罕見睪丸營養不良性鈣化腫瘤之案例分享與文獻回顧

李翊維¹  唐靖^1,2

¹國泰綜合醫院外科部 泌尿科  ²汐止國泰綜合醫院外科部 泌尿科

Dystrophic calcified tumor of the testis – A case report and literature review

¹Yi-Wei Lee  ^1,2Chin Tang

¹Division of Urology, Department of Surgery, Cathay General Hospital, Taipei City, Taiwan

²Division of Urology, Department of Surgery, ShiJi Cathay General Hospital, New Taipei City, Taiwan

We report a 43-year-old man without known systemic disease. According to the patient’s statement, he has been married for 10 months but his wife did not conceive a child. Therefore, he visited our urology out-patient department for fertility consultation. At physical examination, a left intratesticular hard nodules were palpated. He denied fever, local tenderness or other urinary symptoms. β-HCG and α-fetoprotein were obtained and both were negative. Semen analysis showed asenthospermia without oligospermia. Scrotal ultrasound revealed a 1.53 x 1.4cm intratesticular tumor at the anterior-medial side of the left testis with prominent acoustic shadow. Doppler mode revealed adequate blood flow on both side of the testis with no evidence of hypervascularity to signify an acute inflammatory process. After a thorough discussion with respect to the nature of the lesion and the possibility of malignancy, a surgery to remove the mass was planned. Intra-operatively, upon opening the tunica albuginea, an extremely hard calcified tumor with local adhesion to the tunica albuginea was noted. Frozen section of the tumor and its adjacent tissue showed no evidence of malignancy or germ cell neoplasm in situ. Hence, a partial orchiectomy was performed. The final histopathological report showed diffuse dystrophic calcification with minimal epidermoid cyst and some keratinous materials. Immunostaining for CD117 is negative, and no other germ cell tumor component is found with immunostaining for PLAP. After the surgery, this patient recovered smoothly without any discomfort and was discharged at post-operation day 1.

Dystrophic calcified nodule of the testis was first reported by Minkowitz and colleagues in 1965, with less than 10 subsequent cases being reported in the literature. The etiology of this lesion is controversial, partly owing to its rarity. Potential theory of pathogenesis includes osteoid metaplasia of the testis, regressed testicular malignancy, or even partial testicular infarction. We share our experience of managing such rare disease to raise the awareness for such peculiar subtype of testicular tumor, and highlighting the importance of accurate pre-operative diagnosis to avoid unnecessary radical surgery that could jeopardize patient’s fertility.