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Adenomatoid Tumors of the Epididymis
'TnR Jo-cnNAl.. OF UROI,OGY
Vol. 79, No. 3, March 1958 Printed in U.S.A.
TCMORS OF THE EPIDIDYMIS IAN M. THOMPSON* l"rom the Department of
['ni11ersity of Texas Medical Branch,
Texas
It has become incrnasingly apparent that the most common neoplasm of the epididyrn.is is an adcnomatoid one. Although the term has neither genetic rectitude nor complete aeecptancc, it seems applicable in reference to morphologic suitability and in the resolution of much prior confusion in the terminology of epididymal tumorn. The earlier literature applied such terms as adenoma, angioma and cystadenorna to the adenomatoid tumor. It is not surprising then that prior to the rnviP\\' of primary epididymal tumors by Longo,1 malignancies were considered more common. Since a channeling of caRes into the unified ade11omaioid has dcYcloped, it is clear that benign growths account for approximately 80 per eent, and of these perhaps 75 per cent are adenomatoid. As to the derivation of thiR type of tumor, a mesothelial origin seems more tenable than endothelial, epithelial or mesonephric. Most frequently annotated as involving the adenomatoid tumors have been found in other locations, notably the spermatic cord, tunica vaginalis and, in the female, the uterus and tubes. Regarding there has been no eYidence to incriminate prior infection or trauma as inRtigative or contributory . Clinically, adenomatoid tumon; have been seen to occur at any age, but reputedly nre more common in the third and fourth decades. The lack of matology referable to the tumor has been noteworthy. Data. gleaned from the large:;;t series of cases reported 2 suggest that the globus minor is involved four times more frequently than the glohus major. Purportedly the tumors arise more often 011 the left., yet bilateral occurrence has been described. 3 Slow growth has been another characteristic finding, and upon examination, encapsulated separability from the epididymi::; and teRticle. Tenderness to palpation has been lacking aside frorn the infrequent instance of the compensation complex. The tumors rather ob,,iom,ly are not transilluminable, The pathologic appearance of the adenomatoid tumor grossly is round, well circumscribed, iirm and relatively smooth. The yellowish cast of the cut surface is similar to the intact appearance. Histologically, the pseudoacinar spaces "·hich are chanwteri:;;tic arc lined by a cuboidal type of cell which has in its likeness to the epithelial cell instigated misguided conjecture as to an epithelia.l origin (fig. l, A). The stroma is of connective tissue type and often scanty. A scattering of lyn1phocyte8 is commonly associated with a focal collection of lymphocytes resembling a lymph follicle (fig. 1, . Smooth muscle may also he found in ,·arying amounts throughout the stroma. Aecepted for publicr,tion July 26, 1957. * Preseni. nrldress: Seetion of Orology, University Hospital, Ann Arbor, Mich. 1 Longo, V. J., J\lcDonald, J. R. and Thompson, G. J.: Primary neoplasms of the epididymis· Special reference to adenomatoid tumorn. J.A.M.A., 147; 937-941, 1951. 2 Thompson, G. J. Tumors of the spennatic cord, epididymis, and testicular tunics. Surg. Gynec. & 62: 712-728, l(Yl6. '' Morin, L. J.: adenornatoid tumor of the epididyrnis. J. U rol ., 75: 819--82:-l, 1956.
519
520
IAN M. THOMPSON
FIG. 1. Adenomatoid tumor of epididymis. A, cleft-like pseudoacinar spaces visible, lined with flattened cuboidal type of cell. B, note characteristic lymphocytic aggregates located in close proximity to pseudoacinar spaces.
Data derived from five instances of adenomatoid tumor seen at the University Hospital in the past six years coincide with facts acquired from prior reportR. The ages of the five patients were 82, 80, 67, 52, and 39 years. Three were unaware of the existence of the tumor; in the other two no symptoms had been experienced, but the presence of a mass had been noted for at least eight to ten years. Concomitant pathology was prostatic in two cases, ophthalmologic in one, and cardiovascular in two. As to location, four were found to be in the region of the globus minor and one in the globus major. Four of the five were discovered in the left scrotal compartment. All tumors were described as firm, rounded, movable, and distinctly separable from the testis. Moderate tenderness to palpation was noted in one man. Surgical excision was accomplished in each instance under local anesthesia and the tumors without exception were easily enucleated from the surrounding tissue. The postoperative courses of these individuals corroborate the accepted lack of recurrence or coexisting malignancy. Despite the fact that the adenomatoid tumor is becoming better known an
The adenomatoid tumor is the most common epididymal neoplasm. Five cases of these tumors are reported. Despite the benignancy of the tumor, surgical excision is mandatory in view of its clinical similarity to some of the malignant neoplasms.
Vol. 79, No. 3, March 1958 Printed in U.S.A.
TCMORS OF THE EPIDIDYMIS IAN M. THOMPSON* l"rom the Department of
['ni11ersity of Texas Medical Branch,
Texas
It has become incrnasingly apparent that the most common neoplasm of the epididyrn.is is an adcnomatoid one. Although the term has neither genetic rectitude nor complete aeecptancc, it seems applicable in reference to morphologic suitability and in the resolution of much prior confusion in the terminology of epididymal tumorn. The earlier literature applied such terms as adenoma, angioma and cystadenorna to the adenomatoid tumor. It is not surprising then that prior to the rnviP\\' of primary epididymal tumors by Longo,1 malignancies were considered more common. Since a channeling of caRes into the unified ade11omaioid has dcYcloped, it is clear that benign growths account for approximately 80 per eent, and of these perhaps 75 per cent are adenomatoid. As to the derivation of thiR type of tumor, a mesothelial origin seems more tenable than endothelial, epithelial or mesonephric. Most frequently annotated as involving the adenomatoid tumors have been found in other locations, notably the spermatic cord, tunica vaginalis and, in the female, the uterus and tubes. Regarding there has been no eYidence to incriminate prior infection or trauma as inRtigative or contributory . Clinically, adenomatoid tumon; have been seen to occur at any age, but reputedly nre more common in the third and fourth decades. The lack of matology referable to the tumor has been noteworthy. Data. gleaned from the large:;;t series of cases reported 2 suggest that the globus minor is involved four times more frequently than the glohus major. Purportedly the tumors arise more often 011 the left., yet bilateral occurrence has been described. 3 Slow growth has been another characteristic finding, and upon examination, encapsulated separability from the epididymi::; and teRticle. Tenderness to palpation has been lacking aside frorn the infrequent instance of the compensation complex. The tumors rather ob,,iom,ly are not transilluminable, The pathologic appearance of the adenomatoid tumor grossly is round, well circumscribed, iirm and relatively smooth. The yellowish cast of the cut surface is similar to the intact appearance. Histologically, the pseudoacinar spaces "·hich are chanwteri:;;tic arc lined by a cuboidal type of cell which has in its likeness to the epithelial cell instigated misguided conjecture as to an epithelia.l origin (fig. l, A). The stroma is of connective tissue type and often scanty. A scattering of lyn1phocyte8 is commonly associated with a focal collection of lymphocytes resembling a lymph follicle (fig. 1, . Smooth muscle may also he found in ,·arying amounts throughout the stroma. Aecepted for publicr,tion July 26, 1957. * Preseni. nrldress: Seetion of Orology, University Hospital, Ann Arbor, Mich. 1 Longo, V. J., J\lcDonald, J. R. and Thompson, G. J.: Primary neoplasms of the epididymis· Special reference to adenomatoid tumorn. J.A.M.A., 147; 937-941, 1951. 2 Thompson, G. J. Tumors of the spennatic cord, epididymis, and testicular tunics. Surg. Gynec. & 62: 712-728, l(Yl6. '' Morin, L. J.: adenornatoid tumor of the epididyrnis. J. U rol ., 75: 819--82:-l, 1956.
519
520
IAN M. THOMPSON
FIG. 1. Adenomatoid tumor of epididymis. A, cleft-like pseudoacinar spaces visible, lined with flattened cuboidal type of cell. B, note characteristic lymphocytic aggregates located in close proximity to pseudoacinar spaces.
Data derived from five instances of adenomatoid tumor seen at the University Hospital in the past six years coincide with facts acquired from prior reportR. The ages of the five patients were 82, 80, 67, 52, and 39 years. Three were unaware of the existence of the tumor; in the other two no symptoms had been experienced, but the presence of a mass had been noted for at least eight to ten years. Concomitant pathology was prostatic in two cases, ophthalmologic in one, and cardiovascular in two. As to location, four were found to be in the region of the globus minor and one in the globus major. Four of the five were discovered in the left scrotal compartment. All tumors were described as firm, rounded, movable, and distinctly separable from the testis. Moderate tenderness to palpation was noted in one man. Surgical excision was accomplished in each instance under local anesthesia and the tumors without exception were easily enucleated from the surrounding tissue. The postoperative courses of these individuals corroborate the accepted lack of recurrence or coexisting malignancy. Despite the fact that the adenomatoid tumor is becoming better known an
The adenomatoid tumor is the most common epididymal neoplasm. Five cases of these tumors are reported. Despite the benignancy of the tumor, surgical excision is mandatory in view of its clinical similarity to some of the malignant neoplasms.