Testis & paratestis

Epididymal tumors

Papillary cystadenoma

Last author update: 1 December 2014
Last staff update: 20 October 2022

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PubMed Search: Papillary cystadenoma epididymis

Swapnil U. Rane, M.D.
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Cite this page: Rane S. Papillary cystadenoma. PathologyOutlines.com website. https://www.pathologyoutlines.com/topic/testisepidpapcyst.html. Accessed April 15th, 2024.
Definition / general
  • Also called papillary cystadenofibroma
  • 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)
  • 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)
  • No specific laboratory features
  • Negative for germ cell tumor markers
Case reports
  • 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

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


Case with clear cells



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
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