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Table of Contents
Definition / general | Epidemiology | Sites | Etiology | Clinical features | Diagnosis | Laboratory | Radiology description | Prognostic factors | Case reports | Treatment | Clinical images | Gross description | Gross images | Microscopic (histologic) description | Microscopic (histologic) images | Virtual slides | Cytology description | Cytology images | Positive stains | Negative stains | Electron microscopy description | Molecular / cytogenetics description | Differential diagnosis | Additional referencesCite this page: Adenomatoid tumor. PathologyOutlines.com website. http://www.pathologyoutlines.com/topic/testisepidadenomatoid.html. Accessed July 15th, 2017.
Definition / general
- Benign tumor of mesothelial origin affecting testicular adnexa
Epidemiology
- 30% of testicular adnexal tumors, 73% of benign tumors of testicular adnexa in study of 314 tumors (J Urol 1976;116:476)
- Usually 3rd to 5th decade; rare - 5 year old boy (J Pediatr Surg 2011;46:E15) and 70 year old man (Arch Esp Urol 1984;37:61)
Sites
- Most commonly lower pole of epididymis; also tunica vaginalis, spermatic cord
Etiology
- Mesothelial origin based on immunohistochemical features and ultrastructural studies (Cancer 1970;25:171)
- Similar tumor in spermatic cord, ejaculatory duct, fallopian tube, uterus
Clinical features
- Presents as solid, well circumscribed mass in scrotum, often associated with pain
- Usually 1 - 5 cm, rarely larger (Cancer 1972;30:244)
- Benign, even if it extends into testis
Diagnosis
- Suspected clinicoradiologically, confirmed histologically
Laboratory
- No specific laboratory finding; however, negative markers for germ cell tumor are helpful in excluding a germ cell malignancy
Radiology description
- Not specific
- USG reveals a relatively hypo, iso to hyperechoic mass at lower pole of epididymis, not distorting the testis
Prognostic factors
- Uniformly benign behavior, no reports of malignant transformation
Case reports
- 30 and 35 year old men (J Cytol 2009;26:30, BMJ Case Rep 2011 Mar 8;2011)
- 38 year old man with solid mass attached to tunica (Case of the Week #297)
- 39 and 40 year old men (Oncol Lett 2014;7:1718)
- 41 year old man with intratesticular tumor growth (Int J Surg Pathol 2011;19:838)
- 41 year old man (J Cytol 2013;30:65)
- 52 year old man with painless nodule in right scrotal sac (Indian J Urol 2011;27:556)
Treatment
- Complete excision
- Frozen section examination may prevent unnecessary radical orchiectomy
Clinical images
Images hosted on other servers:
Solid mass at lower pole of right testis
MRI, lesion at lower right testis
Intratesticular 8 mm lesion
Gross description
- 1 - 5 cm, well circumscribed solid tumor, adherent to testis / testicular adnexa
- Cut surface may have small cystic spaces
Gross images
Images hosted on other servers:
Well encapsulated tumor
Firm, whitish gray, homogenous
Microscopic (histologic) description
- No distinct growth pattern
- Unencapsulated, cuboidal to flat cells forming cords that are either epithelial-like or form channels with dilated lumina simulating vessels
- Cells have acidophilic cytoplasm with cytoplasmic vacuoles
- Nuclei lack nucleoli
- Mitoses and necrosis are usually absent
- Intervening stroma may have smooth muscle and elastic fibers, desmoplastic quality and inflammatory cells
- Rarely, tumor may extend into testicular parenchyma (Arch Ital Urol Androl 2014;86:44) or even rarer, be totally inside the testis (Eur Urol 1996;30:127, Indian J Urol 2009;25:126)
- Patterns have been decribed (Cancer 1974;34:306, Am J Clin Pathol 1981;76:627) but most tumors show a mixture of:
- Adenomatoid (tubular): glandular pattern with cytoplasmic vacuoles giving a signet ring appearance
- Angiomatoid (canalicular): cells have a more endothelial appearance
- Solid (plexiform): cells have a more epithelial appearance
- Cystic (mixed): rare; tumor is in form of cystic spaces lined by cuboidal to flattened lining epithelium
Microscopic (histologic) images
Images hosted on PathOut server:
Case of Week #297
Various images
Pankeratin+
CK5 / 6-
Calretinin+
WT1+
D2-40+
Images hosted on other servers:
Low magnification
Intracytoplasmic vacuoles
Cytological features
Adenomatoid pattern
Lymphoid infiltrate
Dilated tubular structures
Various images
Tubules, cords and glandular arrangement
PanCK+
Calretinin+
Virtual slides
Images hosted on other servers:
Adenomatoid tumor
Cytology description
- Smears are moderately cellular with sheets of monotonous round to oval cells showing indistinct cell borders and moderate to abundant pale cytoplasm with vacuolations
- Nuclei are eccentric in location but regular with inconspicuous nucleoli
Cytology images
Images hosted on other servers:
Moderate cellularity
Monolayered sheets of cells
Positive stains
Negative stains
Electron microscopy description
- Prominent microvilli, desmosomes and tonofilaments associated with dilated intercellular spaces
Molecular / cytogenetics description
- No specific genetic abnormality has been identified
Differential diagnosis
- Malignant mesothelioma: HBME1+, mitoses and necrosis
- Metastatic adenocarcinoma: positive for one or more of CEA, PSA, MOC31 / BerEP4 and CD15 are useful
- Papillary cystadenoma of epididymis
Additional references
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