Diffuse fibrous proliferation of tunica vaginalis associated with testicular infarction: a case report

Paratesticular fibrous pseudotumour in a 26-year-old Nigerian man: A case report

INTRODUCTION AND IMPORTANCE

Benign fibroblastic proliferation located within the scrotum are uncommon. They are also identified as fibrous pseudotumour and usually arise from the paratesticular region. Their pathogenesis is unknown. These tumours are difficult to diagnose pre-operatively and resemble intra-scrotal malignancy.

CASE PRESENTATION

We managed a 26-year-old Nigerian man with a five-year history of left sided hemiscrotal swelling. The mass was excised, and histology showed benign fibroblastic proliferation.

DISCUSSION

Most paratesticular tumours are benign. Imaging studies that show the mass as separate from the testis, normal levels of tumour markers and clinical features not suggestive of malignancy make the case for organ-sparing mass excision, in the treatment of paratesticular fibrous pseudotumour, very strong.

CONCLUSION

Intra-scrotal benign fibrous proliferation is a challenge to diagnose pre-operatively but excision of this benign mass without an orchidectomy is practicable when pre-operative assessment suggests a benign disease.

Paratesticular Fibrous Pseudotumor in Children: A Case Report and Review of Literature

BACKGROUND

Paratesticular fibrous pseudotumor (PFP) is a rare benign tumor that can mimic malignant tumors; thus, radical orchiectomy was the standard treatment in the past.

OBSERVATION

A 15-year-old boy came to our attention for a hard right inguinal swelling. An ultrasound showed a highly vascularized mass. The boy underwent a gonadal-sparing excision of the mass that was diagnosed to be a PFP. The patient recovered well, without recurrences at the follow-up.

CONCLUSIONS

PFP is mostly asymptomatic, and its diagnosis is incidental. Only further 4 pediatric cases were reported in the literature. Our case confirms that gonadal-sparing surgery is an optimal treatment.

Perspective in Pediatric Pathology, Chapter 24. Testicular Inflammatory Processes in Pediatric Patients

Acute scrotal pain in children represents a major diagnostic and therapeutic challenge. An important initial differentiation should be made between epididymitis and other processes that cause acute scrotal pain, such as testicular torsion and tumor. Infectious agents disseminating through the blood flow can damage the testis by causing orchitis. On the other hand, infections ascending via spermatic pathways typically lead to epididymitis [ 1 ].

Pediatric fibrous pseudotumor of the tunica vaginalis testis

We describe a 16-year-old male with ultrasound evidence of a 1.3 cm right paratesticular nodule, which was managed by intraoperative frozen section and excisional biopsy. The pathologic findings were consistent with benign fibrous pseudotumor of the tunica vaginalis testis, which is a very rare lesion in the pediatric population. Consideration of fibrous pseudotumor in the differential diagnosis of pediatric paratesticular masses may help prevent unnecessarily aggressive therapy.

Fibrous pseudotumors of the testis: The balance between sparing the testis and preoperative diagnostic difficulty

OBJECTIVE

To determine a paradigm that will be helpful for urologists to manage fibrous pseudotumors, which are a very rare condition of the testis.

MATERIAL AND METHODS

We retrospectively evaluated the patients with fibrous pseudotumors in our uropathological database from 1995 to 2013. Patients who had tumor markers and ultrosonography (USG) screening before surgery and a final pathology report of a fibrous pseudotumor were included in the study.

RESULTS

In total, 838 patients with a testis mass were evaluated. Only 6 of these patients met the inclusion criteria. The mean age was 34 years (min: 20, max: 72). Serum tumor markers were in the normal range for all patients. The scrotal tumors were not clearly related to the testis parenchyma, and the radiologists could not definitively determine the nature of the masses (benign or malignant). A concomitant hydrocele was detected in 2 patients. After inguinal exploration, radical orchiectomy was performed in one patient with an ipsilateral atrophic testis, and biopsies were taken from the lesions for frozen section analysis in the other 5 patients. Pathologists reported benign tumors for all of these patients based on the frozen sections, and testicular sparing surgery was then performed in these 5 patients.

CONCLUSION

If scrotal tumors are detected by ultrasonography in patients with normal tumor markers, and the tumor cannot be clear distinguished from the testis, these patients might have a fibrous pseudotumor, and organ-sparing surgery can be performed on these patients.

Bilateral fibrous pseudotumors of the tunica albuginea in a pediatric patient

Fibrous pseudotumor, previously named nodular fibrous periorchitis, is a very rare disease entity in the pediatric patient. This is the first reported case of bilateral synchronous fibrous pseudotumors in the testes of a pediatric patient.

Diffuse fibrous pseudotumor of the testicular tunics associated with an inflamed hydrocele

Fibrous pseudotumors of the testicular tunics and paratesticular soft tissue are uncommon lesions. They typically arise as painless scrotal masses that may be associated with a hydrocele or history of trauma or infection. Although these lesions are clinically worrisome for a malignant neoplasm, they are thought to be reactive in nature, since they are composed of dense fibrous tissue with interspersed bland fibroblasts and myofibroblasts and mixed inflammatory cells. Once excised, these lesions behave in a benign fashion. Typically, these masses are multinodular, but in rare cases they are diffuse, bandlike myofibroblastic proliferations that encase the testis and are termed fibromatous periorchitis. Herein, we describe a 57-year-old man with a diffuse fibrous pseudotumor/fibromatous periorchitis that encased the left testis and adnexa and arose in close apposition to an inflamed hydrocele.