Para-testicular Adnexa and Spermatic Cord Tumours

Question 1

Adenomatoid tumor

Answer 1

• Benign tumor of mesothelial origin
• Most common benign paratesticular tumor
• Usually based in the epididymis and well circumscribed
• Expresses markers typical of mesothelial origin
• Third - fifth decade
• Testicular adnexa

Macro:
* Typically paratesticular well circumscribed, white-tan firm nodule
* Almost always unilateral and solitary
* Generally firmer than seminoma
* Most commonly occurs at lower or upper pole of the epididymis

Micro:
* Tubules, cords or small nests
* Composed of or lined with cuboidal cells
* Moderate to abundant eosinophilic cytoplasm with single to multiple vacuoles
* Signet ring cell morphology and lipoblast-like morphologies very common
* Other patterns: adenoid, angiomatoid, cystic, glandular, oncocytic, solid, tubular
* Thin bridging strands crossing glandular / tubular spaces
* Peripheral lymphoid aggregates
* Infiltrative growth common
* Can become infarcted

IHC:
Mesothelial markers:
* Thrombomodulin
* HBME-1
* CK 5/6
* Calretinin
* Cytokeratin

Question 2

Vasitis nodosa/Sperm granuloma

Answer 2

• Granulomatous condition of vas deferens that resembles spermatic granuloma of epididymis
• Usually post vasectomy or herniorrhaphy
• Occasionally associated with recanalization

Micro:
* Proliferating ductules and dilated tubules containing spermatozoa in wall of vas deferens
* Also associated with small bundles of hyperplastic smooth muscle
* Vas deferens may show irregular thickening
* May see perineural or vascular invasion by proliferating ductules