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Tuberculous epididymal mass is a condition that presents as a painless scrotal swelling. It resembles a testicular mass and is more often diagnosed after orchidectomy. About 22% of all genitourinary tuberculosis show epididymal involvement and 22% of epididymal tuberculosis are bilateral. This report reiterates the need for an increased awareness amongst the treating urologists that would enable an earlier diagnosis, appropriate treatment and may avert the need for orchidectomy in most cases. A 35-year-old diabetic male presented with rapidly enlarging right testicle associated with recent onset of pain over the testis. He also had fever and chills. At the age of 18, he was treated for pulmonary tuberculosis. The right testicle was enlarged, irregular and mildly tender. The right epididymis was also irregular and nodular, blended with the right testicle and indistinguishable from it. A clinical diagnosis of testicular tumour was made. Tumour markers were normal and he underwent high orchidectomy. Histopathological diagnosis confirmed right epididymal tuberculosis. This case report mainly highlights the need for a high index of suspicion amongst the treating physicians. A previous history of treatment for pulmonary tuberculosis should alert the physician to think in lines of tuberculous pathology in epididymis too. A prompt diagnosis and early, appropriate treatment would largely prevent removal of testicles in most cases.

Background Primary omental tumors are uncommon, and omental fibromas account for 2% of these tumors. Due to the low incidence of omental fibromas and the limited relevant literature, it is challenging for clinicians to make an accurate diagnosis of this condition, especially before surgery. Case summary A 30-year-old man was admitted to the hospital because of a left epididymal mass with vague discomfort for more than 1 mo. A physical examination was performed, and the findings showed that the epididymal mass may have entered the abdominal cavity. Pelvic computed tomography was performed in our hospital and revealed a left inguinal hernia with a mass in the hernial contents, and no masses were found in the left epididymis. A traditional inguinal hernia incision was made. Intraoperative hernia contents were found to be of the greater omentum, and a 2.5 cm-diameter mass was found at the distal end of the greater omentum. The scrotum and epididymis did not exhibit other masses. Then, the mass of the greater omentum was excised. Intraoperative frozen pathological examination suggested a spindle cell tumor. The postoperative pathological examination suggested that the mass was an omental angiofibroma. Postoperatively, the patient recovered well and was discharged. Outpatient re-examinations were performed at 1 mo and half a year after the operation and showed no obvious abnormalities. Conclusion Due to the low morbidity rate associated with and latent nature of omental tumors, these tumors are difficult to diagnose preoperatively; thorough medical history taking, detailed physical examinations, and necessary imaging auxiliary examinations can help clinicians diagnose and treat these cases.

BackgroundTo compare the middle-term efficacy and safety results between scrotoscope-assisted (SA) minimally invasive excision and traditional open excision (OE) for the treatment of epididymal mass.MethodsA total of 253 males with surgery excision of epididymal mass from 2012 to 2018 were included in this retrospective study. Patients were divided into two groups: the traditional OE group and the SA group. Patient demographics and intraoperative and postoperative outcomes were obtained and compared between these two groups.ResultsAbout 174 patients (68.8%) underwent SA, and the other 79 (31.2%) underwent OE. Demographic data were similar between the two groups. Compared with OE surgery, SA could significantly shorten the operating time (19.4 ± 4.1 vs. 53.8 ± 12.9 min), reduce blood loss (5.3 ± 1.5 vs. 21.3 ± 5.6 ml), and downsize the operative incision (1.5 ± 0.3 vs. 4.5 ± 0.8 cm). Additionally, postoperative complications were significantly less occurred in the SA group than those in OE (15.5% vs. 21.5%), in particular scrotal hematoma (1.7% vs. 12.7%) and incision discomfort (2.8% vs. 6.3%). Patients in the SA group had a significantly higher overall satisfaction score (94.8 ± 3.7 vs. 91.7 ± 4.9) and a significantly shorter length of hospital stay (4.1 ± 0.9 vs. 5.0 ± 1.5 days) than those in the OE group. No postoperative testicular atrophy occurred in the SA group.ConclusionSA is emerging as a novel and effective option with promising perspectives for epididymal mass therapy.

Immunoglobulin G4 related disease (IgG4-RD) is a systemic fibro inflammatory condition that usually presents with multiorgan involvement. We present a rare case of 54 year old male with an isolated IgG4-RD of epididymis. The patient presented with a progressive swelling of the left testicle. A clinical diagnosis of tuberculosis was made. Ultrasound scrotum showed a relatively hetero-echoic mass lesion involving the left epididymis in close proximity to the left testis. There was a focal spindle cell proliferation and an increase in number of plasma cells and keloid like collagen. Immunohistochemistry was positive for vimentin and IgG4 and negative for CD34. Serum level of IgG4 was elevated (165 mg per dL). Computed tomography of abdomen and thorax did not show any systemic involvement. HE was posted for excision of the epididymal mass. Intraoperatively, the mass was found to be densely adherent to left testicle and inseparable from it, necessitating left total orchiectomy. Histopathology and immunohistochemistry with elevated serum IgG4 levels confirmed the diagnosis of IgG4-RD of the epididymis. To the best of our knowledge, this condition is an extremely rare entity, with only very few cases of isolated IgG4-RD of epididymis reported in medical literature, with no other systemic manifestations.

Epididymal tumors are rare lesions which we come across in routine practice nbsp It is also a rare site of solid tumor metastases and mimics the chronic mass forming inflammatory pathologies leading to a diagnostic dilemma Most of the cases of epididymal metastases are diagnosed incidentally Most cases of epididymal metastases are from genitourinary and gastrointestinal malignancies We present a case of a middle aged male presenting with complaints of pain and palpable lump in left inguino scrotal region where ultrasound revealed epididymal mass The diagnosis of epididymal metastases from jejunal adenocarcinoma was made on the basis of CT

An 11-year-old boy presented with fever and abdominal pain, and was diagnosed with retroperitoneal lymphadenitis. At the same time, a painless right scrotal mass was observed. On imaging the testis and the epididymal mass both had abundant blood flow, although tumor markers were negative. Although the right testis had shrunk after antibiotic treatment, swelling was persistent and incisional biopsy was therefore performed, resulting in diagnosis of granulomatous orchitis (GO). No recurrence was found. In cases of scrotal swelling in both the testis and the epididymis of an older child, it is necessary to consider the possibility of inflammatory GO, and orchiectomy should not be performed without careful consideration.

Paratesticular region is an obscure anatomical region that includes spermatic cord and its contents, tunica of the testes, epididymis and appendices of epididymis and testis. Paratesticular tumours may closely resemble and be clinically indistinguishable from testicular tumours, resulting in a diagnostic dilemma. Preoperative distinction between the benign and malignant paratesticular tumour is extremely difficult, resulting in difficulty in diagnosis and management. We hereby present a case of a 56-year-old male who reported with a painless bilateral scrotal mass and underwent surgical excision of the same. The final biopsy report was paratesticular leiomyoma. The main purpose of this manuscript is to emphasize on the fact that it is imperative for the treating urologists to be aware of such potentially benign rare entity. A high index of clinical suspicion is mandatory, as lack of knowledge about this condition would result in an unnecessary radical orchidectomy.

Adenomatoid tumor of the epididymis is a rare benign neoplasm of mesothelial origin, mostly localized in the epididymis. It is usually presented as an indolent, painless scrotal enlargement. Immunohistochemically it is characterized by strong positivity for calretinin and epithelial markers, while tumor marker values are within the reference ranges. In this paper, two cases of 28- and 37-year-old men with adenomatoid tumors of the epididymis are described. In both, the tumor was presented as an indolent, slowly growing palpable mass in the epididymis. Tumor markers were in the normal range, digital examination found painless scrotal enlargement, while ultrasound showed a nonhomogeneous tumor. Immunohistochemically, they were characterized by strong positivity for calretinin and epithelial markers. If a localized epididymal mass is found, it is necessary to conduct an adequate diagnostic examination to differentiate inflammatory process from the neoplasm. An excision of the lesion is the most recommended option that also preserves testicular function and fertility. Histological and immunohistochemical evaluation are mandatory for a definitive diagnosis.

Ovarian epithelial type tumors of the testis have been a rare clinical entity. Its awareness and management remain a clinical challenge. We described the case of an 18-year-old, obese male patient who presented with scrotal enlargement. He underwent eversion of tunica vaginalis and resection of epididymal mass. The histology of the resected sample showed an ovarian epithelial type borderline tumor. We believe our case helps to strengthen awareness and management of this rare disease.

On July 16, 1975, at 26 years of age, after almost 6 months of observing a left epididymal mass slowly enlarge, with work up for epididymal tuberculosis, I finally underwent a left inguinal orchiectomy and resection of what proved to be a pure seminoma. A subsequent lymphangiogram was reported to be normal, and I proceeded to prophylactic abdominal irradiation. All would be fine, I was reassured by my surgeon and radiation oncologist; no, there was no need to undergo sperm banking, and the radiation therapy would surely cure this most irradiationsensitive of cancers. As a young pediatric resident, who was I to question my consultants? I rapidly learned the consequences of poor communication between physicians and their patients. There I was, hospitalized on the openmale cancer ward of a large university teaching hospital, about 12 beds lined up on either side of a very long central corridor, and a great television room with armchairs at the end. It was there that those of us allowed out of bed would convene in the evenings, and when my roommates learned I was a doctor, out poured all the questions they had not dared ask of their physicians, and their physicians had not addressed with them in anticipation of their concerns. One assumed he would die of a completely resected indolent thyroid cancer, because no one had told him otherwise. Others had no idea that they even had cancer. So many colleagues and friends were supportive, from my fiancee and a few of my closest friends to the professor of surgery, who stopped by my bed and joked that because they had spent so muchmoney training me, I needed to get better fast and “earn my keep.” Other colleagues and friends found it hard to visit or even speak about my cancer. I understood their discomfort, which I, too, would most likely have shared previously; it was my cancer, and I had to deal with it, not them. I took 4 weeks off residency for my radiotherapy, helped my dearest friends with their home reconstruction, and cooked meals for us all in the evenings (they somehow knew that distracting me with mundane tasks was good medicine), and I managed to maintain my weight with a little support from metoclopramide. And then I got onwithmy pediatric residency training. Alas, my cancer had not read the textbooks. By March 1976, while undertaking a senior residency in pediatric oncology, I was experiencing significant reflux esophagitis, inordinate belching, and, after a negative work up for gall bladder disease, underwent a barium swallow. My radiology colleague supervising the study looked pale as he informed me that there were mediastinal masses squashing my esophagus and, oh yes, there appeared to be a solitary, left-lung parenchymal metastasis. Now the conversation took on a different tone. I met with a senior radiation oncologist who tried to reassure me that he did, indeed, have one long-term survivor of recurrent metastatic seminoma over the course of his long career, a bassoonist from a prominent professional orchestra, who, alas, was unable to play the bassoon any longer after they finished irradiating his lungs. With this level of reassurance, I embarked upon mediastinal irradiation and focal left-lung boost to around 30 Gy, planned my bachelor party with a circle of friends in Paris before my departure for my marriage in the United States in June, and continued to work daily as a senior resident on the pediatric oncology ward. I remember distinctly, one day during irradiation, meeting with a senior radiation oncologist who sat me down and stunned me with crucial and unexpected questions: Did I realize that I might die of this? (Of course, I had not!) Who were the sources of my emotional support? (I had not even informed my elderly parents of any of this, relying onmywonderful older sister to help me through.) I realized these were the kinds of questions I should be asking the parents of the little children for whom I was currently caring on the pediatric cancer ward, especially the 9-year-old boy with pulmonary metastatic Wilms tumor, who thought it so cool that he was receiving radiation therapy at the same time as his doc. He did not survive the experience. I made it to my bachelor party in Paris, despite an unmeasurably low platelet count and exhaustion for much of the 3 days, made it to my wedding, and returned to England on honeymoon, where I felt a lump in my right testis. Sure

Dykes TM, Stone A, Canby-Hagino E= 78-year-old man with a history of benign prostate hypertrophy presented with a painless, firm right scrotal mass on routine physical examination. Scrotal sonography (Figs. 1A and 1B) with a linear 10-MHz transducer showed a focally enlarged lower pole of the epididymis with heterogeneous echotexture compared with the rest of the epididymis and a moderate-sized right hydrocele. Directly contiguous with the lower pole epididymal mass was a 1.8-cm hypoechoic mass in the lower pole of the right testicle. There was also a subtle, striated echotexture pattern in the right testicle compared with the left. The left testicle and epididymis were normal except for small epididymal head cysts and a small hydrocele. Because of the concern for a primary testicular neoplasm, abdominal and pelvic CT was performed and showed no retroperitoneal lymphadenopathy. Right orchiectomy was performed. The result of gross pathologic examination was a 1.3cm, yellow-tan cerebriform mass within the inferior medial pole of the right testis arising at the junction of the distal epididymis and the lower pole testis. The tumor appeared to involve the epididymis but did not extend through the tunica vaginalis. There was also a 2.0-cm pale area in the upper right testicular pole. Representative sections from the distal

Epididymal Metastasis from a primary carcinoma of the prostate gland is a rare but recognised phenomena. We describe a case of such metastasis which, unlike previous reports, presents as a painful epididymal mass. Therefore it is important for urologists to consider epididymal metastasis as part of the differential diagnosis in a patient with known carcinoma of the prostate and a tender epididymal mass.

An 82 year old man with a unilateral epididymal mass was found, on histopathologic examination of a surgically removed specimen, to have a primary papillary adenocarcinoma of a clear cell variant which mimicked renal cell carcinoma. Repeated imaging studies confirmed the absence of renal cell carcinoma. Because the present case had great similarities in histologic appearance and anatomical location to papillary cystadenoma of the epididymis, it may be a malignant counterpart of the latter type of tumor.

A case of interstitial cell tumor of the testis which clinically simulated an epididymal mass is presented, with a review of the literature. The electronmicrographic studies did not contribute to the histologic diagnosis.

The diagnosis of systemic sporotrichosis was established after an epididymal biopsy. The case and literature are reviewed.

Epididymal masses in infants and children are rare. The majority of them are benign. We report on the management of a child with embryonal carcinoma of the testis which presented as an Epddymal mass.