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17 January 2014 - Case of the Week #297

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(7) We have recently updated these topics in our CD Markers chapters based on the reviews by Nat Pernick, M.D.: CD12, CD13, CD14, CD15, CD16, CD17 and CD18.


Case of the Week #297

Clinical History:
A 38 year old man presented with a solid mass attached to the tunica of the testis.

Micro images:



Note: we have removed 3 images which had the same diagnosis, but were from a different case.

What is your diagnosis?































Diagnosis:
Adenomatoid tumor (oxyphilic variant)

Discussion:
The tumor consists of small, irregular clusters and cords of large cells with abundant eosinophilic cytoplasm with small cytoplasmic vacuoles. Nuclei are round to oval with distinct nucleoli, but there is no pleomorphism, no atypia and no mitotic activity.

Immunostains were performed:

Pankeratin+

Calretinin+

WT1+

D2-40+

CK5/6-



Adenomatoid tumor is the most common tumor of the epididymis (other than spermatic cord lipomas), and a similar tumor occurs in the spermatic cord, ejaculatory duct and fallopian tubes / uterus. Adenomatoid tumor typically affects men ages 20-39 years who present with a painful epididymal tumor.

Grossly, it is a circumscribed, firm, gray-white mass up to 5 cm, which may be cystic. Microscopically, it may have infiltrative borders, with the features described above. Tumor cells have mesothelial features, including immunoreactivity for cytokeratin, EMA and hyaluronidase, and negative staining for CEA, mucin, PAX2 and PAX8 (Am J Surg Pathol 2011;35:1473). The tumor cells have prominent microvilli, desmosomes and tonofilaments. The oxyphilic variant has been described in one ovarian tumor (Int J Gynecol Pathol 2007;26:16).

The differential diagnosis includes testicular tumors with epithelioid cells, including epithelioid hemangioma (vascular spaces have no intervening tumor cells, positive for factor 8, Ulex europaeus I lectin and CD34; negative for keratin) and large cell calcifying Sertoli cell tumors (centered in testis, frequent calcifications, intratubular growth, keratin is weak / negative). Mesothelial hyperplasia may have similar appearing cells, but does not form a mass.

Adenomatoid tumor is benign, and accurate diagnosis will prevent unnecessary orchiectomy (Clin Med Pathol 2009;2:17).

Nat Pernick, M.D., President
and Palak Thakore, Associate Medical Editor
PathologyOutlines.com, Inc.
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