Fibrous pseudotumor of the vaginalis testis: report of a case

In this study, the authors have reported a case of a benign fibrous pseudotumor of the tunica vaginalis testis in a 24-year old man who was admitted with a left scrotal mass. Scrotal ultrasound and surgical investigation demonstrated the presence of a left testicular tumor; radical orchiectomy was performed by inguinal route. Microscopic examination revealed a pseudotumor of the testicular tunica vaginalis. As this is an uncommon lesion and preoperative diagnosis is difficult, unnecessary radical orchidectomy is often carried out.     

Fibrous pseudotumor of tunica vaginalis and epididymis

Paratesticular fibrous pseudotumors are rare, and less than 10% of them affect the epididymis. We report a case of testicular trauma that progressed to a painless palpable tumor in the right hemiscrotum with increased local volume. Orchiectomy followed by anatomic-pathologic examination revealed a paratesticular fibrous pseudotumor. The best treatment is scrotal exploration and frozen biopsy. On confirmation of the diagnosis, only the tumor and the tunica vaginalis are resected. Should the benign nature not be possible to determine, orchiectomy is the procedure of choice. We also reviewed published reports for this possibility in the differential diagnosis of testicular masses.     

睾丸纤维性假瘤

目的 :探讨睾丸纤维性假瘤的病理及临床特点。　方法 :总结近年收治的睾丸纤维性假瘤 3例 ,均经病理证实。　结果 :3例均行睾丸切除 ,经随访无复发。　结论 :该病术前诊断困难 ,最好的治疗方法是在术中做冰冻切片检查 ,一经证实 ,则应切除假瘤及附近的鞘膜 ,不必行睾丸切除     

Fibrous pseudotumor of the tunica vaginalis testis

The incidence of fibrous pseudotumor of the tunica vaginalis testis is rare. It is a benign, fibroproliferative process with hyalinization and sometimes with focal calcification. In most cases malignancy is suspected although by careful physical examination it may be possible to establish the diagnosis pre-operatively. The best form of therapy is frozen section biopsy of the pseudotumor followed by excision; including if necessary the tunica vaginalis. If the pseudotumor is locally extensive an epididymectomy is sometimes necessary. A study of the literature reveals that because of the rarity of this lesion orchidectomy appears to have been performed in most cases. A case report of a patient with fibrous pseudotumor of the tunica vaginalis testis is presented.     

A case of chronic scrotal hematocele and review of the literature]

A 38-year-old man visited our hospital because of swelling of left scrotal content. He had no history of trauma of scrotum, fever, pain or dysuria. Physical examination revealed a tumor larger than a fist in the left scrotum. Ultrasonography revealed an echogenic mass with echolucent area in the scrotum. Surgical extirpation of the left scrotal tumor was performed under the diagnosis of left testicular tumor. The mass was encapsulated by a white fibrous membrane and was 700 g in weight. The tumor contained 200 ml of dark brown pus-like material. Histological examination revealed deposition of cholesterine crista and infiltration of lymphocyte in tunica vaginalis with extremely atrophic testis, destructive spermatogenesis and atrophic epididymis. Twenty one cases of chronic scrotal hematocele have been reported in the Japanese literature. The age of the patients reported was 38 to 77 years old with a mean age of 65 years. Orchiectomy was done under the diagnosis of testicular tumor in 20 of the 21 cases. Our case was thought to be of an idiopathic chronic scrotal hematocele. The disease should be considered even in the absence of a particular cause such as injury and inflammation of scrotal content.     

Retroperitoneal germ cell tumor with testicular calcification indicating tiny testicular origin: consideration of the origin of retroperitoneal germ cell tumors: report of two cases

Two cases of germ cell neoplasm retrospectively considered to have been of testicular origin are reported. Case 1. A 19-year-old male with brain, liver and retroperitoneal tumors was diagnosed with yolk sac tumor by retroperitoneal tumor biopsy. After multidisciplinary treatment, a region of calcification was detected in the left testis on scrotal sonography and left high inguinal orchiectomy was performed. Case 2. A 57-year-old male with neck, lung and retroperitoneal tumors was diagnosed with yolk sac tumor by supraclavicular biopsy. From initial examination, scrotal sonography revealed a small calcified lesion in the right testis. After chemotherapy, high inguinal orchiectomy and retroperitoneal lymphadenectomy were simultaneously performed. Pathologic evaluation of these testicular specimens revealed calcification and a fibrous scar in correspondence with the clinical diagnosis. These changes were considered as scars of the primary testicular tumor due to burned-out tumor or the result of reaction to chemotherapy. Since a primary tumor of testicular origin may exist in the extragonadal germ cell tumor, it is important to examine the intrascrotal contents in detail in the case of so-called extragonadal germ cell tumors with palpably normal testes. In such cases, there are two possible conditions, an occult testicular tumor and a burned-out testicular tumor. We briefly reviewed 42 such cases in the Japanese literature. It appears that there are very few true extragonadal germ cell tumors, and that the possibility of primary testicular origin metastasizing from viable occult testicular tumor or burned-out testicular tumor with spontaneous regression is high in retroperitoneal germ cell tumors.     

A fibrous pseudotumor of the tunica vaginalis testis. A report of a new case and a review of the literature

Presentation of one case of benign fibrous pseudotumor of the tunica vaginalis testis in a 22-year-old male patient who underwent radical orchiectomy due to suspected testicular neoformation. Contribution of radiological findings with ultrasound and CAT, emphasizing the significance of considering this rare entity as part of the differential diagnosis of extratesticular intrascrotal masses.     

Testicular metastasis of multiple myeloma: a case report

A 49-year-old man was admitted to our department with the complaint of right scrotal painless swelling in May 1986. The patient had been treated for multiple myeloma since November 1985. Right orchiectomy was performed under the diagnosis of malignant testicular tumor. The right scrotal mass was 5 x 7.5 x 3.5 cm in size. Histological diagnosis was testicular metastasis of multiple myeloma. Testicular metastasis of multiple myeloma is very rare and only 5 cases have been reported in the Japanese literature. The 6 cases including our case with testicular metastasis of multiple myeloma in Japan are reviewed.     

Diffuse fibrous proliferation of tunica vaginalis associated with testicular infarction: a case report.

Fibrous pseudotumor of the tunica vaginalis testis is an uncommon lesion of unknown pathogenesis. Although this reactive process of testicular tunics is benign, this usually is diagnosed after radical orchiectomy. The authors describe a case of fibrous pseudotumor of the tunica vaginalis testis associated with testicular infarction. To our knowledge, this is the first case presented with similar association, second case consisting predominantly of myofibroblasts and the fourth reported case encountered in childhood.     

Case report on testicular tumors in non-twin siblings

A case report of testicular tumors in non-twin siblings is presented. A 42-year-old male was admitted to Kansai Electric Power Hospital with the complaint of swelling of the left scrotal contents. Left radical orchiectomy was performed with the diagnosis of a left testicular tumor. Histological examination revealed a seminoma of the left testis. Fifteen years later, his 43-year-old younger brother was admitted to Osaka University Hospital with the complaint of painless swelling of the left scrotal contents. Left radical orchiectomy was carried out with the diagnosis of a left testicular tumor. Histological examination showed a seminoma of the left testis. The former patient had a history of a scrotal trauma, but there was no history of orchitis or cryptorchism in these two siblings. To our knowledge, there have been reported 44 sets of testicular tumors in siblings. Eleven of these sets appeared in twins, while the other 33 sets were described in non-twin siblings. We discussed the 45 cases including our case of testicular tumors in siblings.     

Two cases of spermatocytic seminoma]

Two cases of spermatocytic seminoma are reported. The first case was a 58-year-old man who visited our hospital with a complaint of painless swollen left scrotal content. Left orchiectomy was performed under the diagnosis of testicular tumor. Since the pathological diagnosis first made was anaplastic seminoma, he was treated with combined chemotherapy (PVB, 1 course). However, since the pathological diagnosis after re-examination of the specimen, was spermatocytic seminoma, he underwent prophylactic radiation therapy. The second case was a 64-year-old man who visited our hospital with a complaint of painless swelling of right scrotal content. Right orchiectomy was performed under the diagnosis of testicular tumor. The pathological diagnosis was spermatocytic seminoma. He underwent prophylactic radiation therapy. Postoperatively these two patients have been well with no evidence of recurrence. These are the 14th and 15th cases of spermatocytic seminoma reported in Japan.     

A case of idiopathic chronic scrotal hematocele

A case of chronic scrotal hematocele is reported. A 63-year-old male first noticed the painless swelling of his left scrotal contents about 30 years before he visited our clinic on September 16, 1987. Examination revealed a hard mass, 10 x 8 cm in diameter, in the left scrotum. The scrotum did not transmit light. Since it was impossible to exclude testicular tumor completely, we performed left high orchiectomy. The extracted mass contained old brownish black clotted blood and a normal testis. Histopathological examination revealed that the hematocele showed a dense, fibrous wall with hyalinization. Six cases of chronic scrotal hematocele including our case have been reported in the Japanese literature.     

High resolution sonography in diagnosing testicular neoplasms: clinical significance of false positive scans

We describe the use of high resolution real-time ultrasound to evaluate scrotal masses. From August 1980 to September 1984, 249 patients underwent scrotal ultrasound using high resolution real-time scanners with 10 mHz. transducers to evaluate scrotal abnormalities. The ultrasound diagnosis was consistent with a testicular neoplasm in 20 patients. Pathological and surgical confirmation was available in all 20 patients. Only 10 of 20 patients had malignant tumors, whereas 10 had benign lesions (false positive rate of 50 per cent). Testicular lesions producing false positive studies were principally hypoechoic in 8 patients and hyperechoic in 2. Testicular neoplasms characteristically were hypoechoic with or without focal hyperechoic areas. There was 1 false negative ultrasound study. Our results suggest that radical orchiectomy should not be performed indiscriminately in all patients with testicular lesions that are sonographically suspicious for neoplasm. In selected cases with hyperechoic sonographic features associated frequently with benign testis lesions open testicular biopsy and a testis-sparing operation may be indicated.     

Inflammatory pseudotumor of the prostate: a case report

We report a rare case of inflammatory pseudotumor of the prostate. A 42-year-old man with a history of hematospermia and chronic prostatitis presented with difficulty in voiding. Cystoscopy demonstrated a large non-papillary tumor occupying the prostatic urethra along with two bladder stones. Magnetic resonance imaging (MRI) demonstrated a 7-cm prostatic mass protruding toward the bladder and the rectum. Transrectal biopsy of the prostate demonstrated a fibrous lesion containing inflammatory cells without evidence of malignancy. We performed transurethral resection of the prostatic lesion to release the bladder outlet obstruction, followed by cystolithotripsy. Histopathological examination of the surgical specimen demonstrated a benign fibromuscular lesion with spindle cell proliferation, leading to a diagnosis of inflammatory pseudotumor. Postoperatively, the patient voided normally without any signs of recurrence on follow-up at five months. Inflammatory pseudotumor is an unusual benign lesion of unknown etiology. Only 10 previous cases of the disease involving the prostate have been reported in English and Japanese literature. Prostatic involvement of inflammatory pseudotumor may show a presentation similar to malignant prostatic sarcoma. Thus, accurate identification of this benign process is important in order to avoid unnecessary radical surgery.     

Epidermoid cyst of the testis: a case report

A 28-year-old man was admitted to our department with the chief complaint of a painless nodule in the left scrotal content. Physical examination revealed that a small, thumb-finger sized, hard mass with a smooth surface was palpable at the upper part of the left scrotal content. With the preoperative diagnosis of testicular tumor, the left testis was explored under ischemia. Appearance of the testis was normal and the mass was felt in the upper portion of the testis. Since the mass was suspected to be malignant, left radical orchiectomy was performed. The histological diagnosis was epidermoid cyst of the testis. Sixty-five cases of testicular epidermoid cyst including this case have been reported in the Japanese literature, and are reviewed briefly here.     

Intrascrotal malignant fibrous histiocytoma: a case report and review of the literature

A 75-year-old man visited our clinic on November 11, 1982 with the complaint of a painless mass in the right scrotum. The mass was hen's egg sized and hard. Surgery was performed under the diagnosis of testicular tumor. Right hemiscrotectomy with right inguinal orchiectomy was performed because of a scrotal skin invasion of the tumor. The spermatic cord, testis and epididymis were grossly normal. The tumor was located just beneath the testis, and it was considered to be scrotal tunicus in origin. The tumor was elastic and hard, and the cut surface showed a yellowish white and lobulated appearance. The histological diagnosis was malignant fibrous histiocytoma. Postoperatively, radiotherapy for a total dosage of 4,910 rads was given. The patient is alive and well without any sign of recurrence 19 months after operation. The 20 cases reported in Europe, America and Japan, including our case, were tabulated and some discussion is made.     

Asymptomatic calcifying fibrous pseudotumor compressing heart cavities

Calcifying fibrous pseudotumor is a rare benign lesion composed mostly of dense hyalinized colagen with multiple dystrophic or psammomatous calcifications and variable lymphoplasmacytic infiltrate. Children and young adults are most commonly affected by this tumor of uncertain pathogenesis. This is a case of an asymptomatic young woman with calcifying fibrous pseudotumor of the pericardium compressing heart cavities. Partial resection and marsupialization of the mass was performed.     

Malignant fibrous histiocytoma of the spermatic cord: A case report

We present a case of malignant fibrous histiocytoma of the spermatic cord. An 86-year-old man was admitted to the hospital with a right painless scrotal mass. Under the diagnosis of a testicular tumor, right radical orchiectomy was performed. Grossly, the tumor firmly adhered to the spermatic cord. The right testis and epididymis were normal. The histologic diagnosis was malignant fibrous histiocytoma. There was local recurrence 2 months after surgery. The recurrent tumor was resected with the surrounding soft tissue, but the patient died 5 months after the initial operation.     

Simple testicular cyst: A rare cause of scrotal swelling in infancy

A simple testicular cyst is a rare cause of scrotal swelling in infancy. Only 10 cases have been reported in children less than two years of age in the English literature. Pathogenesis of the lesion is unclear. Preoperative diagnosis is possible using ultrasonography (US). Testis-sparing surgery with simple enucleation of the cyst has a favorable outcome. We report two patients with a simple testicular cyst, who were 9 and 8 months of age. The first case was referred with a presumptive diagnosis of hydrocele, and the second infant was admitted with a history of testicular swelling. Ultrasonography provided accurate preoperative diagnosis in both of the cases. The patients were successfully treated with testis-sparing surgery with outstanding long-term results. This unusual lesion of infancy should be considered in the differential diagnosis of a scrotal mass.     

Scrotal scanning: present value and limits of interpretation.

Forty-three testicular scans have been performed on 38 patients presenting with various scrotal symptoms. Scan diagnosis correlated correctly with the clinical findings in 86 per cent of cases. The most common cause of false positive testicular scan was found to be hydrocele. The mechanism responsible for this observation has been explored in a rat model. A false negative diagnosis was made in 2 cases owing to a small retracted scrotum in 1 patient and a markedly late discovered torsion in the second.