Uropathology

Cas 0811738

Liens et agrandissements sur : images et texte en bleu. Links - Zoom: pictures and highlighted text.
 

Sujet de 27 ans se présentant une tumeur testiculaire douloureuse. Serologie négative.

 

27 yo male complaining of a painful testicular tumour. Serology negative.

 
  Orchidectomie.   Orchidectomy.  
     
      Zone 1  
     
  Zone 2   Zone 3  
     
  Zone 3   Zone 3  
     
     
 

Zone compacte autour du foyer 3

Dense whitish area around zone 3

   
         
     
         
     
  Réticuline   Reticulin  
     
  Périphérie de la zone 3   Periphery of the zone 3  
     
  Cytokératine   Cytokeratin  
     
  Actine muscle lisse   Smooth muscle actin  
     
  Calrétinine   Calretinin  
 

Diagnostic proposé:

 

 

 

 

 

 

 

 

 

 

Tumeur adénomatoïde infarcie.

 

Proposed diagnosis:

 

 

 

 

 

 

 

 

 

 

Infarcted adenomatoid tumour.

 
  Arguments      
  dans le texte de réference ci-dessous, en gras   Highlighted in the text of the reference below  
  References and Abstracts  

Infarcted adenomatoid tumor: a report of five cases of a facet of a benign neoplasm that may cause diagnostic difficulty.

  Am J Surg Pathol. 2004 Jan;28(1):77-83  
 

Skinnider BF, Young RH.Department of Pathology and Laboratory Medicine, Vancouver Hospital and Health Sciences Center, and University of British Columbia, Vancouver, British Columbia, Canada. bskinnid@vanhosp.bc.ca

We describe five cases in which adenomatoid tumors showed extensive necrosis, presumably due to infarction, and posed diagnostic difficulty. The tumors occurred in four males (three with epididymal tumors and one with an intratesticular tumor) and one female (with a parafallopian tube tumor) 35 to 44 years of age. Two of the men presented with acute scrotal pain simulating epididymitis, and two with a palpable mass. The parafallopian tube tumor was an incidental finding. The tumors were solitary, grossly well-circumscribed, uniformly solid masses that ranged in size from 1.1 to 3.5 cm. Microscopically, they were all characterized by central necrosis with pale mummified adenomatoid tumor identified at least focally but often overshadowed by nondescript necrotic tissue. Viable adenomatoid tumor was identified in all cases but was minor in amount in two of them. The necrosis was surrounded by a florid reactive process of fibroblasts and myofibroblasts that had plump nuclei often with prominent nucleoli, and occasional mitoses. Two of the epididymal cases had adjacent rete testis showing epithelial hyperplasia with hyaline globule formation. The microscopic appearance often suggested the possibility of a malignant neoplasm because of: 1) blurring of the normal relatively easily identifiable junction between adenomatoid tumor and adjacent tissue; 2) irregular pseudo-infiltration of fat by reactive tissue and adenomatoid tumor; 3) paucity of typical adenomatoid tumor due to the infarction and the fact that viable tumor usually showed a solid pattern; and 4) atypia of the associated reactive cells. This unemphasized feature of adenomatoid tumors may potentially lead to more aggressive therapy than warranted if it is not correctly interpreted.

 
 
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  A Diagnostically Challenging Case of an Infarcted Adenomatoid Tumor of the Epididymis (Click here for PDF)  
 
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  Adenomatoid tumour, WHO Blue Book (Click Here)  

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Adenomatoid tumor and mesothelioma in Ackerman's Surgical Pathology 8 ed.

Adenomatoid tumor is the most common neoplasm, most patients being in the third or fourth decade of life. It presents clinically as a mass, sometimes associated with pain. Grossly, it appears as a small (average size, 2 cm), solid, firm, grayish white nodule, occasionally containing small cysts. Microscopically, the lesion is unencapsulated, and on rare occasions it involves the adjacent testis. There is a proliferation of cells ranging from cuboidal to flattened, which form solid cords with an epithelial appearance alternating with channels having dilated lumina simulating vascular structures. The prominent intervening stroma may contain abundant smooth muscle and elastic fibers; it may also have a reactive desmoplastic quality and be infiltrated by inflammatory cells. The tumor cells may exhibit prominent cytoplasmic vacuolization. Histochemically, there is positivity for hyaluronidase-sensitive mucosubstances but negativity for lipids. Immunocytochemically, there is strong reactivity for keratin and epithelial membrane antigen (EMA) and negativity for CEA and factor VIII­related antigen. By electron microscopy, the tumor cells have prominent microvilli, desmosomes, and tonofilaments, and the intercellular spaces are dilated.

This tumor also occurs in the testicular spermatic cord and ejaculatory duct in males and in the fallopian tube and uterus in females. Its histogenesis has been argued for years, the proposed candidates for the cell of origin being mesothelial, mesonephric, müllerian, and endothelial. The accumulated evidence obtained from the previously discussed techniques, the sporadic detection of a continuity between the peritoneal lining and the cells lining the tubular structures, and the occasional occurrence of these tumors in association with typical papillary mesotheliomas within the abdominal cavity indicate that adenomatoid tumors are of mesothelial nature, as originally proposed by Masson et al. Although generally regarded as benign neoplasms, the frequent coexistence of chronic inflammation and fibrosis suggests that at least some of the cases may represent instead a peculiar form of nodular mesothelial hyperplasia. This lesion should be distinguished from epithelioid (histiocytoid) hemangioma, which can also occur in this area and which can be so similar as to have been referred to (somewhat misleadingly) as the "vascular form" of adenomatoid tumor. As expected, epithelioid hemangioma is immunoreactive for FVIII, Ulex europaeus I lectin, and CD34, but usually not for keratin. The behavior of true adenomatoid tumor is invariably benign, even when extending into the testis.