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Presented by Jonathan Epstein, M.D. and prepared by Robert E LeBlanc, M.D.
Case 1: A 55 year old man was noted to have a paratesticular mass which underwent resection.
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1. Question
Week 531: Case 1
A 55 year old man was noted to have a paratesticular mass which underwent resection.images/JIE5513 1.jpg
images/JIE5513 2.jpg
images/JIE5513 2.jpgCorrect
Answer: Adenomatoid tumor
Histology: This lesion consists of tubules lined by flattened epithelium. In other areas the tubules have a somewhat cribriform appearance with similarly flattened epithelium. Some of the tubules are so small, resembling signet ring cells vacuoles. There are no red blood cells within the empty spaces. Nuclei are uniform with at most small central nucleoli. Cytoplasm is slightly eosinophilic. The lesion lacks mitotic figures, necrosis, and vascular invasion.
Discussion: This lesion has the classic morphology of an adenomatoid tumor. These lesions are mesotheliomas occurring in a characteristic location. The most common location is paratesticular next to the head of the epididymis, and also occurring near the fallopian tube and serosa of the uterus. Although mesotheliomas, we do not use this term since it can misconstrue malignant behavior. They have a characteristic morphology as seen in the current case with flattened tubules resembling vessels. However, there are no red cells within these lumina. They also may resemble metastatic signet ring cell cancer given the presence of prominent small lumina resembling cytoplasmic vacuoles. Some lesions may also be complicated by a prominent smooth muscle component. An additional feature that may sometimes be seen with adenomatoid tumors that may be worrisome for malignancy is central infarction. These lesions can minimally invade the adjacent testis. It is key to recognize these lesions as they are one of the few lesions occurring around the testes that is entirely benign where an orchiectomy need not be performed. If one diagnoses adenomatoid tumor on frozen section, the lesion may be only locally excised and radical orchiectomy is avoided. This lesion was unusual and was sent in for consultation because it was negative for calretinin. Over 90% of adenomatoid tumors are positive for calretinin. However, despite repeating the immunostains twice this lesion was entirely negative. Nonetheless, the morphology is classic and even with negative calretinin the diagnosis can be established.
Incorrect
Answer: Adenomatoid tumor
Histology: This lesion consists of tubules lined by flattened epithelium. In other areas the tubules have a somewhat cribriform appearance with similarly flattened epithelium. Some of the tubules are so small, resembling signet ring cells vacuoles. There are no red blood cells within the empty spaces. Nuclei are uniform with at most small central nucleoli. Cytoplasm is slightly eosinophilic. The lesion lacks mitotic figures, necrosis, and vascular invasion.
Discussion: This lesion has the classic morphology of an adenomatoid tumor. These lesions are mesotheliomas occurring in a characteristic location. The most common location is paratesticular next to the head of the epididymis, and also occurring near the fallopian tube and serosa of the uterus. Although mesotheliomas, we do not use this term since it can misconstrue malignant behavior. They have a characteristic morphology as seen in the current case with flattened tubules resembling vessels. However, there are no red cells within these lumina. They also may resemble metastatic signet ring cell cancer given the presence of prominent small lumina resembling cytoplasmic vacuoles. Some lesions may also be complicated by a prominent smooth muscle component. An additional feature that may sometimes be seen with adenomatoid tumors that may be worrisome for malignancy is central infarction. These lesions can minimally invade the adjacent testis. It is key to recognize these lesions as they are one of the few lesions occurring around the testes that is entirely benign where an orchiectomy need not be performed. If one diagnoses adenomatoid tumor on frozen section, the lesion may be only locally excised and radical orchiectomy is avoided. This lesion was unusual and was sent in for consultation because it was negative for calretinin. Over 90% of adenomatoid tumors are positive for calretinin. However, despite repeating the immunostains twice this lesion was entirely negative. Nonetheless, the morphology is classic and even with negative calretinin the diagnosis can be established.
