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

Horn-yo Chien¹, Sun-Lang Chen^1,2, Wen-Jung Chen¹, Zuou-Yi Shieh¹, Shao-Chuan Wang^1,2

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 4^th and 6^th 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.