A case of fibrous pseudotumor originating from tunica vaginalis testis

Abstract

32歳男性.患者は陰嚢の無痛性腫瘤を自覚するも放置していたが, 数ヵ月前より腫瘤の増大を認めたため著者らの施設へ受診となった.精索の良性腫瘍を疑い摘除術を施行したところ, 術中所見として陰嚢固有鞘膜内面に多発する結節状腫瘤を認めた.主病変と思われる3cm大の腫瘤を摘除し術中迅速病理にて悪性所見は否定され, そののち精巣, 精巣上体, 精管を温存し可及的に腫瘤を摘除した.腫瘤は多発性結節状, 表面平滑, 弾性硬, 割面は白色充実性であった.病理組織学的には線維性偽腫瘍と診断された.腫瘤は線維性組織よりなりリンパ球や形質細胞の浸潤が見られた.悪性細胞は認められなかった.尚, 線維性偽腫瘍は炎症や外傷を契機に反応性肉芽腫性増殖により形成される腫瘤性病変で, 肺や消化器, 皮膚など全身に認められる疾患であるが陰嚢内に発生する腫瘤性病変としては比較的稀であるといえる

A 32-year-old man presented with a complaint of painless palpable mass of the left scrotal content. Based on the preoperative diagnosis of scrotal or spermatic cordal benign tumor, local excision was performed. The histological diagnosis was scrotal fibrous pseudotumor. In Japan, only 35 cases of fibrous pseudotumor of the scrotum have been reported including our case. Orchiectomy was performed in 15 cases. Fibrous pseudotumor is a benign fibroproliferative lesion with dense hyalinization and sometimes focal calcification. It may be induced by previous intrascrotal inflammatory events such as epididymitis, an infected hydrocele, prior surgery or trauma. Although a relatively rare disease, a fibrous pseudotumor should be considered in the differential diagnosis of testicular and testicular tunica tumors. Our case was of a benign pseudotumor and orchiectomy could have been avoided.