Paratesticular tumors. A clinicopathological study from a single tertiary hospital in North India

Our plain-English summary of Paratesticular tumors. A clinicopathological study from a single tertiary hospital in North India, by P.A.M. Paul, N. Calton, S. Arnestina, et al (Annals of Diagnostic Pathology, 2021).

The study

• Authors: P.A.M. Paul, N. Calton, S. Arnestina, K.J. Mammen
• Journal: Annals of Diagnostic Pathology
• Published: 2021;50:151658
• Cited by: 4 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Objective: Paratesticular tumors (PTT) are rare and form a heterogenous group, ranging from benign to malignant high grade sarcomas. This study was undertaken to describe the clinicopathological spectrum of PTTs received over a 20-year period.

Methods: All primary and secondary PTTs diagnosed from 2000 to 2019 in the pathology department of a tertiary care hospital in North India were retrospectively reviewed. Gross, histopathological features and immunohistochemistry (IHC) findings were correlated with clinical details.

Results: A total of 169 intra-scrotal tumors were diagnosed during the study period, out of which there were 30 PTTs (in 27 patients) comprising 17.75%. Age range was 4 to 85 years (median 58 years). Benign PTTs were the commonest (n = 21, 70%), followed by metastasis to the paratesticular region (n = 6, 20%) and then primary malignant PTTs (n = 3, 10%). The commonest benign PTT was lipoma (n = 16, 76.19%), followed by adenomatoid tumor (n = 3, 14.28%) with one case each (4.76%) of cellular angiofibroma and hemangioma. Among primary malignant PTT, there were two cases of rhabdomyosarcoma, and one case of biphasic malignant mesothelioma. Metastatic tumors included four cases of prostatic adenocarcinoma, and one case each of pancreatic signet ring cell carcinoma and clear cell renal cell carcinoma.

Conclusion: PTTs show a wide clinicopathological spectrum. Benign PTTs are commoner than malignant PTTs. Meticulous grossing and histopathological examination supplemented by IHC is essential for an accurate diagnosis of this heterogenous class of tumors, which influences the role of adjuvant therapy and patient prognosis.

Copyright © 2020 Elsevier Inc. All rights reserved.

In plain English

This was a retrospective review of tumors found next to the testis (paratesticular tumors) that were diagnosed in the pathology department of one tertiary care hospital in North India from 2000 to 2019. Of 169 tumors inside the scrotum, 30 were paratesticular tumors, found in 27 patients (17.75%). Most were benign (21, 70%), and the commonest of these was lipoma (16 cases). Six (20%) had spread from cancers elsewhere, mostly the prostate. Three (10%) were primary cancers: two rhabdomyosarcomas and one biphasic malignant mesothelioma. The mesothelioma was in an 85-year-old man with a right-sided scrotal swelling of one year's duration. It involved a thickened tunica vaginalis and grew into the scrotal skin. No history of asbestos exposure was documented for him. Special staining (immunohistochemistry) could not be done in his case because of cost. The authors concluded that these tumors vary widely and that benign ones are commoner than malignant ones. They named small sample size and possible selection bias as the main limitations.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Retrospective review of pathology cases (descriptive case series) from a single hospital
• Who was studied: 30 paratesticular tumors in 27 patients, ages 4 to 85 years (median 58), drawn from 169 intra-scrotal tumors among 1125 intra-scrotal biopsies and orchidectomies received from 2000 to 2019 at a tertiary care hospital in North India
• Exposure: Not an exposure study. For the one malignant mesothelioma case, no history of asbestos exposure was documented.
• Main results:
  • Of the 30 paratesticular tumors, 21 (70%) were benign, 6 (20%) were metastases to the paratesticular region and 3 (10%) were primary malignant tumors
  • Among the 21 benign tumors, lipoma was commonest (16, 76.19%), followed by adenomatoid tumor (3, 14.28%), with one cellular angiofibroma and one hemangioma
  • The three primary malignant tumors were two rhabdomyosarcomas and one malignant mesothelioma
  • Biphasic malignant mesothelioma was diagnosed in an 85-year-old man with a right-sided tender scrotal swelling of 1 year's duration
  • In the mesothelioma case, a 14 × 12 × 9 cm widely infiltrative growth involved a thickened tunica vaginalis. The scrotal skin was adherent to the tumor, while the testis, epididymis and spermatic cord showed no tumor infiltration.
  • Immunohistochemistry could not be performed in the mesothelioma case because of financial constraints
  • Primary malignant tumors were larger than benign ones: median 15 cm (range 11.5 to 19 cm) versus median 5 cm (range 1 to 10.5 cm)
  • The four prostate cancer metastases were found incidentally as microscopic deposits. They made up 1.4% of 284 bilateral orchidectomies done as surgical castration for prostate cancer.
• The authors' conclusion: The authors concluded that paratesticular tumors are rare and show a wide pathological spectrum, and that benign tumors (most often spermatic cord lipoma) are commoner than malignant ones. They also concluded that careful gross and microscopic examination supplemented by immunohistochemistry is essential for accurate diagnosis.
• Limitations the authors state:
  • Small sample size and possible selection bias

Topics

Medical terms in this study, explained in our Lexicon: Paratesticular, Sarcoma, Pathology, Immunohistochemistry, Metastasis, Adenomatoid Tumor, Biphasic Mesothelioma, Malignant Mesothelioma.

Related studies

• Paratesticular mesotheliomas — R.E. McDonald, A.L. Sago, et al. (1983)
• Sonography of intrascrotal adenomatoid tumor — W.C. Leonhardt, G.A. Gooding (1992)
• Primary tumors and cysts of the heart and pericardium — H.A. McAllister (1979)
• Mucinous adenoid tumor of the paratesticular tissue — M.G. Mukerjee, M. Norris, et al. (1976)
• Fibrous mesotheliomas (pseudofibroma) of the scrotal sac: a light and ultrastructural study — B. Benisch, B. Peison, et al. (1981)
• Scrotal peritoneal mesothelioma on PET/CT — S. Ozguven, M. Aras, et al. (2014)

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