副睾丸部 Adenomatoid Tumor の1例

抄録

The case: age: 31. Male. Unmarried. About 3 months before, this patient noticed pain in left testis. As the pain became worse in the last few days, he visited the hospital. The left posterior epididymis was swollen to the size of the tip of a thumb. Stiffness and tenderness were slight. Left epididymectomy was done under the diagnosis of tuberculous epididymitis.
The surface of the tumor was flat and smooth. It was yellowish in color, and ball shaped and hard. The section was gray-yellowish white in color and was like meat. However, no direct connection with epididymis was evident.
Histologically, the cell border of the tumor was indistinct. The cell was generally cubic or multilateral in shape and the cytoplasma was slightly stained with eosin. Epitheloid cells with bright nuclei were surrounded by connective tissue in funicular, adenomatous, or indefinite groups, and were accompanied by several stages of vacuolations including even signet-ring-like cells. The vacuolated cells looked like lymphangioma. In the marginal part of them, layers of smooth muscle fibers and spreading type or clearly bordered round-shaped groups of lymphoid cells were seen. One peculiar feature of this case was unusual positive fat coloration. However, it was not seen in vacuoles.
Including this case, 35 cases in Japan were discussed. The side of the tumor was on the left in 21 cases and the right in 11 cases. The side was not reported in the remaining 3 cases. The location of the tumor was in the tail part in 20 cases, in the cephalic part in 9 cases, and in the spermatic cord in 1 case. The location was not reported in the remaining 5 cases. When they were classified by age; 30s was the top with 18 cases, followed by 40s 7 with cases and then 50s with 5 cases.
The histogenesis is still in dispute. However, two popular theories are that of mesothelioma and that of Mueller's tube origin. The author is for the latter theory from the similarity to the cross section of 22mm embryos and the appendix of the testis, which is generally believed to be originated from the Muller tube. However, there is still uncertainty concerning the histology of the cells of this tumor. Another findings which made me support the theory of Mueller's origin are adenomatous features of the cells and a chain appearance in the appendix of testis.
Those that are reported as multiple adenomatoid tumors, malignant adenomatoid tumor or localized infiltration usually show multiple, papillary, soft and uncovered tumors on the serous membrane of hydrocele and should be differentiated from those which are single, round, and hard, being covered by a membrane. They all should be called mesothelioma. And it is not adequate to consider the disseminated sites as metastais and filtration which mean malignant changes.