THE KURUME MEDICAL JOURNAL Vol. 27, P.97-100, 1950 ADENOMATOID TUMOR OF THE SPERMATIC CORD NOBUYUKI MIYOSHI, SHINSHI NODA, KOUSAKU ETO AND MASAHI O ARAKAWA Department of Urology, and First Department of Pathology, Kurume University School of Medicine, Kurume, 830, Japan Received for publication March 18, 1980 We have encountered a case of tumor of the spermatic cord, a relatively rare disease. The case is a 60-year old man. Histologic examinations revealed that the tumor was an adenomatoid leiomyoma. The case of adenomatoid tumor hitherto reported in Japan totals 66 inclusive of ours. However, they are reported as primary epididymal tumor in literature. Ours is also a tumor which developed in the epididymal region, but it is most likely to have originated from the tunica vaginalis of the spermatic cord judging from the macroscopic and histologic findings. INTRODUCTION On palpation, the intrascrotal tumor was felt along the spermatic cord in- The tumor of the spermatic cord is dependent of the left testis and epi- a relatively rare disease. Its histologic didymis. classification was made by Prince (1942). It was a mass with a size of the tip The incidence of this disease as intra- of the small finger, the surface of scrotal tumor is the second highest which was smooth. It was elastic and after tumor of the testis and higher hard in consistency, spherical, movable than that of tumor of the epididymis and non-tender. and tunica vaginalis testis. The testis and epididymis on the According to the overseas literature, right and lymph nodes in the inguinal about 70 percent of the cases of tumor region on both sides showed no abnor- of the spermatic cord are benign and mal signes. After admission, various about 30 percent malignant. examinations were conducted, but no We have encountered a case of ade- abnormalities were observed in any nomatoid tumor originating from the aspect physical, biochemical and radi- spermatic cord, the details of which ological. are reported here. As for the past history, he had pulmonary tuberculosis 30 years earlier. Suspected of tumor of the sperma- CASE tic cord from the findings above, ex- tirpation of tumor was performed under A 60-year old man was seen at this local anesthesia. An incision was made hospital with left intrascrotal tumor on the skin of left scrotum under local as the chief complaint on October 19, anesthesia to let contents of the scro- 1978. He noticed the tumor in 1971 but tum come out of the wound. lef it untreated for eight years since The tumor mass was found about 3 it was asymptomatic. cm away from the tail of the epididy- 97 98 MIYOSHI, ET AL. mis and was not communicated directly with the epididymis. The tumor was located along the spermatic duct and it was removed with a part of the spermatic duct. The tumor removed measuring about 1.0 cm •~ 1.2 cm •~ 1.0 cm was almost spherical in shape. The cut surface was grayish white (Fig. 1). Histopathologically, many lumens were formed among the bundles of smooth muscles. On the whole, small Fig. 1. A cut section of adenomatoid vacuoles were conspicuous and partly tumor of cord. lymphatic nodules were also formed. Cells forming the lumens varied in shape from those which were cubic and looked like epithelial cells to others which were flat and resembled endothe- lial cells of the vascular lumen. These cells had no atypia, nor were there any malignat patterns (Figs. 2, 3). DISCUSSION Of the neoplasms in the scrotum other than the testis, tumor of the Fig. 2. Photomicrograph of tumor show- spermatic cord is found the most, and ing bundles of smooth muscle and epithelial- it is originated from various tissues like tubules. (H. E •~ 50). that constitute the spermatic cord, that is, the spermatic duct, blood ves- sels, lymph vessel, connective tissue, adipose tissue, smooth muscle, striated muscle, fascia and nerve tissue. Seventy percent of tumors of the spermatic cord are benign tumors, most of which is accounted for by lipoma. The remaining 30 percent are malig- nant tumors, most of which are sarcoma (Beccia et al., 1976). As for adenomatoid tumor, there have long been much confusion and argument as to the pathology, the origin and classification. Fig. 3. Photomicrograph of tumor show- ing conspicuous infiltration of lymphoid Since Sakaguchi (1917) reported it cells. (H. E •~ 50). as adenomyoma, it has been given various names such as adenomatoid ADENOMATOID TUMOR OF THE SPERMATIC CORD 99 mesothelioma, adenof ibroma, adeno- rian origin have hitherto been proposed. fibromyoma, adenomyoma, angiomatoi At present, the mesonephric origin tumor, f ibroma, lymphadenoma, lymph- and Mullerian origin appear to be sup- angioma, mesothelioma, myoadenof i- ported by various investigators. broma, adenomatoid leiomyoma and Only one clinical case like ours can mixer adenomatoid. hardly provide data enough to discuss Golden and Ash (1945) studied clini- histogenesis of this tumor, so we have cally and pathologically 15 cases of need for further study of the follow- benign tumors which developed in the ing literature of various investigators genital system although their origin (Evans 1943, Lee et al. 1950, Sundarasi- is unknown and which showed a spe- varao 1953, Jackson 1958, Marcus and cific structure histologically, and de- Lynn 1970). signated these tumors as adenomatoid The histology of this tumor is very tumor. Thus, the term adenomatoid characteristic as can be seen in our tumor has been used up to today. case. According to Mostofi and Price After the concept of this tumor had (1973), it consists of two major compo- been established, many reports were nents the epithelium and fibrous published one after another. interstice plus bundles of the smooth Jackson (1958) reported 109 cases ; muscle and chronic inflammatory cells. by region they are broken down to Moreover, not only the components, epididymis 67, tunica vaginalis testis the composition ratio and arrangement 12, fallopian tube 13, uterus 16 and are full of variations, but also the ovary 1. constituent components arevaried. Recently, 188 cases of adenomatoid The epithelium-like cells vary in tumor were reported by Beccia et al. shape from a cubic, low cylindrical or (1976). flat one to one which resembles endo- In Japan, 62 cases of the disease thelium-like cells, and are often ac- have been reported by Ohara et al. companied by various degrees of vacuo- (1979), and 4 additional cases including lization. the present one have appeared in the The nucleus is generally round or literature after 1979. ovoid, located in the center of the cell, Of them, as many as 64 cases are re- and rich in chromatin or shows forma- ported to be primary epididymal tumor. tion of small vacuoles. These cells are Some of these reported cases have arranged like a cord, tubule, adenoma nothing to do with the epididymis but or lymphangioma. are reported as primary epididymal On the other hand, the interstice tumor, which is beyond our understand- shows sparse connective tissue and even ing. dense collagenized tissue in some pla- Two cases of adenomatoid tumor of ces. the spermatic cord, one by Seta et al. The ratio of the interstice to (1970) and the other by us have been epithelium-like cells is varied. Many reported in Japan. tumors have a mass of the smooth Mostof i and Price (1973) have also muscle, and in about 3 percent of the reported four cases of adnomatoid tu- tumors, the smooth muscle is dominat- mor of the spermatic cord. ing. In almost all tumors, lymphocyte- As histogenesis of this tumor, (1) like cells form small nodules mainly endothelial origin, (2) mesothelial ori- around the tumor. gin, (3) mesonephric origin and (4) Millle- Many lumens, especially small ones, 100 MIYOSHI, ET AL. of the glandullar structure between REFERENCES bundles of the smooth muscles and clusters of infiltrating lymphocytes BECCIA,D. J., KRANE, R. J. and OLSSON, C. A. were observed also in our case. (1976). Clinical management of non-testi- cular intrascrotal tumors. J. Urol. 116, Cells that form the lumens varied 476-479. %. in shape from the epitheliumlike one EVANS, N. (1943). Mesothelioma of epididymis to the endothelium-like one, so the and tunica vaginalis. J. Urol. 50, 249-254. case was diagnosed as mixed adenoma- GOLDEN,A. and ASH, J. E. (1945). Adenomatoid toid tumor and leiomyoma (socalled tumor of the genital tract. Am. J. Pathol. adenomatoid leiomyoma). 21, 63-79. Clinically, the incidence is high in JACKSON,J. R. 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