Testicular Adenomatoid Tumour Treated with Local
Excision on the Benignity Predicting Magnetic
Resonance Imaging Findings
Artykuł opublikowany w Urologii Polskiej 2008/61/2.
Sahin Kabay, Mehmet Yucel, Orhan Ozbek, Esra Gurlek Olgun
- Dumlupinar University Faculty of Medicine, Department of Urology, Turkey
Dumlupinar University Faculty of Medicine, Department of Radiology, Turkey
Dumlupinar University Faculty of Medicine, Department of Pathology, Turkey
guz jądra gruczolakowłókniakomięśniak magnetyczny rezonans jądrowy wycięcie guza
Adenomatoid tumours are usually presented as paratesticular
masses. Paratesticular benign neoplasm’s are generally not encapsulated
and are commonly presented between the structures of
adjacent tissues and may show clear-cut infiltration . Although
most intratesticular tumours are malignant, paratesticular tumours
are generally benign (accounting 70% of all). We report a rare case
of adenomatoid tumour of the testis treated by local excision on the
basis of Magnetic Resonant Imaging (MRI) scans suggesting benign
A 28 year-old man was referred to our urology clinic
with two-month history of a slowly enlarging and painless
scrotal mass. He had no history of epididymitis, torsion,
trauma, genitourinary surgery and constitutional symptom.
Physical examination revealed 1 cm, nontender intrascrotal
mass at the lower pole of the left testis. Serum levels of the
alpha-fetoprotein (AFP), beta-human chorionic gonadotropin
(ß-hCG) and lactate dehydrogenase (LDH) were within
Scrotal ultrasonography (US) revealed a 15x13 mm heterogeneous
regular contour mass in the lower pole of the testis
and the mass relatively hypoechoic to the epididymal parenchyma.
The mass did not bulge the outer counter of the testis.
With the ultrasonogaphic findings, the mass was thought to
arise from the tunica albuginea or epididymis and preoperative
scrotal MRI was performed to verify this impression. Scrotal MRI
was performed using fast spin echo T2-weighted images in the
coronal-oblique and sagittal planes. Before and after contrast
administration T1-weighted images were performed in the
coronal-oblique and sagittal planes. MRI revealed a 1.5 cm mass
which had regular contour and heterogeneous parenchyma. The
mass had hyperintense and hypointense parenchyma according
to epididymis and testis in T1 and T2-weighted images, respectively
(Figure 1). After IV gadolinium administration, minimum
contrast-enhancement was observed by solid mass (Figure 2).
The patient underwent left inguinal exploration with local
excision of only the intratesticular lesion. Histological examination
revealed benign fibrous, smooth muscle and mesothelial proliferation, consistent with an adenomatoid tumour growing
down into the testicular tissue from the inner surface of the tunica
albuginea (Figure 3). At 9 months of follow-up, no disease
recurrence was observed.
Adenomatoid tumours are the most common paratesticular
neoplasm’s and account for approximately 30% of all paratesticular
neoplasm’s and are rare benign neoplasm’s of the
mesothelial origin and commonly found near the lower pole of
the testis [2, 3]. These tumours usually arise in the epididymis;
however, they have been reported in the spermatic cord, suprarenal
recess, prostate, ejaculatory duct and tunica albuginea in
men and in the uterus and fallopian tubes of women [4,5].
The clinical presentation is almost invariably a mass swelling,
which may or may not be painful and is occasionally accompanied
by a hydrocele. These findings are by no means specific to a
tumour type and cannot distinguish a benign from a malignant
High-resolution scrotal ultrasonography remains the primary
imaging method and when used with the appropriate
clinical data, may be extremely helpful in establishing the
diagnosis. In general, benign tumours are homogeneous
and hyperechoic, whereas malignant ones are either homogeneously
hypoechoic or have a heterogeneous pattern of
hypo- and hyper- echoic areas. However, the ultrasonographic
appearance may be misleading and homogeneous;
hyperechoic liposarcoma has been reported . MRI may
locate the tumour better and define its relationship to various
paratesticular structures in greater detail, which, is not
always possible with ultrasonography .
A recent study which involved 12 cases of paratesticular adenomatoid
tumour has provided immunohistochemical evidence
indicating a mesothelial cell origin .
The only local mass excision with inguinal incision was
performed on the basis of the slow growth history, the small
tumour size, normal serum levels of tumour markers (AFP,
ß-hCG, LDH) and imaging methods (MRI, US). The superior
portion of the testis and the epididymis were normal. MRI findings
were useful in suggesting that the palpable mass arose
from tunical surface or in the testis. MRI showed that a 1.5 cm
mass had regular contour and heterogeneous parenchyma. The
mass had hyperintense parenchyma in T1-weighted images and
hypointense parenchyma in T2-weighted images according to
epididymis and testis.
Watanabe et al. have found that dynamic contrast-enhanced
MRI evaluation may be useful in distinguishing testicular tumour
from other testicular disorders; in this series malignant testicular
tumour had increased contrast enhancement compared with
contralateral normal testicular parenchyma .
The adenomatoid tumour showed less contrast enhancement
than ipsilateral testicular parenchyma and contralateral
parenchyma. This finding confirms to the prediction
of benignity of the mass based on the work of Watanabe et
The potential value of MRI is further evaluation of scrotal
disease when sonographic features are insufficient or unusual.
MRI evaluation may provide additional morphologic evidence
precise localization and the origin of the mass.
We report this case because of the rarity of intratesticular
adenomatoid tumour and the importance of organ-sparing
surgery by preoperative MRI images. MRI evaluation may be a
useful diagnostic tool, if there is any doubt in considering rare
benign intratesticular neoplasm’s in the differential diagnosis
of testicular masses with normal levels of preoperative serum
tumour markers. However, the MRI is not widely available and is
an expensive technique, which limits its routine use in the clinical
practice. It’s also experienced staff dependent. Until disappearance
of these difficulties, this technique with MRI should be
considered as a part of clinical studies, before it is accepted as a
cost-effective technique in the clinical practice.
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Dumlupinar University Faculty of Medicine
Department of Urology
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