Intratesticular leiomyoma of the body of the testis

Intratesticular Leiomyoma: A Case Report

The majority of intratesticular masses are malignant. Although uncommon, benign lesions can be found as an intratesticular mass. An extremely rare lesion in the testicle is a leiomyoma, which has only been reported a handful of times in the literature. We report here a case of intratesticular leiomyoma, the associated imaging, and pathologic findings.

Intratesticular leiomyoma: A case report and a literature review

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Testicular Leiomyomùa is a rare entity.

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Clinical presentation and physical examination are non specific, and cannot distinguish it from a testicular cancer.

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Imaging is based on ultrasound, which describes the features of the testicular leiomyoma precisely, but cannot make the diagnosis.

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Only pathological examination of the specimen after surgery can confirm the diagnosis.

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A frozen section of the mass followed by mass excision can lead to organ sparing surgery if the diagnosis is suspected intraoperatively.

Introduction

Leiomyomas are benign tumors that originate from smooth muscles cells. Intratesticular leiomyoma is a very rare type of benign testicular masses. Through the literature, only 11 cases were reported.

Presentation of case

A 36 years old man presented with painless right scrotal mass. Clinical examination showed right upper polar testicular mass, well circumscribed and highly vascularized on sonography. Serum tumor markers were normal. Patient was explained the possibility of an organ sparing surgery if frozen section shows no sign of malignancy. Midline incision with frozen section was performed, with wide local excision. Pathological examination of the specimen confirmed intratesticular leiomyoma. Two years after the surgery, patient showed no sign of recurrence.

Discussion

Intratesticular Leiomyoma is usually revealed as a non-tender firm scrotal mass that increases in size. Sonography is the imaging modality of choice for assessing intrascrotal pathology, and cannot distinguish benign from malignant tumor. Surgical management is subject of debate. While some authors recommend radical orchiectomy, others suggest the use of frozen section intraoperatively, and perform conservative treatment by mass excision in the absence of signs of malignancy.

Conclusion

Intratesticular leiomyoma is a very rare finding. When suspected, conservative management using frozen section followed by mass excision can be done, but final diagnosis remains on pathological examination and immunohistochemistry of the specimen.

Leiomyoma of the testis: case report, review of literature, and discussing the role of contrast-enhanced ultrasound

Leiomyomas are benign mesenchymal neoplasms that originate from smooth muscle cells. Leiomyoma of the testis is exceedlingly rare. We present a case demonstrating a 1.3 cm hypoehoic mass of the left testis but with significant enhancement on contrast-enhanced scrotal ultrasonography concerning for a malignant neoplasm in a 33-year-old Hispanic male. However, his final pathology revealed a benign disease, specifically intratesticular leiomyoma. We discuss the role of contrast-enhanced scrotal ultrasound in this disease process.

Intratesticular Angioleiomyoma

Angioleiomyomas are common benign smooth muscle tumors that occur in the subcutis of the extremities and to a lesser extent, of the head and trunk. Rarely, these tumors have been reported in other deeper tissues, but never within the testis. We present what we believe to be the first report of intratesticular angioleiomyoma, occurring in a 58-year-old man with a painless testicular swelling. Orchidectomy was the treatment of choice in this patient, as there was no reliable imaging technique to clinically distinguish this benign lesion from the more common malignant intratesticular tumors.