Tumor adenomatoide del epidídimo: una infrecuente observación

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Abstract

Objetivos: Presentar un nuevo caso de un tumor adenomatoide del epidídimo, el primero en nuestro hospital en 46 años. Método: Mediante el formato de caso clínico realizamos un breve análisis de la literatura sobre el tumor adenomatoide del epidídimo, señalando aspectos relacionados con la forma de presentación, diagnóstico y terapéutica, entre otros. Resultado: Se trata de un varón de 30 años, ingresado en nuestra sala por dolor e inflamación a nivel del epidídimo izquierdo. La exploración física y el estudio ultrasonográfico mostraron la existencia de un tumor de 5x5x2 cm a ese nivel. El tumor fue extirpado, practicándose el estudio histopatológico que fue concluyente para un tumor adenomatoide del epidídimo. Conclusiones: El tumor adenomatoide del epidídimo es un tumor de la región paratesticular, aunque se puede encontrar fuera de esta zona, siendo el mismo muy infrecuente. Su origen hasta el momento es mesotelial, señalándose que la inflamación juega algún papel en el desarrollo de estos tumores. El estudio ultrasonográfico y la exploración clínica son fundamentales para su diagnóstico. Son tumores benignos en la mayoría de los casos, pero se han señalado en raras ocasiones tumores malignos de este tipo. El tratamiento consiste en la exéresis quirúrgica, con biopsia intraoperatoria para evitar una posible castración.

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Most cited references 19

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Multimodality imaging of paratesticular neoplasms and their rare mimics.

Syed Akbar, Tawfeeq Sayyed, Syed Jafri … (2003)

Extratesticular neoplasms are rare but clinically significant lesions that affect patients of all ages. These neoplasms are generally asymptomatic but may have potentially life-threatening sequelae. Lipoma is the most common primary benign paratesticular neoplasm and the most common tumor of the spermatic cord. Adenomatoid tumor is the most common tumor of the epididymis, followed by leiomyoma. In adult patients, it is imperative to consider sarcomas in the differential diagnosis of all solid tumors of the scrotum. The most common sarcomatous tumors in pediatric patients are embryonal sarcoma and rhabdomyosarcoma. Metastases, particularly from testicular, prostatic, renal, and gastrointestinal primary malignancies, can also occur. Mimics of paratesticular neoplasms including polyorchidism and splenogonadal fusion are rare but must also be considered for optimal management. Ultrasonography (US) is currently the imaging modality of choice. However, US findings are often variable and nonspecific and do not usually allow definitive characterization. Specific computed tomographic and magnetic resonance imaging findings with respect to tumor location, morphologic features, and tissue characteristics can aid in the evaluation of paratesticular neoplasms and help narrow the differential diagnosis. Copyright RSNA, 2003

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Clinical management of non-testicular intrascrotal tumors.

D J Beccia, R J Krane, C A Olsson (1976)

Our 10-year experience with non-testicular intrascrotal tumors has been combined with an extensive survey of the literature. The over-all incidence of malignancy affecting intrascrotal structures is high: 1) 25 per cent of epididymal neoplasms are malignant, 2) excluding cord lipomas, 56 per cent of cord tumors are malignant and 3) 59 per cent of scrotal tunic neoplasms are of malignant origin. Because of the high incidence of malignancy and because tumors of these structures are often misdiagnosed, a clinical approach to the diagnosis and management of non-testicular intrascrotal masses is presented.

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Fine needle aspiration of epididymal nodules in Chandigarh, north India: an audit of 228 cases.

Sathanur R. Srinivasan, A Rajwanshi, R Nijhawan … (2006)

Epididymal nodules are not infrequently encountered in surgical practice. These are generally small and slippery and fine needle aspiration cytology (FNAC) is not easy. But as it is rapid and less traumatic than a biopsy, this is a favoured technique in the assessment of epididymal nodules. In the present study, all the cases of epididymal nodules aspirated from January 1998 to August 2004 were retrieved from the cytology files of the Department of Cytology, Post Graduate Institute of Medical Education and Research, Chandigarh, India. A total of 228 cases were retrieved and divided as follows: tuberculous epididymitis 70 (30.7%), non-specific inflammation 10 (4.4%), microfilaria 2 (0.9%), hydrocele 26 (11.4%), spermatocele 42 (18.4%), spermatic granulomas 12 (5.3%), adenomatoid tumour 3 (1.3%), leiomyosarcoma 1 (0.4%) and lipoma 1 (0.4%). Thirty-six (15.8%) cases were labelled as benign aspirate not otherwise specified. FNAC material was inadequate for opinion in 22 (9.65%) cases and three (1.3%) cases revealed evidence of a haematoma. FNAC was useful in the diagnosis of 90.3% of cases, thereby avoiding surgical biopsy and other investigations. Therefore, FNAC has an important role in the differential diagnosis of epididymal nodules as it can detect malignancy and benign conditions such as tuberculosis and acute and chronic epididymo-orchitis.