Torsed appendix epididymis in an adult: misdiagnosis as tumor of tunica vaginalis on sonography

Our plain-English summary of Torsed appendix epididymis in an adult: misdiagnosis as tumor of tunica vaginalis on sonography, by D.M. Yang, H.C. Kim, S.W. Kim, et al (Journal of Medical Ultrasonics, 2018).

The study

• Authors: D.M. Yang, H.C. Kim, S.W. Kim, J.S. Kim, K.Y. Won
• Journal: Journal of Medical Ultrasonics
• Published: 2018;45(2):363-365
• Type of article: Case report
• Read it: PubMed · Publisher

Abstract

We report the sonographic findings in a case of torsed appendix epididymis that occurred in an adult, which was misdiagnosed as a tunica vaginalis tumor such as cystic mesothelioma. Scrotal gray-scale sonography revealed an ovoid-shaped, heterogeneously hypoechoic mass with multiple tiny cystic foci and thick septa in the sac of the right tunica vaginalis, which abuts to the right epididymal head. Color Doppler sonography showed no blood flow within the mass. Pathological examination revealed torsion of the appendix epididymis.

In plain English

This case report came from the radiology and pathology departments of Kyung Hee University Hospital at Gangdong in Seoul. It described one 60-year-old man admitted with one day of right scrotal pain and no history of trauma. Ultrasound showed an oval mass of about 1.8 by 0.9 cm, with many tiny cysts and thick internal walls, in the sac of the right tunica vaginalis (the lining around the testis), next to the head of the epididymis. Color Doppler showed no blood flow in the mass. It was first identified as a tunica vaginalis tumor, including cystic mesothelioma, or a hematocele. At surgery 10 days later the mass was removed. Pathology showed a twisted (torsed) appendix epididymis with vascular congestion, edema and hemorrhage, not a tumor. The authors said they did not consider torsion because there was no scrotal wall swelling and no increased blood flow around the mass, and that the patient's older age also contributed. They concluded that torsed testicular appendage should be considered for a multi-cystic mass in this sac, even in an adult. The article does not mention asbestos.

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: case report
• Who was studied: One 60-year-old man with a 1-day history of right scrotal pain and no history of trauma, reported by authors at Kyung Hee University Hospital at Gangdong, Seoul, Republic of Korea
• Exposure: No asbestos or other exposure was studied. The article does not mention asbestos; mesothelioma appears only as the initial, incorrect ultrasound diagnosis.
• Main results:
  • Gray-scale ultrasound showed an ovoid, heterogeneously hypoechoic mass of about 1.8 by 0.9 cm with multiple tiny cystic foci and thick septa in the sac of the right tunica vaginalis, abutting the right epididymal head, with a small amount of hydrocele.
  • Color Doppler ultrasound showed no blood flow within the mass and no enhancement around it.
  • The mass was initially identified on ultrasound as a tunica vaginalis tumor, including cystic mesothelioma, or hematocele.
  • At surgery 10 days later, a red bean-shaped mass about 2 cm in diameter, connected to the epididymal head, was found and resected.
  • Microscopic examination showed an enlarged appendix epididymis with vascular congestion, edema and hemorrhage. The pathological diagnosis was appendage with congestion and edema.
  • The authors did not consider torsion because there was no scrotal wall edema and no surrounding hyperemia on ultrasound. They said the patient's older age also contributed to the misdiagnosis.
• The authors' conclusion: The authors concluded that torsed testicular appendage should be considered when a multi-cystic mass is seen on ultrasound in the sac of the tunica, even in an adult.

Topics

Medical terms in this study, explained in our Lexicon: Epididymis, Misdiagnosis, Tunica Vaginalis, Mesothelioma.

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• Adenomatoid tumour of the epididymis: histochemical and ultrastructural study of 2 cases — M. Nistal, F. Contreras, et al. (1978)
• Imaging of mesothelioma of tunica vaginalis testis — M. Bertolotto, I. Boulay-Coletta, et al. (2016)
• A new case of malignant mesothelioma of the tunica vaginalis testis. Immunohistochemistry in comparison with an adenomatoid tumor of the testis — H. Moch, H. Ohnacker, et al. (1994)
• Rare tumors of the testis and mesothelial proliferation in the tunica vaginalis — M. Colecchia, G. Mikuz, et al. (2012)

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