Bilateral seminomas coexisting with adenomatoid tumor: An unusual occurrence.

Coexistence of bilateral seminomas and adenomatoid tumor is rare. We encountered an interesting case of bilateral testicular seminomas along with a paratesticular nodule which was diagnosed as an adenomatoid tumor on histology. Although seminomas and adenomatoid tumor are frequent neoplasms, bilaterality and their coexistence have been rarely described and can pose diagnostic difficulties. Herein, we describe a case of a 53-year-old man who presented with bilateral testicular swellings which were diagnosed as bilateral seminomas with an adenomatoid tumor in the left paratesticular region on histopathology. The pathological findings of these coexistent tumors and the utility of immunohistochemistry in establishing a correct diagnosis in such scenarios are discussed.

Laparoscopic Excision of a Uterine Adenomatoid Tumor and a Coexisting Ovarian Teratoma: A Case Report and Literature Review.

Adenomatoid tumors (ATs) are rare, benign neoplasms occurring mainly in reproductive organs such as the uterus, ovaries, fallopian tubes, and testes. Uterine adenomatoid tumors (UATs) are generally incidentally diagnosed during histopathological examination of excisional biopsies performed for other indications, most commonly uterine leiomyomas. We herein present a 38-year-old woman who underwent laparoscopic excision of a uterine leiomyoma and a right ovarian teratoma. Microscopic examination of the excisional biopsy revealed that the enucleated uterine tumor was composed of proliferating glandular tissue covered with single-layered cells that were surrounded by proliferating smooth muscle cells, corresponding exactly to the features of UATs. The excised ovarian cyst was confirmed to be a typical mature cystic teratoma. According to these histopathological findings, the patient was finally diagnosed with a UAT and coexisting teratoma. No recurrence was detected up to 6 months after excision. To the best of our knowledge, this is the eighth case report on laparoscopically enucleated UATs. Although recurrence risk may be low in UATs, further case reports are necessary to elucidate the safety and validity of laparoscopic excision for UATs.

A cystic, septated lesion in the liver with unusual diagnosis.

A 51-year-old male patient from Iraq presented with symptoms of right upper-quadrant abdominal pain. Imaging showed a 9 cm, lobulated cystic lesion in the right liver lobe with thin septations, suggestive of a hydatid cyst. Although serology for hydatid disease was negative, the cystic lesion was treated by percutaneous drainage. Owing to persisting symptoms, he was re-evaluated showing the same cystic lesion unchanged. On the presumptive diagnosis of a cystadenoma or cystadenocarcinoma, patient underwent laparotomy. A solitary, cystic lesion was found that was removed by local excision. Macroscopical examination revealed a multilocular, septated tumour. Histopathological assessment showed lining of the cysts with epithelioid cells that showed immunohistochemical features consistent with a mesothelial origin; the pathology findings are consistent with an adenomatid tumour; in the differential diagnosis a benign multicystic mesthelioma was also considered. These are rare cystic lesions in the liver of which only few cases have been described in literature.

Tumor adenomatoide de epidídimo: Aportación de 5 casos y revisión de la literatura / Adenomatoid paratesticular tumor: report of 5 new cases and literature review

OBJETIVO: Presentar los 5 casos de tumor adenomatoide epididimario, diagnosticados en los últimos 11 años en nuestro centro. Revisión bibliográfica y discusión del diagnóstico diferencial y tratamiento de este tipo de lesiones poco frecuentes en la práctica clínica. MÉTODO: Se realiza un análisis retrospectivo de los casos de tumor adenomatoide epididimario diagnosticados durante los últimos 11 años en nuestro hospital, desde enero de 2001 a febrero de 2012. RESULTADOS: La edad media de la serie fue de 44 años. El motivo de consulta predominante fue masa escrotal no dolorosa de larga evolución, con nódulo palpable, generalmente dependiente del epidídimo. En el 60% de los casos se realizó ecografía abdominal, en la cual se observó lesión paratesticular nodular de ecogenicidad compatible con tejido sólido. En el 60 % de los casos se analizaron los marcadores tumorales relacionados con tumores testiculares: alfafetoproteína (AFP), beta-gonadotropina coriónica humana (b-HCG) y lactato deshidrogenasa (LDH), que resultaron normales. Se realizaron 3 tumorectomías, 1 epididimectomía y 1 orquiectomía radical. CONCLUSIONES: El hallazgo de una masa sólida epididimaria es infrecuente en la práctica clínica. La exploración física y pruebas de imagen deben confirmar el origen paratesticular de la lesión, siendo entonces la epididimectomía transescrotal el tratamiento de elección. Ante duda diagnóstica, el abordaje quirúrgico por vía inguinal con biopsia intraoperatoria de la tumoración es mandatorio

OBJECTIVE: To report 5 cases of adenomatoid tumor of the epididymis that have been diagnosed in the last 11 years at our hospital. We performed a bibliographic review with discussion of diagnosis, differential diagnosis and treatment of this rare type of lesion. METHOD: We have performed a retrospective analysis of epididymal adenomatoid tumors diagnosed during the last 11 years in our hospital, from January 2001 to June 2012. RESULTS: The average age of the series was 44 years. The predominant reason for consultation was long duration painless scrotal mass, with palpable nodule, usually dependent of the epididymis. 60% of the patients have been studied with abdominal ultrasound, which showed a nodular paratesticular lesion, with an echogenicity compatible with solid tissue. Tumor markers associated with testicular tumors (alpha-fetoprotein (AFP), beta-human chorionic gonadotropin (b-HCG) and lactate dehydrogenase (LDH)) were analyzed in 60% of the cases, being normal in all patients. 3 lumpectomies, 1 epididymectomy and 1 radical orchiectomy have been performed. CONCLUSIONS : The discovery of a solid epididymal mass is uncommon in clinical practice. Physical examination and imaging tests should confirm the paratesticular origin of the lesion, being then trans---scrotal epididymectomy the treatment of choice. If diagnosis is uncertain, inguinal approach and intraoperative biopsy are mandatory

Adenomatoid tumor of the testis in a child.

Adenomatoid tumors are rare benign neoplasms thought to be of mesothelial origin. Although most reported cases arise from the epididymis, rare cases have been reported in the spermatic cord, testicular tunica, ejaculatory ducts, prostate, and suprarenal recess. We describe a 4.5-year-old boy who presented with a relatively asymptomatic right testicular mass that was resected and confirmed to be adenomatoid tumor of the testis by histopathology. Because of its rarity, the clinical and histopathologic aspects are discussed.

Transmural peritoneal adenomatoid tumour in the ileocaecal region causing massive haemoperitoneum and low gastrointestinal bleeding: differential diagnosis with capillary haemangiomas.

Peritoneal adenomatoid tumours are rare benign neoplasms originating from mesothelial cells. We present a case of peritoneal adenomatoid tumour penetrating into the bowel wall and causing massive intra- and extraluminal bleeding.

Laparoscopically resected uterine adenomatoid tumor with coexisting endometriosis: case report.

Adenomatoid tumors are rare benign mesothelial tumors of the genital tract, and only a few cases of uterine adenomatoid tumors treated at laparoscopic surgery have been reported. Herein is reported the case of a laparoscopically resected uterine adenomatoid tumor with coexisting endometriosis. A 34-year-old nulliparous woman with suspected uterine fibroma and endometrial cysts underwent laparoscopic surgery in which both the uterine tumor and the endometrial cysts were enucleated. Enucleation of the uterine tumor was difficult, and, therefore, the border between the tumor and normal myometrium was divided using a harmonic scalpel for tumor resection. Microscopic examination of the tumor showed irregularly proliferating smooth muscle cells and many round hiatuses lined by epithelial-like cells. These epithelial-like cells were immunohistochemically positive for mesothelin and podoplanin, and negative for CD34, which suggests that the tumor was an adenomatoid tumor. This may be the fourth reported case of an adenomatoid tumor resected using the laparoscopic approach.

Tumor adenomatoide paratesticular: una serie de nueve casos / Paratesticular adenomatoid tumor: a report of nine cases

Introducción: los tumores paratesticulares son raros. La mayoría son benignos, siendo el más frecuente el tumor adenomatoide. En ocasiones estos tumores infiltran el parénquima testicular y es necesario plantear un diagnóstico diferencial con tumores malignos, por lo que la biopsia intraoperatoria, en estos casos, permite realizar una cirugía conservadora. Material y métodos: presentamos de forma retrospectiva nuestra extraordinaria serie de 9 casos de tumores adenomatoides paratesticulares durante un periodo de 9 años (2000- 2008). Resultados y conclusiones: describimos la edad de los pacientes (media de 49,6 años) y la clínica de inicio (nódulo palpable doloroso). La localización de la lesión más frecuente fue en el epidídimo, que habitualmente se manifiesta como un nódulo de pequeño tamaño, generalmente oval en la cola del epidídimo. En nuestra serie tenemos un caso de lesión testicular intraparenquimatosa y otro en túnica vaginal; el resto se localizan en el epidídimo. El diagnóstico de sospecha fue por ecografía, con confirmación histológica posterior. Describimos el diagnóstico diferencial y el tratamiento quirúrgico, que se aplicó en el 100% de los casos, así como sus características anatomopatológicas(AU)

Introduction: Paratesticular tumors are rare. Most of them are benign, and adenomatoid tumors are most common. These tumors sometimes infiltrate the testicular parenchyma and require differential diagnosis with malignant tumors. In such cases, intraoperative biopsy allows for performing conservative surgery. Materials and methods: A retrospective study of nine patients with paratesticular adenomatoid tumors seen during a nine-year period (2000-2008) is reported. Results and conclusions: Patient age (mean, 49.6 years) and most common initial signs (tender nodule) are reported. The tumor most commonly occurred as a small, usually oval, nodule in the tail of epididymis. Our series included a case each of intraparenchymal tumor of the testis and tumor of the tunica vaginalis. Diagnosis was initially made based on a ultrasound scan and subsequently confirmed by histology. Differential diagnosis and surgical treatment, performed in all patients, are reported, and also the pathological features of surgical specimens(AU)

Adenomatoid tumor of the pleura.

A case of adenomatoid tumor of the pleura is reported, and its differential diagnosis from benign and malignant pleural lesions is discussed. A small pleural nodule was incidentally found during a thoracic operation in a 54-year-old woman with esophageal cancer. The patient had no history of exposure to asbestos, and was well with no sign of recurrence 14 months after the operation. A 7 mm, circumscribed tumor had characteristic features of adenomatoid tumor. The tumor was composed of an aggregation of irregularly shaped tubulocystic spaces with fibrous stoma. The spaces were lined by flattened and occasional cuboidal epithelioid cells with cytoplasmic vacuolization, and several spaces contained pale blue mucinous fluid. On immunohistochemistry the tumor cells were positive for AE1/AE3, CAM5.2, vimentin, cytokeratin 5/6, D2-40, calretinin, thrombomodulin, and WT-1, but negative for CEA, Leu M1 (CD15), thyroid transcription factor-1, epithelial membrane antigen, desmin, glucose transporter-1 (GLUT-1), CD31, and CD34. The MIB-1 (Ki-67) labeling index was 1-2%, indicating low proliferative activity. Adenomatoid tumor of the pleura is rare, and the pathogenesis has not been elucidated. Recognition of these benign mesothelial lesions in the pleura is important to avoid misdiagnosis. The immunohistochemistry in the present case supports its mesothelial origin.

[Adenomatoid tumor of the testis with testicular pain: a case report].

A 30-year-old man who complained of sudden right scrotal pain visited our clinic. Physical examination revealed a palpable mass with tenderness on his right testis. An emergent operation was performed for acute scrotum. The intraoperative findings showed a small, white, elastic solid, a smooth surface tumor that originated from the tunica albuginea of the right testis. It seemed to be benign macroscopically and partial orchiectomy was performed. Soon after surgery, the pain disappeared. Pathohistological examination revealed an adenomatoid tumor of the testis which originated from the rete testis. Adenomatoid tumor of the testis is a rare benign tumor. In general, it can be diagnosed by observation of an incidental, pain-free and small palpable mass of the testis. Therefore, we should be aware that an adenomatoid tumor of the testis can be one of the differential diagnoses of acute scrotum.

Tumor adenomatoide de epidídimo e intratesticular: A proposito de nueve casos y revisión de la literatura / Adenomatoid tumors of the epididymis and testicle: report of 9 cases and bibliographic review

OBJETIVO: Describir los casos de tumores adenomatoides del Hospital Universitario La Paz en los últimos 15 años.MÉTODOS: Se ha realizado estudio clínico, anatomopatológico y quirúrgico de los varones con tumoración testicular o paratesticular con resultado histológico de tumor adenomatoide.RESULTADOS: En total hay nueve casos; siete presentaron tumor adenomatoide de localización paratesticular y dos intratesticular. La exéresis de la masa fue el tratamiento de elección en los epididimarios y orquiectomía en los intratesticulares.CONCLUSIONES: Los tumores adenomatoides son neoplasias benignas, poco frecuentes, de posible origen mesotelial. Como consecuencia de su naturaleza benigna, el tratamiento de elección es la exéresis local (cirugía conservadora), aunque en dos casos se llevó a cabo orquiectomía debido a su localización(AU)

OBJECTIVE: To report the cases of adenoma-toid tumors seen at Hospital Universitario La Paz in the last 15 years.METHODS: A clinical, pathological, and surgical study was conducted of males with testicular or paratesticular tumors with a histological report of adenomatoid tumor.RESULTS: Among the nine cases studied, seven had parates-ticular and two intratesticular adenomatoid tumors. Treatment of choice was mass removal for epididymal tumors and or-chidectomy for intratesticular tumors.CONCLUSIONS: Adenomatoid tumors are uncommon be-nign neoplasms of a possible mesothelial origin. Because of their benign nature, the treatment of choice is local excision (conservative surgery), but orchidectomy was performed in two cases due to tumor location(AU)

[Adenomatoid tumor of the adrenal gland. Case report and review of the literature]. / A mellékvese adenomatoid tumora, avagy irodalmi barangolás egy igen ritka mesothelialis daganat nyomán.

Adenomatoid tumors of the adrenal gland are rather rare, asymptomatic neoplasias with benign behavior and usually are diagnosed incidentally. The authors report a case of an adenomatoid tumor of the right adrenal gland in a 32-year-old man who sought evaluation because of fever and renal pain. During investigation a tumor, localized in right adrenal gland, was identified by ultrasonography and CT. The patient underwent adrenalectomy with histopathological and immunohistochemical diagnosis of adenomatoid tumor of the adrenal gland. Based on literature data the epidemiology, symptoms, differential diagnosis, treatments, histopathology and prognosis of adenomatoid tumors of the adrenal gland are discussed.

Adenomatoid of the adrenal gland.

Adenomatoid tumors are common in the genital tract but rare in the adrenal gland. These tumors can be difficult to diagnose when present in extragenital sites. This type of adrenal tumor lacks specific radiographic features and can be confused preoperatively with more common adrenal gland tumors. We present the case of a 54-year-old man with an incidental right adrenal mass with calcified components and elevated urinary levels of homovanillic acid that was found to be an adenomatoid tumor of the adrenal gland.

Endometrial adenocarcinoma with coexisting adenomatoid tumor of the uterus.

BACKGROUND: Uterine adenomatoid tumors may be present in up to 1% of hysterectomy specimens, and their infiltrative pattern may simulate that of adenocarcinomas. CASE: This is a report on the coexistence of a uterine adenomatoid tumor and an endometrial adenocarcinoma, both chance findings in a 41-year-old woman undergoing hysterectomy because of a preoperative diagnosis of metrorrhagia due to leiomyomas. CONCLUSION: Although uterine adenomatoid tumors are believed to be rare, they may pose a differential diagnostic problem in the pathologic staging of endometrial carcinomas, because they form gland-like lumina and infiltrate the myometrium. To our knowledge, no previous coexistence of these two tumors has been reported.

[Paratesticular adenomatoid tumor, presentation as epididymal pain]. / Tumor adenomatoide paratesticular, presentación como dolor epididimario.

OBJECTIVE: To describe an additional case of adenomatoid tumor of the epididymis. METHODS/RESULTS: A 55-year-old man consulted for epididymal pain. Palpation and ultrasound evaluation disclosed an epididymal tumor. The patient underwent orchidectomy; histological examination of the surgical specimen confirmed an adenomatoid tumor. CONCLUSIONS: Adenomatoid tumor of the epididymis is an uncommon tumor of the paratesticular tissue. Although its etiopathogenesis remains unclear, there appears to be a mesothelial involvement. Ultrasound evaluation and clinical examination are essential in making the preoperative diagnosis. It is a benign tumor and surgical excision can achieve cure. If the intraoperative frozen section is found to be benign, the tumor can be excised or enucleated without semicastration.

Sarcoidosis involving a paratesticular adenomatoid tumor.

Adenomatoid tumor is a common paratesticular neoplasm which may occur at any age and can involve the epididymis, testes, spermatic cord, and ejaculatory duct. Sarcoidosis of the genitourinary tract is exceedingly rare with approximately 30 cases of epididymal sarcoidosis reported. We report the first case of an epididymal adenomatoid tumor involved by classic sarcoid granulomata in a patient with systemic sarcoidosis.