精巣上体平滑筋腫の1例

Abstract

53歳, 有痛性の左陰嚢内腫瘤を主訴とした.触診上, 同部に直径約3cmの弾性硬な腫瘤と, 萎縮した精巣と思われる弾性軟な腫瘤が認められたが, 両者の境界は不明瞭で, 精巣或いは精巣上体を含む傍精巣組織のどちらから発生した腫瘍かの鑑別は困難であった.陰嚢部の超音波検査では直径約3cmの内部エコーがモザイク状の腫瘍が認められたが, 萎縮した精巣と思われる腫瘤との境界は不明瞭であった.陰嚢部CTでも, heterogeneousな部分とhomogeneousな部分が混在した腫瘍で, 精巣との境界は不明瞭であった.肉腫等の傍精巣腫瘍の可能性も否定できないため手術を行い, 病理組織学的に精巣上体原発の平滑筋腫と診断された

A 53-year-old man came to our hospital complaining of painful induration in the left scrotum. It was difficult to determine by manual palpation whether the induration was derived from the testis or paratesticular tissues including epididymis. Computerized tomographic scanning and ultrasonography revealed a left paratesticular mass, 3 cm in diameter, with unclear margin of the atrophic testis, which was suspected as originating from the epididymis. Although tumor extirpation was intended, he underwent inguinal orchiectomy due to strong adhesion of the mass to the ipsilateral atrophic testis. The tumor was opalescent, gum elastic, and solid, measuring 5 x 3 x 2 cm in size. Histopathological examination revealed a primary leiomyoma of the epididymis. The details of this rare case of primary epididymal leiomyoma that originated from the epididymal tail are reported herein.