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Testis and epididymis
Paratesticular tumors
Ovarian epithelial type
Copyright: 2002-2017, PathologyOutlines.com, Inc.
PubMed Search: Ovarian epithelial type testis
Paratesticular tumors
Ovarian epithelial type
Author: Swapnil U. Rane, M.D.
Topic Completed: 1 May 2014
Revised: 28 March 2019
Copyright: 2002-2017, PathologyOutlines.com, Inc.
PubMed Search: Ovarian epithelial type testis
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Table of Contents
Definition / general | Terminology | Epidemiology | Sites | Etiology and pathophysiology | Clinical features | Laboratory | Radiology description | Radiology images | Prognostic factors | Case reports | Treatment | Gross description | Gross images | Microscopic (histologic) description | Microscopic (histologic) images | Positive stains | Negative stains | Differential diagnosisCite this page: Rane S. Ovarian epithelial type. PathologyOutlines.com website. https://www.pathologyoutlines.com/topic/testisparatestovarian.html. Accessed February 21st, 2020.
Definition / general
- Paratesticular tumors resembling ovarian surface epithelial tumors
- Can be serous, mucinous, endometrioid or Brenner tumor; most common is serous type
- Can be benign, borderline or malignant, commonly benign or borderline
Terminology
- Similar to ovarian counterparts
Epidemiology
- Mean age 47 years, range 11 - 87 years (Am J Clin Pathol 1986;86:146)
Sites
- Paratestis: tunica vaginalis, tunica albuginea, epididymis, rete testis and paratesticular soft tissue
- May involve testis
Etiology and pathophysiology
- May arise from Müllerian metaplasia of mesothelium, Müllerian remnants within paratesticular region or testicular embryonic mesothelial inclusions
Clinical features
- Most common presentation is painless scrotal swelling of varying duration
- Also chronic swelling with sudden increase in size
Laboratory
- Normal AFP, HCG and LDH levels help rule out more common germ cell tumors
- No diagnostic serum marker is known
Radiology description
- Heterogenous cystic mass
- Radiological examination is not diagnostic as other benign and malignant cystic lesions are more common
- Presence of solid nodules / papillary projections within cystic lesions is characteristic of serous tumors though not diagnostic
Radiology images
Images hosted on other servers:
Intratesticular scrotal mass
Posterolateral mass
Prognostic factors
- Not well characterized due to rarity but presence of metastases is single most important factor
- Most patients reported in literature with nonmetastatic disease have not recurred (mean duration of followup of these cases reported is ~2 years after primary surgery with / without adjuvant chemotherapy); see also Am J Clin Pathol 1986;86:146
- Two patients with longer followup showed local and distant recurrence 4 and 7 years after primary surgery (Am J Surg Pathol 1995;19:1359)
Case reports
- 18 year old man with paratesticular mucinous cystadenoma arising from oviduct-like Müllerian remnant (Arch Pathol Lab Med 2006;130:1715)
- 29 year old man with serous papillary adenocarcinoma of tunica vaginalis with metastasis (Cancer 1991;67:1450)
- 47 year old man with serous papillary cystadenocarcinoma of testis (J Androl 2010;31:434)
- 50 year old man with papillary serous cystadenoma (Int Urol Nephrol 1989;21:169)
- 50 year old man with papillary serous carcinoma of tunica vaginalis (Pathol Res Pract 2000;196:781)
- 59 year old man with serous papillary cystic tumor of borderline malignancy with focal carcinoma arising in testis (Hum Pathol 1992;23:75)
- 59 year old man with borderline serous papillary tumor of testis (Anticancer Res 2012;32:5011)
- 59 year old man with intratesticular mucinous cystadenocarcinoma (Arch Pathol Lab Med 1992;116:1360)
- 64 year old man with serous borderline tumor of paratestis (Pathol Int 2008;58:311)
- 73 year old man with intratesticular endometrioid papillary cystadenocarcinoma (Jpn J Clin Oncol 2011;41:674)
- Papillary cystadenoma within testis (Am J Clin Pathol 1974;61:724)
- Clear cell adenocarcinoma of tunica vaginalis with adjacent uterus-like tissue (Pathol Int 2004;54:641)
- Testicular papillary cystadenomatous tumor of low malignant potential (J Urol 1988;139:378)
Treatment
- Radical high inguinal orchidectomy ± adjuvant chemotherapy
Gross description
- Unilocular or multilocular cyst with serous / mucinous contents
- Cyst wall shows variable nodularity / papillary projections
- Calcification may be identified grossly
Gross images
Images hosted on other servers:
Intratesticular mass
Microscopic (histologic) description
- Cystic tumors with ciliated tall columnar epithelium
- Nuclear atypia and stratification in borderline and malignant cases
- Psammoma bodies are commonly noted in serous adenocarcinomas
- Mitoses and apoptosis are common in high grade serous adenocarcinoma
Microscopic (histologic) images
Images hosted on other servers:
Papillary projections and psammoma bodies
H&E, CK7, CK20, chromogranin
Positive stains
Negative stains
- Serous tumors: calretinin, thrombomodulin, CK5 / 6, CK20
Differential diagnosis
- Malignant mesothelioma (for serous papillary adenocarcinoma): positive for calretinin, thrombomodulin, CK5 / 6 (Int J Surg Pathol 2011;19:692)
- Metastatic mucinous adenocarcinoma
- Metastatic prostatic adenocarcinoma: PSA+, AMACR+
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