Priemer David S, Trevino Karen, Chen Shaoxiong, Ulbright Thomas M, Idrees Muhammad T
1 Indiana University School of Medicine, Indianapolis, IN, USA.
Int J Surg Pathol. 2017 Sep;25(6):480-487. doi: 10.1177/1066896917707040. Epub 2017 May 1.
The paratestis (PT) is defined by the testicular tunics, epididymis, spermatic cord, rete testis, and embryonic remnants. It gives rise to a large diversity of pathologies, including those of soft tissue, which may prompt orchiectomy. We performed a 17-year search of our database for orchiectomies for a PT soft-tissue mass. In a total of 4741 orchiectomy specimens, 138 orchiectomies were performed for primary neoplastic or nonneoplastic masses of the PT soft tissue or had an incidental PT soft-tissue mass. Of these, 65.9% were neoplastic. The mean age was 40.2 years (range: <1 to 87 years) and was similar for neoplastic and nonneoplastic lesions. The most common malignancies were rhabdomyosarcoma (31/63 malignancies), liposarcoma (19/63), and leiomyosarcoma (5/63), with the former occurring in younger patients (average: 18.3 years). No malignancies were incidental. The most common benign neoplasm was spermatic cord lipoma (24/28 of benign neoplasms); however, most were incidental. This was followed by leiomyoma (3/28) and hemangioma (1/28). The most common nonneoplastic lesions were adrenal rests (22/47 nonneoplastic cases); however, all were incidental findings. Of 47 nonneoplastic masses, 22 prompted orchiectomy, and of these, the most common diagnosis was fibrous/nodular periorchitis (11/47). Of 88 nonincidental lesions, 25 were either benign neoplasms (3/25) or nonneoplastic (22/25). These data indicate that PT soft-tissue neoplasms prompting orchiectomy are disproportionately rhabdomyosarcomas, though these are principally in young patients. In older patients, malignancies are more frequently liposarcomas. However, almost one-third of orchiectomies performed for PT soft-tissue masses yield benign lesions, indicating an opportunity to reduce unnecessary procedures.
副睾旁组织（PT）由睾丸被膜、附睾、精索、睾丸网和胚胎残余组织构成。它会引发多种病变，包括软组织病变，这可能促使进行睾丸切除术。我们对数据库进行了为期17年的检索，以查找因PT软组织肿块而进行的睾丸切除术。在总共4741份睾丸切除标本中，有138例是针对PT软组织的原发性肿瘤性或非肿瘤性肿块进行的睾丸切除术，或者有偶然发现的PT软组织肿块。其中，65.9%是肿瘤性的。平均年龄为40.2岁（范围：小于1岁至87岁），肿瘤性和非肿瘤性病变的年龄相似。最常见的恶性肿瘤是横纹肌肉瘤（63例恶性肿瘤中的31例）、脂肪肉瘤（63例中的19例）和平滑肌肉瘤（63例中的5例），前者多见于年轻患者（平均年龄：18.3岁）。没有恶性肿瘤是偶然发现的。最常见的良性肿瘤是精索脂肪瘤（28例良性肿瘤中的24例）；然而，大多数是偶然发现的。其次是平滑肌瘤（28例中的3例）和血管瘤（28例中的1例）。最常见的非肿瘤性病变是肾上腺残余组织（47例非肿瘤性病例中的22例）；然而，所有都是偶然发现。在47例非肿瘤性肿块中，22例促使进行了睾丸切除术，其中最常见的诊断是纤维性/结节性睾丸周炎（47例中的11例）。在88例非偶然病变中，25例是良性肿瘤（25例中的3例）或非肿瘤性病变（25例中的22例）。这些数据表明，促使进行睾丸切除术的PT软组织肿瘤中横纹肌肉瘤的比例过高，不过主要发生在年轻患者中。在老年患者中，恶性肿瘤更常见的是脂肪肉瘤。然而，因PT软组织肿块进行的睾丸切除术中，几乎三分之一产生良性病变，这表明有机会减少不必要的手术。
