Adenofibroma of the Testis Discovered at Exploration for Torsion After Trauma

0022-5347/03/1705-1943/0 THE JOURNAL OF UROLOGY® Copyright © 2003 by AMERICAN UROLOGICAL ASSOCIATION

Vol. 170, 1943, November 2003 Printed in U.S.A.

DOI: 10.1097/01.ju.0000089871.35418.45

ADENOFIBROMA OF THE TESTIS DISCOVERED AT EXPLORATION FOR TORSION AFTER TRAUMA CRAIG G. ROGERS, JONATHAN I. EPSTEIN

AND

CHRISTIAN P. PAVLOVICH

From the Department of Urology, James Buchanan Brady Urological Institute, Johns Hopkins Medical Institutions, Baltimore, Maryland KEY WORDS: testis, testicular neoplasms, adenofibroma, wounds and injuries

Adenofibroma of the testis is unusual, with only 1 previously reported case. We report a case of adenofibroma of the testis discovered during exploration for torsion after testicular trauma, and briefly review the literature. CASE REPORT

A 19-year-old male presented with acute right testicular pain. He reported being kicked in the groin 2 weeks earlier with gradual swelling of the left testis. He denied hematuria, dysuria or fever. On physical examination the right testis was tender, firm, high and transverse lying. The left testis was nontender, enlarged, irregular and firm. Doppler ultrasound showed absence of perfusion of the right testis consistent with torsion, and a large hypoechoic lesion of the left testis with scattered internal echoes and cystic structures, which was thought to be consistent with hematoma (fig. 1). Bilateral scrotal exploration was performed. The right testis was darkened with a 360-degree intravaginal torsion. Reduction resulted in prompt return of color and Doppler signal. The left testis was firm and enlarged with subtunical nodularities but there was no evidence of rupture or hematocele. The left testis was biopsied before bilateral orchiopexy. The final pathological evaluation was consistent with adenofibroma (fig. 2). The postoperative course was uneventful. Serum ␣-fetoprotein and human chorionic gonadotropin levels were Accepted for publication June 13, 2003.

FIG. 2. Testis biopsy (high power) demonstrates adenofibroma. Reduced from ⫻44.

within normal limits. The patient was discharged home the day after surgery without complications. DISCUSSION

Adenofibroma of the testis is unusual, with only 1 case previously reported in the literature.1 The manner in which this tumor was found, during exploration for testicular torsion after trauma, is also unusual. Although testicular trauma is infrequently associated with torsion of the testis, there is no proved association between trauma and testicular tumors. Adenofibromas have been described in mullerian derivatives, such as ovary, uterus and fallopian tubes.2 The testis tumor in this case resembled adenofibroma of the ovary. There are rare reports of testicular and paratesticular tumors that are morphologically analogous to common epithelial tumors of the ovary.3 Cells of testicular and paratesticular tissue may be able to differentiate into mullerian type epithelium. REFERENCES

FIG. 1. Ultrasound of left testis reveals 3.2 ⫻ 4.4 ⫻ 2.1 cm hypoechoic lesion with internal echoes and cystic structures.

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1. Murao, T. and Tanahashi, T.: Adenofibroma of the rete testis. A case report with electron microscopy findings. Acta Pathol Jpn, 38: 105, 1988 2. McClure, R. F., Keeney, G. L., Sebo, T. J. and Cheville, J. C.: Serous borderline tumor of the paratestis: a report of seven cases. Am J Surg Pathol, 25: 373, 2001 3. Kosmehl, H., Langbein, L. and Kiss, F.: Papillary serous cystadenoma of the testis. Int Urol Nephrol, 21: 169, 1989