NDP12: Paratesticular leiomyoma - a rare entity
  • 2019-01-07,
  • 上傳者: TUA秘書處,
  •  0
簡宏祐1 陳順郎1,2 陳文榮1 謝佐宜1 王紹全1,2
1中山醫學大學附設醫院泌尿科 2中山醫學大學醫學系
Paratesticular leiomyoma - a rare entity
Horn-yo Chien1, Sun-Lang Chen1,2, Wen-Jung Chen1, Zuou-Yi Shieh1, Shao-Chuan Wang1,2
1Division of Urology, Chung Shan Medical University Hospital, Taichung, Taiwan
2School of Medicine, Chung-Shan Medical University, Taichung, Taiwan
Preface: Leiomyomas are benign tumors originate from smooth muscle. The most common site involving genitourinary tract is renal pelvis, and it is extremely rare to discover lesions in the paratesticular tissue. Herein, we present a case of paratesticular leiomyoma with the initial presentation of painless testicular tumor and review the related literatures.
Case Report: A 56-year-old male presented at our urology outpatient department due to progressively enlarged right testis. On physical examination, there was a more than 5 cm in diameter, firm, non-tender mass adhesion to right testis. The spermatic cord was intact and no palpable inguinal lymph nodes. Blood and urine biochemistry , as well as tumor marker including alpha-fetoprotein (AFP), beta-hCG and lactate dehydrogenase (LDH), were within normal limit. A scrotal sonography revealed a 5.6 cm paratesticular, hypo-echoic lesion with normal testis echogenicity & blood supply.  For further differentiation, the character of the mass on MRI showed enhancement with heterogenous T1 and T2 signals, without restricted diffusion. The patient received right paratestcular tumor excision with testis sparing and the histologic examination confirmed leiomyoma.
Discussion: Testicular and paratesticular leiomyoma are rare tumors of the testes. It arises from smooth muscle cell and can develop in any part of the genitourinary tract. The majority of these tumors were found in the renal capsule but tumor over epididymis, spermatic cord and the tunica albuginea have been reported before. The tumors mostly occur between  the 4th and 6th decades of life. Most of these lesions are indolent, slow growing paratesticular masses. Such aaratesticular lesions should be differentiated with adenoid tumor, testicular appendage with torsion, lipoma, inguinal-socortal hernia, fibrous pseudotumor and leiomyoma. It is difficult to make preoperative distinction between the benign and malignant paratesticular tumour even by MRI, and the final diagnosis depends on histopathologic examination. By this case, we put emphasis on the high index of clinical suspicion for urologists to be aware of such potentially benign rare disease. Timely diagnosis and appropriate excision of the lesion would prevent the need for unnecessary orchiectomy in most of the patients.
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    2019-01-07 12:49:50
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