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Title: |
Cytologic Features of Paratesticular Adenomatoid Tumor | |||||||||||||||||||
| Authors: | Ana Perez-Campos, M.D., JosÈ A. JimÈnez-Heffernan, M.D., M.R.C.Path., Francisco PÈrez, M.D., and Blanca Vicandi, M.D. | |||||||||||||||||||
| To the Editors: Adenomatoid tumor (AT) is one of the most common primary neoplasms of the paratesticular area. Most occur in the epididymis, although they can involve the tunica albuginea, spermatic cord, tunica vaginalis and testis.1 On the basis of clinical and imaging studies, their distinction from malignant neoplasms may be difficult, especially if they have an atypical (nonepididymal) location.2 Since a report by PÈrez-Guillermo et al,3 there have been few cytologic descriptions.4 The tumor is mentioned in some textbooks on fine needle aspiration.5,6 We present 2 further cases of AT of the tunica albuginea and spermatic cord in which cytologic samples were obtained after scraping the tumor sample submitted during intraoperative consultations. The patients, 54- and 81-year-old men, presented with well-defined scrotal nodules. Ultrasonography disclosed extratesticular tumors that involved the albuginea and spermatic cord region. They had no relation to the epididymis. AT, leiomyoma and neurinoma were considered the most likely diagnoses. However, the unusual location of the lesions motivated intraoperative consultations. For this purpose, small tissue samples were obtained. The cytologic features were very similar and consisted of highly cellular smears composed of large, plump cells distributed mainly in cohesive clusters (Figure 1). Cellular dissociation with single cells and smaller groups was present. Neoplastic cells showed a moderate to abundant amount of cytoplasm and polygonal to slightly elongated morphology. Although monolayered groups predominated, tridimensional clusters were also present. The nucleus was round to oval, with a smooth contour, occasional binucleation and moderate pleomorphism (Figure 2). One case showed a small number of spindle cells with elongated nuclei. All these features were considered consistent with AT. The diagnosis was followed by conservative surgical excision of the lesion, and it was confirmed after pathologic study. Immunohistochemical analysis showed intense expression of cytokeratins, vimentin and calretinin, supporting the postulated mesothelial origin of the neoplasms.1 In both cases the tumor showed numerous bundles of smooth muscle cells. This is a well-known finding in AT.1 However, this feature was evident in the cytologic samples from only 1 case. Malignant mesothelioma and metastatic carcinoma should be considered the main differential diagnoses. Although rare, malignant mesothelioma may arise in the tunica vaginalis, spermatic cord and epididymis. The majority are of the epithelial type and identical to those of the pleura. On cytology, mesothelioma tends to show greater atypia and cellular dissociation, with a predominance of single cells. Finally, metastatic carcinoma should be considered. The presence of a predominance of monolayered groups and cells with a slightly spindle morphology, oval nuclei, abundant cytoplasm and monomorphic appearance favor the possibility of AT. However, the cytologic features may be similar, and information regarding an antecedent carcinoma should always be requested. The most important therapeutic consideration is differentiation from primary testicular neoplasms. This is easily achieved on cytology, either by preoperative fine needle aspiration or during an intraoperative consultation, avoiding aggressive surgical procedures. | ||||||||||||||||||||
| Keywords: | adenomatoid tumor, testicular neoplasms, scrape samples | |||||||||||||||||||
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