Multiparametric Ultrasound Diagnostic Approach to Malignancy-Mimicking Adenomatoid Tumors of the Scrotum: Is Strain Elastography Enough?

Background: Paratesticular tumors (PTs) are very uncommon, accounting for almost 5% of intrascrotal tumors. Of these, adenomatoid tumors (ATs) represent about 30% and most frequently arise in the tail of the epididymis. Ultrasound (US) examination is the first-choice imaging method employed for the evaluation of the scrotum. Unfortunately, there are no specific US-imaging features useful for distinguishing an AT from a malignant lesion. To increase diagnostic accuracy and confidence, new sonographic techniques have incorporated real-time tissue elastography (RTE) under the assumption that malignant lesions are "harder" than benign lesions. Case report: In our paper, we describe a very rare case of a 60-year-old patient with a giant paratesticular mass mimicking malignancy when examined using RTE, i.e., it was stiffer than the surrounding tissue (a hard pattern), which, upon histologic examination, was identified as an AT. Discussion: Our case underscores that there is also a significant overlap between different types of scrotal lesions when RTE is used for examination. Thus, if a PT is found, the imaging approach should always be supplemented with more definitive diagnostic methods, such as FNAC or FNAB, which are the only diagnostic methods capable of leading to a certain diagnosis. Conclusions: Alongside underlining the importance of pre-operative imaging for making correct diagnoses and selecting the correct therapy, we wish to draw our readers' attention to this report in order to demonstrate the clinical implications of a giant AT presenting as stiff lesions when examined using SE.

18F-FDG PET/CT of a Rare Case of an Adenomatoid Tumor of the Adrenal Gland.

A 28-year old man, with previous history of chronic abdominal pain, was referred to our nuclear medicine center for an F-FDG PET/CT following the fortuitous discovery of a 48-mm right adrenal gland lesion of heterogeneous density at the CT scan. The PET/CT showed an isolated heterogeneous significant uptake evocative of neoplasia. Surprisingly, the anatomopathological analysis after surgery revealed an adenoid tumor of the adrenal gland. This case of a rare benign tumor can be a source of false-positive and mimicking malignancies in the exploration of adrenal lesions.

Uterine adenomatoid tumor associated with lymph node lesions: a case report.

We report a case of uterine adenomatoid tumor (AT) with regional lymph node involvement in a 49-year-old woman. Magnetic resonance imaging revealed an aggregated cystic mass in the posterior uterine wall with partial protrusion of the tumor outside the uterus, and cystic masses of same characteristics in the bilateral obturator and right common iliac lymph nodes. FDG PET/CT revealed no significant FDG uptake in the uterine and lymph node lesions. Taking possible lymph node metastasis into consideration, hysterectomy and lymph node biopsy were performed and it revealed AT of the uterus and the lymph nodes histopathologically.

Synchronous occurrence of benign mesothelioma and adenomatoid tumor of uterus: A case report and review of literature.

INTRODUCTION: Synchronous occurrence of benign cystic mesothelioma and adenomatoid tumor of uterus (UAT) are very rare and few cases have been published in the English literature. They are easily misdiagnosed as malignant by clinicians, due to the lack of reports. PATIENT CONCERNS: A case of benign mesothelial combined with uterus adenomatoid tumor (UAT) in a 48-year-old Chinese woman was reported. Our patient presented with abdominal pain and surgery showed a large subserous mass (12.0 × 11.4 × 9.8 cm) combined with a small intramural solid nodule (2.0 × 1.0 × 1.0 cm), and multiple minute neoplastic growth on the ovary. DIAGNOSIS: Due to the patient's symptoms, pathological findings, she was diagnosed with synchronous occurrence of benign mesothelioma and UAT. INTERVENTIONS: We treated her with a total hysterectomy and bilateral adnexectomy. OUTCOMES: The patient is now in stable condition, without any signs of recurrence during 1 year of follow-up. LESSONS: Most mesotheliomas are malignant, synchronous occurrence of benign mesothelioma and UAT are extremely rare. And they are often misdiagnosed as malignancy by clinicians. Our case report can improve the awareness of the disease and avoid excessive treatment.

Tumor adenomatoide da túnica albugínea. Um desafio no tratamento conservador / Tunica albuginea adenomatoid tumor. A challenging case managed conservatively

Os tumores adenomatoides são tumores benignos raros, de origem mesotelial que, no homem, afetam principalmente o epidídimo. Representam mais de um terço dos tumores paratesticulares e o tratamento de eleição é a excisão cirúrgica. Extremamente rara é a origem no parênquima testicular ou na túnica albugínea. Os sinais clínicos e estudos de imagem são frequentemente inconclusivos, não permitindo o diagnóstico diferencial com a neoplasia testicular maligna, resultando em orquidectomias radicais desnecessárias. Os autores descrevem um caso clínico de tumor adenomatoide da túnica albugínea, em que a suspeita clínica e exame anatomopatológico intraoperatório conduziram à realização de uma orquidectomia parcial

The adenomatoid tumors are rare benign mesothelial lesions that in males affect mainly the epididymis. They account for over one third of paratesticular tumors, and the treatment of choice has been surgical excision. The origin in testicular parenchyma or the tunica albuginea is extremely rare. Clinical signs and imaging studies are often inconclusive in differentiate from a more common malignant intratesticular solid tumour, which can result in unnecessary orchiectomies. We present a case of adenomatoid tumor of tunica albuginea where clinical suspicion and intraoperative frozen section analysis led to a partial orchiectomy

Tumor odontogénico adenomatoide extrafolicular mandibular, de ubicación inusual e imagenología atípica. Reporte de un caso / Extra follicular adenomatoid odontogenic tumor in mandible with unusual location and atipic imaging. A case report

Introducción: El tumor odontogénico adenomatoide (TOA) es un tumor poco común, no agresivo, de crecimiento lento e indoloro. Afecta a pacientes entre la segunda y tercera décadas de vida, más común en mujeres. Revisión: El TOA se presenta mayormente en sector anterior maxilar, asociado a la corona y parte de la raíz de un diente no erupcionado (folicular, 70%), o no asociado a un diente sin erupcionar (extrafolicular, 24%). Radiográficamente se observa una lesión de bordes definidos, corticalizados, radiolúcida o mixta con focos radiopacos internos en 2/3 de los casos. Al examen histopatológico se observa una cápsula externa de tejido conjuntivo fibroso rodeando un patrón nodular de células epiteliales fusiformes, con una configuración característica de roseta. Presenta además estructuras tubulares y calcificaciones esféricas. Se presenta el caso de un paciente de sexo femenino, 10 años de edad, con una lesión radiolúcida de bordes definidos, corticalizados, ubicado en región canina mandibular. Mediante exámenes imagenológicos se descartan diversas patologías radiolúcidas. Se confirma el diagnostico presuntivo de TOA mediante el análisis histopatológico. Conclusiones: El TOA mandibular con presentación imagenológica extrafolicular se presenta con poca frecuencia. Es necesario un examen imagenológico adecuado para distinguir características propias de la lesión y poder diferenciarla de otras lesiones radiolúcidas con radiopacidades internas. Es importante la confirmación del diagnóstico mediante examen histopatológico

Introduction: Adenomatoid odontogenic tumor (AOT) is a rare, non-aggressive, slow-growing, painless tumor. It affects patients between the second and third decade of life, being more common in women. Review: Commonly, the AOT affects the anterior maxilla, associated to the crown and part of the root of an unerupted tooth (follicular, 70%), or not associated to an unerupted tooth (extrafolicular, 24%). Radiographically, AOT appears as a radiolucency with a well-defined sclerotic border. It can be completely radiolucent or contain radiopaque foci in 2/3 of cases. Histopathological analysis shows an external capsule composed of fibrous connective tissue surrounding a nodular pattern of fusiform epithelial cells, with a characteristic rosette configuration. It also has tubular structures and spherical calcifications. A case of an extrafollicular AOT in mandible with unusual location and atypical imaging is reported. A 10-year-old female patient, with a well-defined radiolucent lesion, with sclerotic borders, located in the canine mandibular region was evaluated. Imaging tests discarded various radiolucent pathologies. The presumptive diagnosis of AOT was confirmed by histopathological analysis. Conclusions: Mandibular extrafollicular AOT is an infrequent tumor which requires adequate imaging to observe its characteristics and to differentiate it from other radiolucent lesions with internal radiopacities. It is important the confirmation of the diagnosis by histopathological examination

Adenomatoid tumor of the testis mimicking malignant testicular cancer on multiparametric ultrasound.

BACKGROUND: Adenomatoid tumor is one of the most common histological subtypes of paratesticular cancer arising from the epididymis. In very rare cases, these tumors appear as intratesticular lesions originating in the tunica albuginea, representing a diagnostic challenge. CASE PRESENTATION: We present a case of a 51-year-old man with a small (0.9 cm) hyperechoic lesion of the left testicle mimicking testicular cancer on multiparametric ultrasound. The lesion was localized in the peripheral zone, confirming vascularization and increased stiffness on contrast-enhanced ultrasound and real-time elastography. Preoperative tumor markers and hormone levels were within normal ranges. Staging computed tomography was negative. Organ-sparing surgery with tumor enucleation and frozen section analysis was performed, confirming testicular adenomatoid tumor. CONCLUSION: Currently, no typical ultrasound features can definitively distinguish intratesticular adenomatoid tumors from malignant testicular masses. Thus, a surgical approach is almost always considered in such a case for both diagnostic and therapeutic purposes.

Tumor odontogénico adenomatoideo: reporte de un caso / Adenomatoid odontogenic tumor: report of a case

El tumor odontogénico adenomatoide (TOA) es una lesión benigna,infrecuente, clasificada por la OMS dentro de los tumores odontogénicoscon participación del ectomesénquima que muestra una morfología histológica muy peculiar. Esta entidad patológica es de baja prevalencia, representa 0.1% de los tumores y quistes de losmaxilares con raras recidivas. Su frecuencia de aparición es más comúnen pacientes jóvenes, generalmente mujeres, de mayor aparición en maxilar superior, asintomático, asociado a dientes sin erupcionar(principalmente caninos) que plantea diagnósticos diferenciales entre otras lesiones de mayor agresividad como el quiste dentígero y el ameloblastoma. Se presenta el caso de una paciente de nueve años de edad con lesión tumoral en el sector del maxilar superior izquierdo de 40 días de evolución. Clínicamente hay ausencia del órgano dentario número 23. Se indica la realización de una radiografía panorámica, en la cual se observa la presencia del órgano dental 23 en el piso de órbita del maxilar superior izquierdo. Se procede a la remoción quirúrgica con diagnóstico presuntivo de quiste dentígero, se biopsia el total de la lesión, con diagnóstico definitivo por histopatología de TOA, con buena evolución clínica odontológica.

The adenomatoid odontogenic tumor (TOA) is a rare, uncommon,WHO-classified lesion in odontogenic tumors with ectomesenchyma,which shows a very peculiar histological morphology. This pathologicalentity is of low prevalence representing 0.1% of the tumors and cystsof the jaws with rare recurrences. Its frequency of appearance is morecommon in young patients, generally females, of greater presentationin the upper jaw, asymptomatic, associated with unruptured teeth(mainly canines) that presents diff erential diagnoses among other moreaggressive lesions such as dentigerous cyst and ameloblastoma. Wepresent the case of a nine-year-old patient with tumor lesion in the leftupper jaw of 40 days of evolution. Clinically there is absence of the tooth23. A panoramic radiograph is indicated, in which the presence of thetooth 23 is observed in the orbital fl oor of the upper left jaw. Surgicalremoval is performed with a presumptive diagnosis of dentigerouscyst; the total of the lesion was biopsied, with defi nitive diagnosis byhistopathology of TOA with good odontological clinical evolution.

A subserosal, pedunculated, multilocular uterine leiomyoma with ovarian tumor-like morphology and histological architecture of adenomatoid tumors: a case report and review of the literature.

BACKGROUND: Uterine leiomyomas are common uterine tumors, and typical cases of leiomyoma are easily diagnosed by imaging study. However, uterine leiomyomas are often altered by degenerative changes, which can cause difficulty and confusion in their clinical diagnosis. We describe the 17th reported case of a uterine leiomyoma clinically diagnosed as an ovarian tumor; however, the present case shows the most detailed radiological evaluation, including contrast-enhanced magnetic resonance imaging. We first show that a uterine leiomyoma can histologically mimic an adenomatoid tumor. CASE PRESENTATION: A 47-year-old premenopausal, nulliparous Japanese woman with a history of type 2 diabetes mellitus, hypertension, and hyperlipidemia had lower abdominal pain. Ultrasonography confirmed a 6-cm mass in the right-sided space of the pelvic cavity. Magnetic resonance imaging evaluation showed that a multilocular mass was present near the uterus, and a mucinous ovarian tumor was considered. Emergency surgery due to acute abdomen was performed under the diagnosis of pedicle torsion of the ovarian tumor. During surgery, a pedunculated uterine mass without stalk torsion was seen. The mass grossly contained serous and hemorrhagic fluids in the cavities, and pathology examination confirmed that the mass was a leiomyoma with hydropic and cystic degeneration. Anastomosing thin cord-like arrangements of the leiomyoma cells mimicked the architecture of adenomatoid tumors. The tumor cells were positive for the microphthalmia transcription factor but negative for other melanoma markers. Three days postoperatively, she was discharged without sequelae. CONCLUSIONS: Marked intratumoral deposition of fluids may induce the multilocular morphology of a tumor, and the cellular arrangement of the tumor cells with hydropic degeneration mimicked an adenomatoid tumor in this case. Clinicians need to be aware that a subserosal leiomyoma with cystic and hydropic degeneration can mimic an ovarian tumor, and pathologists should be aware that such leiomyomas can mimic adenomatoid tumors. Additionally, perivascular epithelioid cell tumors should not be diagnosed only based on its immunoreactivity for the microphthalmia transcription factor.

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.

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

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.

Middle ear adenomatous tumor: a not so rare glomus tympanicum-mimicking lesion.

BACKGROUND AND PURPOSE: Middle ear adenomatous tumors (MEAT) are rare tumors which can be begin or malignant and can present a neuroendocrine differentiation. Their radiological aspect is very similar to glomus tympanicum (GT) which are the most common tumoral lesions of the middle ear. We present several radiological and clinical findings that could help radiologists to accurately identify MEAT. MATERIAL AND METHODS: We retrospectively reviewed the radiological and clinical findings of three patients with MEAT and of eight patients with GT. Diagnostic was obtained after surgical resection in all cases. All patients had high resolution CT and MR of the middle ear associated with a subtracted digital carotid angiography. Tumor location, size, extension, signal intensity, and enhancement were analysed. From the medical records of the patients, clinical manifestations (hearing loss, tinnitus), evolution length and recurrences were noted. RESULTS: MEAT and GT appeared as tissular lesion with significant enhancement on CT and MR. A vascular blush was present on angiography in all cases of GT and absent from all cases of MEAT. A close relationship between the tumor and the Jacobson's nerve or its branches was identified in all cases of GT. Pulsatile tinnitus was present in all patients with GT and absent in all patients with MEAT. CONCLUSION: A middle ear tissular lesion clearly separated from the Jacobson nerve or its branches, showing significant enhancement after contrast medium injection but with a normal angiography, should make one suspicious for MEAT.

Adenomatoid tumour of the liver.

An unusual primary adenomatoid tumour arising in the normal liver is described. Hepatectomy was performed, and the patient is alive and free of disease 1 year postsurgery. Grossly, the tumour showed a haemorrhagic cut surface with numerous microcystic structures. Histological examination revealed cystic or angiomatoid spaces of various sizes lined by cuboidal, low-columnar, or flattened epithelioid cells with vacuolated cytoplasm and round to oval nuclei. The epithelioid cells were entirely supported by proliferated capillaries and arteries together with collagenous stroma. Immunohistochemical studies showed that the epithelioid cells were strongly positive for a broad spectrum of cytokeratins (AE1/AE3, CAM5.2, epithelial membrane antigen and cytokeratin 7) and mesothelial markers (calretinin, Wilms' tumour 1 and D2-40). These cells were negative for Hep par-1, carcinoembryonic antigen, neural cell adhesion molecule, CD34, CD31 and HMB45. Atypically, abundant capillaries were observed; however, the cystic proliferation of epithelioid cells with vacuoles and immunohistochemical profile of the epithelioid element were consistent with hepatic adenomatoid tumour.

Multilocular adenomatoid tumor of the ovary: ultrasonographic findings.

We report the sonographic findings of a rare benign ovarian tumor in a 69-year-old woman. Transvaginal ultrasonography showed a cystic multilocular lesion with a vascularized central solid portion of the left ovary. Surgery revealed an adenomatoid tumor. Adenomatoid tumors are benign lesions of mesothelial origin, usually solid in nature and rarely located in the ovaries. (c) 2005 Wiley Periodicals, Inc. J Clin Ultrasound 33:233-236, 2005.

Adenomatoid tumor of the tunica albuginea.

Adenomatoid tumors are benign mesothelial tumors most commonly found in the paratesticular structures, especially the epididymis. Herein, we report a case of adenomatoid tumor originating in the tunica albuginea and mimicking an intratesticular neoplasm. We review the ultrasonographic presentation and literature regarding adenomatoid tumors originating in the tunica albuginea and testicular parenchyma.

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.