ABSTRACT
INTRODUCTION: Solid, fat-containing tumors of the testes are extremely rare with only a few cases having been reported so far, contrary to the more frequent occurrence of paratesticular lipomatosis. Testicular angiomyolipomas and gonadal involvement in Cowden's disease, although infrequently occurring, are known examples of fat-bearing testicular lesions. Hereby, we present an extremely rare case of intratesticular angiolipoma. Angiolipomas are benign tumors of the subcutaneous tissue commonly occurring in the trunk and the extremities. Histologically, they are characterized by ample vascularity and an excess of mature adipocytes. Definitive diagnosis is established by biopsy of the lesion. PRESENTATION OF THE CASE: A 35-year-old patient presented to our andrology outpatient clinic for fertility assessment. Physical examination of external genitalia revealed no significant pathology. Testicular ultrasound however depicted an isoechoic lesion on the upper pole of the right testis measuring 1.8 cm × 0.8 cm × 1 cm and exhibiting intense arterial flow. After sonographic and MRI investigation, the patient was referred for semen analysis and cryopreservation. Subsequently, the patient underwent testicular biopsy (frozen section biopsy) and right partial orchiectomy. Final histology reported a noninfiltrating testicular angiolipoma. No recurrences have been observed in the follow-up period. DISCUSSION: Angiolipomas, which mainly occur in the trunk and extremities, are classified as infiltrating and noninfiltrating. The diagnosis is based on both clinical and histologic criteria, and the main method of treatment for both types is by surgical excision. The infiltrating type exhibits higher recurrence rates. CONCLUSION: Angiolipomas commonly occur in the subcutaneous tissue and have been invariably treated by radical excision. Hereby, we report the first case of an intratesticular, noninfiltrating type angiolipoma which was treated by partial orchiectomy.
ABSTRACT
This is a case report of a 32-year-old male with bilateral intra-abdominal cryptorchidism. A large seminoma had developed on the left testis with paraaortic lymph nodes metastasis. The tumour was excised easily. The right testis was found just inside the deep inguinal ring, without the vas deferens in the spermatic cord. The patient requested orchidopexy despite the well-explained risk of cancer development. Therefore, a second right groin incision was performed. In the right inguinal canal, there was a normal-looking vas deferens that ended in an atrophic nubbin of fibrous tissue without an epididymis. This is the sixth case in the literature of failed urogenital union resulting in complete separation of testis and vas deferens. The patient underwent orchidopexy and had four cycles of chemotherapy, which led to complete remission of the metastasis. This case highlights the fact that an impalpable undescended testis and finding of blind-end vas deferentia are not enough to establish the diagnosis of vanished testis. The decision to undergo orchiectomy in cases of bilateral cryptorchidism after puberty is also discussed. In our opinion, the choice should be made by the patient after a discussion of the risk for cancer development in the salvaged testis.
