Testis and epididymis
Epididymal tumors
Papillary cystadenoma

Author: Swapnil U. Rane, M.D. (see Authors page)

Revised: 8 June 2017, last major update December 2014

Copyright: (c) 2003-2017, PathologyOutlines.com, Inc.

PubMed Search: Papillary cystadenoma [title] epididymis
Cite this page: Papillary cystadenoma. PathologyOutlines.com website. http://www.pathologyoutlines.com/topic/testisepidpapcyst.html. Accessed September 20th, 2017.
Definition / general
Terminology
  • Also called papillary cystadenofibroma
Epidemiology
  • Second most common benign neoplasm of epididymis after adenomatoid tumor
  • Sporadic or familial
  • Unilateral or bilateral (40%)
  • Mean age 36 years
  • Associated with von Hippel-Lindau (VHL) disease; 65% with bilateral tumors have VHL vs. 18 - 20% with unilateral lesions (Arch Pathol Lab Med 2010;134:630)
Sites
  • In male GU, occurs in epididymis (develops within efferent ductules of head of epididymis)
  • In female GU, occurs in broad ligament, peritoneum; also fallopian tube and uterus
Clinical features
  • Benign, usually asymptomatic
  • If symptomatic, typically is slow growing swelling in scrotum, with only rare pain or tenderness
  • Rarely discovered during infertility workup (Arch Pathol Lab Med 2010;134:630)
Laboratory
  • No specific laboratory features
  • Negative for germ cell tumor markers
Case reports
Treatment
  • Surgical excision; does not recur
  • If bilateral, patient should be investigated for VHL syndrome
Clinical images

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Complex echo pattern

Gross description
  • Well circumscribed, 1 - 5 cm, gray, brown, yellow tumor nodule
  • Cut surface may show papillary fronds or may be cystic with areas of hemorrhage
Gross images

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Epididymal tumor

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Microcystic with hemorrhage

Microscopic (histologic) description
  • Papillary in foldings project into cystic spaces covered by single to double layered cuboidal / columnar cells
  • Tubules common, colloid type cystic material common
  • Tumor cells have lightly eosinophilic to clear cytoplasm
  • May see dilated efferent ductules
  • May have clear cells resembling metastastic renal cell carcinoma but no mitoses, no necrosis, no pleomorphism
  • Papillary cystadenofibroma: prominent stroma
Microscopic (histologic) images

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Cystic space with papillary excrescences

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Cilia

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Case with clear cells

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Various images

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CK7

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CD10

Cytology description
  • Simple and complex papillary clusters
  • Tumor cells are monomorphic, with moderate to abundant cytoplasm, well defined cytoplasmic borders; round to oval nuclei, finely dispersed chromatin, inconspicuous nucleoli
  • Vacuolations may be present
  • No features of malignancy - i.e. no mitoses, no necrosis, no atypia
  • Usually no psammoma bodies, but see Cytopathology 2014;25:279, Acta Cytol 2004;48:467
Negative stains
Differential diagnosis