Grand RoundsSolid Testicular Mass in a 63-Year-old Man
Section snippets
The Case
A 63-year-old man presented to our clinic with complaints of a right testicular mass. This mass was noted 3 weeks earlier while the patient was performing self-examination in the shower. He reported some aching but denied frank pain. He also denied voiding symptoms, gross hematuria, penile discharge, or weight loss; however, he reported rare night sweats. His urologic history was significant only for a right inguinal hydrocele repair, at age 13, and a vasectomy. His medical and surgical history
Differential Diagnosis
Most solid testicular tumors are malignant. Considerations for a malignant testicular mass are germ cell tumors, including seminoma and nonseminomatous germ cell tumor, as well as non-germ cell tumors, including Leydig cell, Sertoli cell, and granulosa cell tumors. In an older man, lymphoma, spermatocytic seminoma, and a metastatic lesion are on the top of the differential.
Leiomyosarcoma is a rare malignant primary testicular tumor.1 Patients with these tumors range in age from 19 to 76 years
Pathology (Presented by Vikas Mehta, M.D.)
Gross examination of the testis revealed a firm, well-circumscribed, tan-white lesion measuring 6 cm in greatest dimension, with a whorled appearance on cut section. The tumor occupied most of the testicle. Histologic examination revealed a spindle cell tumor arising adjacent to the tunica in the region of the right testis (Fig. 2A). The cells had indistinct cell borders. The nuclei were elongated (and enlarged in some cells) with small nucleoli (Fig. 2B). Low mitotic activity was seen.
Discussion
Leiomyoma is a benign soft-tissue tumor that originates from smooth muscle. Testicular leiomyomas are uncommon, with only a few dozen cases reported.3, 4 Leiomyomas of the male urogenital tract are most common in the renal capsule, but they have also been reported in the tunica vaginalis, tunica albuginea, spermatic cord, and epididymis.4, 5 Leiomyoma is the second most common epididymal neoplasm across all ages, representing 6% of epididymal tumors.4, 6 There have only been 2 case reports of
References (8)
- et al.
Benign soft tissue tumors of the testis
J Urol
(2009) - et al.
Testicular and paratesticular tumours in the prepubertal population
Lancet Oncol
(2010) - et al.
Primary testicular leiomyosarcoma
J Pak Med Assoc
(2011) - et al.
Imaging features of benign solid testicular and paratesticular lesions
Eur Radiol
(2011)
Cited by (1)
A rare case of intratesticular leiomyoma
2015, Singapore Medical Journal
Financial Disclosure: The authors declare that they have no relevant financial interests.