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Leiomyoma of the epididymis
RIMARY tumors of the epididymis are very
Leiomyoma
of
the
Epididymis
VICTOR R. .IABLOKOty, MLD ., Detroit, Michigan, AND WVILLARD C . MEYER, M .D ., Eranston, Illinois
rare, as evidenced by the report of Longo, McDonald and Thompson [I], who collected a total of 134 proved cases of tumors originating in the epididymis up to 1949 . Of these cases, ninety-eight tumors were benign and thirty-six were malignant . The most common benign tumor was adenomatoid tumor or mesothelioma . The next most common tumor was leiomyoma, which represents io per cent of the cases . The authors added nineteen such benign tumors from their clinic to those collected from the literature . Of their nineteen cases, two were leiomyomas and the remaining seventeen were adenomatoid tumors . p
CASE REPORT A fifty-nine year old white man was admitted to the St . Francis Hospital because of a scrotal mass on the left side . He had first noticed the mass inadvertently ten years prior to this admission . The mass had progressively increased in size and was not accompanied with pain . There was no history of venereal disease or trauma to the area . On physical examination the patient's general physical status was excellent . In the left scrotal compartment a palpable mass approximately 4 to 5 cm . in diameter was found which was hard, movable, non-translucent and non-tender . The mass seemed to be attached to the left testicle . The preoperative diagnosis was that of a tumor mass in the left scrotal compartment, probably a spermatocele . The operative findings revealed the tunica vaginalis to contain an enlarged amount of fluid compatible with a low grade hydroccle . Adjacent to the lower pole of the left testis and contiguous with the tail of the epididymis was a hard, nodular mass approximately the size of a walnut. It was well circumscribed and encapsulated . The mass was dissected from the
surrounding cord structures and testis, and was removed without difficulty . The lower pole of the epididymis and a segment of the vas deferens were sacrificed to provide wide excision . Frozen section of the tumor was reported
FIG . I . Leiomvomu of th epididymis ; cut surface of gross specimen . as a leiomyoma . The testicle was left intact and returned to the scrotum . The patient had an uneventful recovery and was discharged six days later . Pathologic examination revealed a mass 4 .2 by 3 .o by 2 .7 cm . in diameter, weighing 21 .3 gm . The firm, oval tumor showed a whitish gray to light brown outer capsule . The cut surface was gray-white, glistening and somewhat bulging, showing whorled trabeculations . (Fig . 1 .) Grossly it resembled the leiomyoma of the uterine musculature. Histologic report revealed the tumor to be encapsulated and composed of interlacing hands of smooth muscle tissue with interspersed areas of dense fibrous tissue. (Fig . 2 .) The individual cells were spindle-shaped, well differentiated and did not present anaplasia or other characteristics of malignant change . Routine hematoxylin-eosin, Masson's trichrome, Mallory's connectivetissue (Krichesky's modification) and Van 149 American Journal of Surgery, Volume 94, July, 1957
Jablokow and Meyer
FIG . 2. Microscopic section of the tumor showing interlacing bands of smooth muscles . Low power photomicrograph .
Gieson's connective-tissue stains were done and confirmed the diagnosis of the leiomyoma .
ture . Friedman and Grayzel [31 state that "No case of recurrence following removal has been reported nor has there been any instance of malignant change in the tumor ."
COMMENTS
Leiomyomas of the epididymis are thought to originate from the smooth muscle fibers of this structure . However, Rubaschew [21 in 1926 maintained that leiomyomas should not be considered primary in the epididymis because they take origin from contiguous tissue. He pointed out that tumors of the epididymis may originate from : (i) cells of embryonal tubules, (2) the wolffian or myotome anlage, and (3) adjacent stromal tissues such as blood and lymphatic vessels, fat and fibrous tissue . The usual presenting complaint in benign tumors of the testis, or particularly of the epididymis, is painless, gradual enlargement of a scrotal mass . Occasionally, intermittent pain with radiation to the groin, abdomen and back is present . In many cases there is an associated hydrocele of the tunica vaginalis . The diagnosis of this type of tumor has not been made preoperatively in the reported cases in the litera-
SUMMARY
A case of Ieiomyoma of the epididymis has been presented . Tumors of this kind are very rare, and less than twenty cases have been reported to date . It is believed that all masses in the scrotal compartment should be explored if there is any question regarding their nature . Occasionally, rare benign tumors of the scrotal contents are found ; however, the grave prognosis of malignant types makes exploration obligatory . REFERENCES 1 . LoNGD, V . J ., McDoNALD, J . R. and THoMPSON, G . 1 . Primary neoplasms of the epididymis . J. A, M. A ., 147: 937-941, 1 951 • 2 . RUBASCHEW, S . Die soliden Geschwuelste des Nebenhodens. Ztschr . f. Urol., 20 : 290-297, 1926 . 3 . FRIEDMAN, H . H . and GRAYZEL, D . M . Myomatous tumors of the epididymis . J. Urol ., 47 : 475-484 1942. 150
Leiomyoma
of
the
Epididymis
VICTOR R. .IABLOKOty, MLD ., Detroit, Michigan, AND WVILLARD C . MEYER, M .D ., Eranston, Illinois
rare, as evidenced by the report of Longo, McDonald and Thompson [I], who collected a total of 134 proved cases of tumors originating in the epididymis up to 1949 . Of these cases, ninety-eight tumors were benign and thirty-six were malignant . The most common benign tumor was adenomatoid tumor or mesothelioma . The next most common tumor was leiomyoma, which represents io per cent of the cases . The authors added nineteen such benign tumors from their clinic to those collected from the literature . Of their nineteen cases, two were leiomyomas and the remaining seventeen were adenomatoid tumors . p
CASE REPORT A fifty-nine year old white man was admitted to the St . Francis Hospital because of a scrotal mass on the left side . He had first noticed the mass inadvertently ten years prior to this admission . The mass had progressively increased in size and was not accompanied with pain . There was no history of venereal disease or trauma to the area . On physical examination the patient's general physical status was excellent . In the left scrotal compartment a palpable mass approximately 4 to 5 cm . in diameter was found which was hard, movable, non-translucent and non-tender . The mass seemed to be attached to the left testicle . The preoperative diagnosis was that of a tumor mass in the left scrotal compartment, probably a spermatocele . The operative findings revealed the tunica vaginalis to contain an enlarged amount of fluid compatible with a low grade hydroccle . Adjacent to the lower pole of the left testis and contiguous with the tail of the epididymis was a hard, nodular mass approximately the size of a walnut. It was well circumscribed and encapsulated . The mass was dissected from the
surrounding cord structures and testis, and was removed without difficulty . The lower pole of the epididymis and a segment of the vas deferens were sacrificed to provide wide excision . Frozen section of the tumor was reported
FIG . I . Leiomvomu of th epididymis ; cut surface of gross specimen . as a leiomyoma . The testicle was left intact and returned to the scrotum . The patient had an uneventful recovery and was discharged six days later . Pathologic examination revealed a mass 4 .2 by 3 .o by 2 .7 cm . in diameter, weighing 21 .3 gm . The firm, oval tumor showed a whitish gray to light brown outer capsule . The cut surface was gray-white, glistening and somewhat bulging, showing whorled trabeculations . (Fig . 1 .) Grossly it resembled the leiomyoma of the uterine musculature. Histologic report revealed the tumor to be encapsulated and composed of interlacing hands of smooth muscle tissue with interspersed areas of dense fibrous tissue. (Fig . 2 .) The individual cells were spindle-shaped, well differentiated and did not present anaplasia or other characteristics of malignant change . Routine hematoxylin-eosin, Masson's trichrome, Mallory's connectivetissue (Krichesky's modification) and Van 149 American Journal of Surgery, Volume 94, July, 1957
Jablokow and Meyer
FIG . 2. Microscopic section of the tumor showing interlacing bands of smooth muscles . Low power photomicrograph .
Gieson's connective-tissue stains were done and confirmed the diagnosis of the leiomyoma .
ture . Friedman and Grayzel [31 state that "No case of recurrence following removal has been reported nor has there been any instance of malignant change in the tumor ."
COMMENTS
Leiomyomas of the epididymis are thought to originate from the smooth muscle fibers of this structure . However, Rubaschew [21 in 1926 maintained that leiomyomas should not be considered primary in the epididymis because they take origin from contiguous tissue. He pointed out that tumors of the epididymis may originate from : (i) cells of embryonal tubules, (2) the wolffian or myotome anlage, and (3) adjacent stromal tissues such as blood and lymphatic vessels, fat and fibrous tissue . The usual presenting complaint in benign tumors of the testis, or particularly of the epididymis, is painless, gradual enlargement of a scrotal mass . Occasionally, intermittent pain with radiation to the groin, abdomen and back is present . In many cases there is an associated hydrocele of the tunica vaginalis . The diagnosis of this type of tumor has not been made preoperatively in the reported cases in the litera-
SUMMARY
A case of Ieiomyoma of the epididymis has been presented . Tumors of this kind are very rare, and less than twenty cases have been reported to date . It is believed that all masses in the scrotal compartment should be explored if there is any question regarding their nature . Occasionally, rare benign tumors of the scrotal contents are found ; however, the grave prognosis of malignant types makes exploration obligatory . REFERENCES 1 . LoNGD, V . J ., McDoNALD, J . R. and THoMPSON, G . 1 . Primary neoplasms of the epididymis . J. A, M. A ., 147: 937-941, 1 951 • 2 . RUBASCHEW, S . Die soliden Geschwuelste des Nebenhodens. Ztschr . f. Urol., 20 : 290-297, 1926 . 3 . FRIEDMAN, H . H . and GRAYZEL, D . M . Myomatous tumors of the epididymis . J. Urol ., 47 : 475-484 1942. 150