Leiomyo-adenomatoid Tumor of the Epididymis

Diffuse WT1 Positivity in Smooth Muscle Component Supports Dual Differentiation of Mesothelial Cells in the Histogenesis of Leiomyoadenomatoid Tumors—A Report of two Cases

Leiomyoadenomatoid tumors of the epididymis are exceedingly rare biphasic tumors composed of an adenomatoid component in the form of gland-like structures lined by single flat or cuboidal cells admixed with smooth muscle. Radiological and gross findings cannot distinguish leiomyoadenomatoid tumors from the more common classic adenomatoid tumors or leiomyomas, and careful microscopic examination is critical in the identification of this esoteric variant. The histogenesis of this entity remains ambiguous. Common hypotheses include a collision tumor, a variant of an adenomatoid tumor with a smooth muscle component, or an adenomatoid tumor arising in the background of reactive smooth muscle hyperplasia. We present 2 cases of leiomyoadenomatoid tumors with diffuse nuclear WT1 positivity in both the adenomatoid and smooth muscle components, supporting the mesothelial origin of these tumors.

Leiomyoadenomatoid tumours of the epididymis: A new case report and review of the literature

Benign tumours of the epididymis are rare, and the most common tumour types include adenomatoid tumours, representing more than half of all cases, and leiomyomas. Here, we reported a case of leiomyoadenomatoid tumours of the epididymis, a very rare, benign histological entity with only few cases described in the English literature, which have been reviewed and summarised. Clinically, the lesion presented as a solitary mass growing at the level of the tail of the right epididymis. After the intraoperative frozen section analysis revealed a benign adenomatoid lesion, the mass was enucleated with a conservative surgery sparing the testis. This case highlights the importance for both pathologists and urologists to be aware of these rare, but benign, tumours, to avoid misdiagnosis, especially in the setting of frozen intraoperative consultation, or primary radical surgical procedures, as radical orchiepididymectomy without frozen section consultation.

Epididymal leiomyoadenomatoid tumor: A case report with literature review

Primary epididymal tumors are rare. Adenomatoid tumors comprise 30% of paratesticular tumors. They are benign neoplasms originating from mesothelial cells. On the other hand, leiomyomas, originating from smooth muscle cells, are less common in paratesticular region. Leiomyoadenomatoid tumor is a benign tumor which combines the morphologic features of adenomatoid tumor and leiomyoma. To the best of knowledge, only two cases of leiomyoadenomatoid tumor in the paratesticular location have been reported in the literature. We document another such case.

Adenomatoid tumors of the female and male genital tract. A comparative clinicopathologic and immunohistochemical analysis of 47 cases emphasizing their site-specific morphologic diversity

Adenomatoid tumors (ATs) are uncommon benign mesothelial tumors with a predilection for the genital tract. We reviewed 47 ATs diagnosed at our institutions during 10-year period. Thirty tumors (64%) originated in the female (21 uterine, 8 tubal, and 1 ovarian) and 17 (36%) in the male (9 epididymal and 8 testicular) genital tract. The median age for females and males was 47.5 and 51 years, respectively. While 83% of tumors in females were incidental findings in resections for unrelated diseases, 94% of male lesions presented as clinical masses leading to surgery. The median size was 2, 1, and 0.5 cm for uterine, epididymo-testicular, and tubo-ovarian lesions, respectively. Architecturally, the microcystic/angiomatoid pattern was the most frequent (32/47; 68%), followed by combined microcystic/trabecular (26/47; 55%) and retiform/adenoid (15/47; 32%) pattern. The trabecular/solid (6%) and macrocystic (4%) patterns were uncommon. However, 57% of cases revealed ≥2 growth patterns. Taken by anatomic site, 20 of 21 uterine cases were at least focally microcystic but none was retiform. In contrast, the retiform pattern dominated in male genital tract tumors (12/17; 71%). Immunohistochemistry showed expression of calretinin (36/36) and D2-40 (30/30) and lack of CD34 (0/30) and PAX8 (0/32). GLUT-1 was expressed in 11/11 male genital tract tumors but in none of the microcystic uterine lesions. Estrogen and progesterone receptor expression was weak and focal (two and three uterine cases, respectively). None stained for the androgen receptor. Our study illustrates the great site-specific morphological diversity of ATs emphasizing their wide site-dependent differential diagnosis.

Leiomyo-adenomatoid tumor of the uterus: a distinct morphological entity?

INTRODUCTION

The morphologic and immunohistochemical findings of a well-circumscribed leiomyoadenomatoid tumor located in the posterior uterine wall are reported.

CASE REPORT

The patient was a 55-year-old white woman who complained of peri/postmenopausal and irregular bleeding during the past 4 months. The adenomatoid component was intermingled with bland smooth muscle fascicles and was composed of vacuolated cells, tubules, and slit-like structures crossed by epithelial bridges. Immunohistochemistry revealed positivity to epithelial and mesothelial markers in the adenomatoid component and strong immunoreaction for smooth muscle markers in the leiomyomatous one.

CONCLUSIONS

The well-defined circumscription and the presence of mesothelial component intermingled with the leiomyomatous proliferation favors the hypothesis that a leiomyo-adenomatoid tumor should be considered as a subtype of adenomatoid tumor with distinctive morphological features. Only four previous cases of this rare neoplasm have been reported to date, one in the epydidimis and the other three cases in the uterine wall, one of them affecting also to the right ovary.

[Cystic adenomatoid tumor of the uterus]

Adenomatoid tumors are benign neoplasms of mesothelial origin, which involve the feminine and masculine genital tracts. They are more generally casually discovered. Our study presents an adenomatoid tumour, of cystic shape, which enables discussion of the histogenesis of this tumour and enlightenment of differential diagnoses which can at times result in an incorrect malignant diagnosis.

Leiomyoma of the epididymis treated with partial epididymectomy

BACKGROUND

A 56-year-old man presented to a urology clinic with a painless left-testicular mass of unknown duration. On physical examination, a firm mass measuring 2 cm x 2 cm and involving the inferior portion of the left epididymis was found. The left testicle, right testicle, and right epididymis looked normal on examination.

INVESTIGATIONS

Assessment of tumor-marker levels, ultrasound examination of the scrotum, Doppler ultrasound examination, surgical exploration, and histologic examination of frozen sections.

DIAGNOSIS

Pure leiomyoma arising from the epididymis.

MANAGEMENT

Complete excision of the mass with its contiguous epididymis, preserving the left testicle and rest of the epididymis.