cases of tumor and TLL of the paratestis were diagnosed over a six-year period. The patients ranged from one to 76 years old and most presented with a scrotal mass. Of these, seven (14.9%) were benign. Lipoma was the most common benign tumor. One case each of adenomatoid tumor, scrotal hemangioma, solitary fibrous tumor, and papillary cyst adenoma were reported. The TLL (70.2%) comprised of 17 cases of epididymal cyst, seven cases of tuberculous epididymitis, four cases of filarial epididymitis, two cases each of non-specific granulomatous epididymitis and fibromatous periorchitis, and one case of mesothelial cyst. Seven malignant tumors (14.9%) were diagnosed all of which were sarcomas. All seven were primary to the paratesticular region. The most common malignant tumor was embryonal rhabdomyosarcoma. One case each of malignant mesothelioma, malignant fibrous histiocytoma, atypical lipomatous tumor/well-differentiated liposarcoma, and myxoid liposarcoma were identified. Conclusion: Neoplasms of the paratesticular region affect patients of all ages, with potentially life-threatening sequelae. Awareness of the entire spectrum and meticulous histopathological examination and immunohistochemical studies are of prime importance in the diagnosis of the various lesions as these influence the mode of therapy and subsequent prognosis of the patient.

Coexistence of bilateral seminomas and adenomatoid tumor is rare. We encountered an interesting case of bilateral testicular seminomas along with a paratesticular nodule which was diagnosed as an adenomatoid tumor on histology. Although seminomas and adenomatoid tumor are frequent neoplasms, bilaterality and their coexistence have been rarely described and can pose diagnostic difficulties. Herein, we describe a case of a 53-year-old man who presented with bilateral testicular swellings which were diagnosed as bilateral seminomas with an adenomatoid tumor in the left paratesticular region on histopathology. The pathological findings of these coexistent tumors and the utility of immunohistochemistry in establishing a correct diagnosis in such scenarios are discussed.

Soft tissue perineuriomas are rare but benign tumours that are composed of peripheral nerve sheath and are most commonly located in the extremity. Diagnosis is confirmed by the immunohistochemical and ultrastructural features of the tumour. Paratesticular location is extremely rare; so far, only one case is reported. Herein, we report a second case of perineurioma in a 16-year-old male in the paratesticular region.

Tumors and tumor-like lesions of the testes and paratesticular structures are rare neoplasms often documented solely in case reports but are morphologically similar to their counterparts in other organ systems. According to the World Health Organization (WHO) classification, miscellaneous tumors of the testis, tumors of collecting ducts and rete testis, tumors of paratesticular structures are differentiated from mesenchymal tumors of the spermatic cord and testicular adnexa. In the differential diagnostics of a space-occupying mass in the testis or paratesticular region, tumor-like lesions should be considered because these lesions represent a large collection pot and occur more often than was originally assumed.

Paratesticular liposarcomas are relatively common sarcomas in the paratesticular region, however, the myxoid variant is considered very rare. Due to the infrequency of this malignant disease, no standard treatment would be available. Multiple treatments have reported in literature with different results. Herein, we presented a case of paratesticular myxoid liposarcoma in a 67-year-old man originating from the right paratesticular soft tissue. Keywords: Myxoid liposarcoma, Paratesticular, Scrotal mass

Uterine rhabdomyosarcoma (RMS) typically presents as a mixed epithelial and mesenchymal tumors. Pure RMSs of the female genital tract are uncommon. Spindle cell variant of RMS is a rare morphologic subtype of embryonal RMS and mostly occurs in the paratesticular region of children. Here, we present a case of uterine spindle cell RMS in a 76-year-old woman. The tumor, 20×15×7 cm in size, was highly necrotic and adherent to the colon and rectum. Tumor cells were mostly spindle-shaped, and isolated rhabdomyoblasts were scattered. Immunohistochemical stains for myoglobin and myo-D1 showed diffuse positivity for tumor cells. The patient died only of disease three months after diagnosis.

Paratesticular liposarcomas are relatively common sarcomas in the paratesticular region, however, the myxoid variant; myxoid liposarcoma (MLS) is considered very rare. MLS peaks around the fourth-fifth decade. Herein, we describe a case of paratesticular MLS occurring in a 19-year-old African American male who underwent resection of a slowly growing testicular mass over a period of one and a half years that was considered initially by his primary care physician to be a benign lesion. The resection margins were positive for tumor and the patient developed local recurrence one year after the initial resection. An extremely unusual age of presentation along with the importance of margin status in tumor recurrence is highlighted.

Spindle cell rhabdomyosarcoma is a rare variant of embryonal rhabdomyosarcoma that affects young males and most commonly involves the paratesticular region. We report a case of paratesticular spindle cell rhabdomyosarcoma in a 14-year-old boy, who presented with a painless scrotal mass. Left inguinal orchidectomy was performed. Histopathological and immunohistochemical examination of the mass revealed spindle cell rhabdomyosarcoma of the paratesticular region.

The adenomatoid tumor of the epididymis (EAT) is a neoplasm located in the paratesticular region. Mesothelial origin has been mentioned and inflammation has played some role in the development of these tumors. Physical examination and testicular ultrasound constituted important tools in the diagnosis. Some reports have mentioned malignant behavior, but it is very rare. Surgical treatment is the procedure of choice. We present the case of a 46-year-old patient with an adenomatoid tumour located in the head of the left epididymis that referred to our department with gradually enlarged intrascrotal mass.

Carcinoid tumors are neuroendocrine tumors and most frequently occur within tissues derived from the embryonic gut. These tumors can occur in any organ but are very rare in the paratesticular region. We hereby report a case of paratesticular carcinoid in a 70-year-old male who, to the best of our knowledge, is the oldest patient reported so far in the world literature.

Lipoleiomyosarcoma is a well differentiated liposarcoma with focal differentiation into mature smooth muscle with atypia. These tumours usually occur in the retroperitonum, although they have been reported in other locations. The inguinal paratesticular region is a rare site for these neoplasms. Their behaviour is similar to that of well differentiated liposarcomas. Their location and the possibility of complete surgical extirpation are key prognostic factors. Two cases of lipoleiomyosarcoma occurring in the paratesticular region are presented together with a review of the literature.

Abstract Paratesticular liposarcoma is a rare neoplasm, described in single case studies or components of larger studies, as histologically well-differentiated liposarcoma (WDL) and dedifferentiated liposarcoma (DL). However, leiomyosarcomatous differentiation is an extremely rare occurrence in WDL and DL. We report a case of leiomyosarcomatous differentiation in a 77-year-old man. The patient presented with a painless right scrotal mass. Magnetic resonance imaging showed a large mass along the right spermatic cord. The resected mass, measuring 17.5 × 12 × 5 cm, was composed of a high-grade pleomorphic undifferentiated sarcomatous component with necrosis. Atypical smooth muscle differentiation was also detected. Additional tumor sampling revealed the presence of a WDL component. Immunohistochemical analysis of the pleomorphic sarcomatous component showed positive staining for MDM2 and CDK4, and negative staining for alpha smooth muscle actin (αSMA) and desmin. The smooth muscle component was positive for αSMA and desmin, and negative for MDM2 and CDK4. Extension from primary retroperitoneal sarcoma was not proved. We diagnosed of DL with leiomyosarcomatous differentiation. Virtual slides The virtual slide(s) for this article can be found here: http://www.diagnosticpathology.diagnomx.eu/vs/1484291498104021.

Neoplasms in the testis and in the testicular adnexa of elderly patients are completely different from those observed in younger patients. Indeed, although conventional seminomas and nonseminomas are mainly observed in the age range of 20-45 years, spermatocytic seminoma, malignant Leydig tumors, and lymphomas in the testis and sarcomas in the paratesticular region are encountered in individuals older than 60 years of age. Here, we discuss the testis and paratesticular region neoplasm more commonly diagnosed in elderly men.

Ganglioneuroma is a benign tumor, affecting the central nervous system, commonly seen in children and young adults. Non-cranial ganglioneuromas are seen predominantly in the posterior mediastinum and retroperitoneum. Paratesticular neoplasms are extremely rare and are susceptible to clinical misinterpretation as malignancy. Tumors of nerve origin are a rarity in the paratesticular region, with a few cases of schwannoma and malignant peripheral nerve sheath tumor being reviewed in the literature. A rare case of ganglioneuroma involving the paratesticular region in an adult is presented.

Rhabdomyosarcoma (RMS) is the most common soft tissue tumor of childhood; about 80% of cases occur before the age of 21 with the remaining 20% evenly spread throughout the remaining decades. A primary paratesticular site is considered to have a good prognosis in comparison with other RMS sites. Histologically, any subtype of RMS, including alveolar, pleomorphic, embryonal, and mixed type, may occur in the paratesticular region, but only a relatively small number of cases are mixed and this variant has a poor prognosis. We report a case of paratesticular RMS (mixed embryonal and alveolar type) in a 16-year-old boy.

A 17-month-old boy had a melanotic neuroectodermal tumor of infancy in the left paratesticular region affecting the retroperitoneal lymph nodes. Immunohistochemical and ultrastructural study showed phenotypical diversity of the proliferating cells within a spectrum of neuroectodermal differentiation. Urinary catecholamine levels were initially elevated but returned to normal values after complete eradication of the tumor. The patient received chemotherapy and is now well, without evidence of disease 28 months after surgery.

Background Solid tumor metastasis to the epididymis is a rare occurrence and is mostly discovered incidentally at autopsy or after therapeutic orchidectomy for prostate cancer. Other primary carcinomas that have been demonstrated to metastasize to the paratesticular region include those originating in the stomach, kidney, ileum, and colon. Case presentation A 72-year-old gentleman presented with a firm and tender mass involving the right epididymis. On examination, he was jaundiced. Computed tomography of the abdomen demonstrated an obstructive stricture of the extra-hepatic bile ducts, in keeping with a cholangiocarcinoma, through which a metal stent was endoscopically inserted for symptomatic relief. Subsequent right radical orchidectomy yielded a diffusely infiltrative adenocarcinoma obliterating the epididymis, extending into the rete testis, vas deferens and spermatic cord and showing widespread vascular and perineural invasion. Residual epididymal, rete, and testicular tubules showed no in situ neoplasia. Morphologically and immunohistochemically the features were in keeping with a metastasis from a primary cholangiocarcinoma. Conclusion Only two cases of bile duct carcinoma metastasising to the male genital tract have previously been reported in the literature, the testis being the main site of metastasis in both cases. To our knowledge, this is the first described case of cholangiocarcinoma metastasising primarily to the epididymis, and presenting as a solitary epididymal metastasis in the absence of disseminated disease. It serves to highlight the importance of performing a thorough examination of the male external genitalia both clinically, in the follow up of cancer patients, and at autopsy.

Most often, mesotheliomas involve the serosal membranes of the pleura and peritoneum. Sometimes, mesothelial proliferations are identified in other locations. A mesothelioma, within the tunica vaginalis of the paratesticular region is rare but often fatal malignancy of the male genitalia. Despite aggressive surgical and systemic therapy the prognosis remains poor with only rare long-term survivors. We report a case of malignant mesothelioma of the tunica vaginalis in 45-years-old and review of the literature is presented.

The purpose of this study was to evaluate the ultrasonographic features of canine lipomas. A group of 94 dogs with a soft tissue mass was considered. All dogs were examined ultrasonographically and cyto/histologic examination was performed. Twenty-four dogs, whose mass was diagnosed as a lipoma, were selected. Fifty-five lipomas were present on the 24 dogs. Fifty-one lipomas were superficial and located subcutaneously. Four lipomas were deep and located in the paratesticular region. Ultrasonographically, lipomas appeared as oval, well-defined, encapsulated, striated masses.

Fibrous proliferation of testicular tunica also known as fibrous pseudotumor of the testis are are uncommon lesions. These lesions are usually difficult to clinically differentiate from testicular tumors. We describe two cases of pseudotumors of the paratesticular region. The tumors in both cases simulated the appearance of a neoplastic process on gross examination. The first patient presented with a testicular mass while the second presented with acute scrotal abscess. A fibromatous pseudotumor completely encased the testes in both patients. In addition to fibrosis, ossification of the tunica led to eggshell calcification on imaging in the first case. Both tumors were successfully resected with an uneventful recovery. Histological examination revealed hypocellular dense collagen bundles with areas of coagulative necrosis with mononuclear inflammatory infiltrate. No evidence of cellular atypia or increased mitosis was seen. There was no tumor recurrence at 15 months follow-up. Fibrous pseudotumors should be considered in the clinical differential diagnosis of testicular and paratesticular masses.

A 78-year-old male patient presented with an inguinoscrotal nodule that had lasted for 3 years. The patient reported a past medical history of hydrocele formation. The final diagnosis was fibrous pseudotumor of the paratesticular region, which was based on a histopathological examination and immunohistochemical findings. The aim of this case report is to spread awareness and recognition of neoplastic and non-neoplastic entities that occur in the paratesticular region. Paratesticular fibrous pseudotumor was first reported by Balloch in 1904. The incidence of fibrous pseudotumor has been reported to comprise approximately 6% of paratesticular lesions and tumors [1]. Mostofi and Price [2] used the term ‘fibrous pseudotumor’ for all of these proliferations with a peak incidence in the third decade of life, but they can occur at any age. Jones et al [3] proposed a classification for benign fibrous proliferations of the paratesticular region and testis on the basis of the benign or malignant nature of the lesions and segregated them into various categories based on location, pathologic features, and immunohistochemical studies. We describe a case of an elderly male presenting with a painless inguinoscrotal nodule.

Fibrous pseudotumour of the testis is a rare benign lesion involving the paratesticular region. It usually presents in nodular form and may cause diagnostic dilemma resulting in unnecessary sacrifice of the testes. We report a rare case of diffuse fibrous pseudotumour which had to be treated by orchiectomy.

Tumors of the spermatic cord are rare. Up to 20% are malignant and usually located in the paratesticular region. We report the rare case of an inguinal fibrolipoma of the spermatic cord with discrepancies between clinical and histopathological findings.

Tumors reminiscent of müllerian epithelial tumors of the ovary have been reported outside of the ovary, including in the pancreas and paratesticular region. The latter are most commonly serous tumors of borderline malignant potential and involve the tunicae. We present the first case of a serous cystadenoma of the epididymis in English reports with a brief literature review.

Correspondence Re: Kawano N, Inayama Y, Nagashima Y, Miyagi Y, Uemura H, Saitoh K, et al. Desmoplastic Small Round-Cell Tumor of the Paratesticular Region: Report of an Adult Case with Demonstration of EWS and WT1 Gene Fusion using Paraffin-Embedded Tissue. Mod Pathol 1999;12:729–34.

Primary epididymal tumors are rare. Adenomatoid tumors comprise 30% of paratesticular tumors. They are benign neoplasms originating from mesothelial cells. On the other hand, leiomyomas, originating from smooth muscle cells, are less common in paratesticular region. Leiomyoadenomatoid tumor is a benign tumor which combines the morphologic features of adenomatoid tumor and leiomyoma. To the best of knowledge, only two cases of leiomyoadenomatoid tumor in the paratesticular location have been reported in the literature. We document another such case.

Introduction Cellular angiofibroma is a benign vascular neoplasm that typically arises in the paratesticular region in men and is easily confused with inguinal or scrotal hernia. Case presentation We present a case of a cellular angiofibroma arising from the spermatic cord of a 74-year-old Caucasian man. Initially, the lesion was confused with a scrotal hernia, but imaging revealed a subcutaneous, inhomogeneous, but well-circumscribed lesion to the surrounding tissues with rich vasculature. Surgical resection of the lesion was performed. Histology revealed a benign tumor of vascular origin rich in fibroblasts. Conclusions Angiofibroma can easily be confused with an inguinal hernia and should be differentiated from Schwann cell tumors, perineuromas, spindle-cell lipomas, aggressive angiomyxomas, angiomyofibroblastomas, solitary fibrous tumors, spindle-cell liposarcomas, and leiomyomas. A safe initial diagnosis is difficult because of its location, nature, and correlation with other structures of the area.

We describe a 6-month-old male infant with a dermoid cyst of the left paratesticular region. To our knowledge, this represents the youngest patient reported with this rare benign teratoma. We advocate enucleation for this particular type of teratoma based on referenced histopathological criteria.

Background Adenomatoid tumors are regarded as distinctive benign mesothelial neoplasms of the paratesticular region, most commonly occuring at the tail of the epididymidis. Because of its rarity, the clinical and histopathological aspects are discussed. Case presentation We present the case of a 41-year-old patient with an adenomatoid tumour located in the tail of the left epididymis that referred to our department with gradual enlarged intrascrotal mass. The diagnosis was achieved by echography, and was confirmed by surgical excision and histological analysis. Conclusion Due to its low incidence in intrascrotal pathology, we believe it is important for the physician to be aware of this interesting entity in order to make a differential diagnosis from other inflammatory processes and to adopt the proper surgical approach.