Patient With Benign Fibrous Pseudotumors Of Paratesticular Tissues

980 words - 4 pages

Introduction:
The term “Fibrous pseudotumor” is generally referred to a group of benign lesions arising as a result of reactive changes in testicular tunics. The condition is also known as inflammatory pseudotumor, proliferative funniculitis, chronic proliferative periorchitis, fibrous mesothelioma and reactive periorchitis (1,2).
The prevalence of this tumor is so rare and most often it shows itself as painless scrotal masses associated with hydrocele or a history of trauma or infection, the usual site of involvement is tunica vaginalis but in some rare cases it can arise from tunica albuginea, epididymis and spermatic cord as well.
It clinically mimics the malignancies of the region (often appearing as painless multi nodular scrotal masses) which often leads to treatment by radical surgical approach.
Microscopically, the mass is consisted of hyalinized collagenous fibrous stroma rich in thin-walled blood vessels, containing few numbers of fibroblasts and inflammatory cells such as lymphocytes and plasma cells (3).
Here we present a case report of a 26 years old man with multiple masses in his scrotum which were diagnosed as prolifrative funniculitis after resection and microscopic evaluations.

Case report:
A 26 years old male presented with multiple painless solid masses in his right hemi scrotum(around the cord and above the right testis)which were first discovered 2 months before his first visit, the patient didn’t state any exact history of trauma or infection and there was no sign of remarkable weight loss or any other alarming signs.
Significant finding in physical examination was palpation of firm nontender nodules at the right testis’s hilum and alongside the right spermatic cord which were adhered to the involved testis and ipsilateral cord and epididymis.
Laboratory tests revealed leukocytosis (WBC=14500) but the CBC test was otherwise normal, in addition ,there were some findings in favor of hematuria in the urine analysis test (Blood/Hb=1+, RBC=18 to 20 , protein=1+),other laboratory assessments including: ESR1hr,Hemostasis tests,blood biochemistry and serum B-hCG and AFP levels were normal.
As a part of routine approach ultrasonographic study of the patient’s scrotum was conducted which showed multiple hypoechoic solid masses around the right cord and testis with the diameter of 28x15mm for the biggest one, the observed masses had posterior shadow which could be due to the presence of the calcification or fibrosis in their texture.
Removal resection of the masses (right testis and epididymis remained intact) showed 10 yellowish gray nodules, varying from 0.3 to 2.5 centimeters in diameter (fig.1).
In microscopy the nodules were consisted of fibroblastic proliferation within a hyalinized fibrocollagenous stroma supplied by thin-walled blood vessels, inflammatory cell (lymphocytes and plasma cells) infiltration was also seen (fig.2).
After completion of the assessments the nodules were diagnosed as proliferative funiculitis....

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