Leiomyoma of the vas deferens.R Kaushik, AK Attri, L Kaur, R Nada
Department of Surgery, Government Medical College and Hospital, Chandigarh, India. , India
Correspondence Address: Source of Support: None, Conflict of Interest: None PMID: 11832607
Source of Support: None, Conflict of Interest: None
Keywords: Aged, Aged, 80 and over, Case Report, Human, Leiomyoma, pathology,surgery,ultrasonography,Male, Testicular Neoplasms, pathology,surgery,ultrasonography,Vas Deferens, pathology,surgery,ultrasonography,
An eighty-year-old male presented with a slowly progressive left testicular swelling for duration of three months. There was no pain, fever or history of trauma. Clinical examination revealed replacement of the left testis tissue by a solid, hard mass about 8 cm x 6 cm, from which the testis could not be separately identified. A diagnosis of testicular tumour was made. There was no clinical evidence of extra testicular spread.
Ultrasound of the testis revealed a large, well-defined encapsulated mass measuring about 5.4 x 3.6 x 5.5 cm, completely replacing the left testis. The mass had a whorled, homogenous appearance similar to that seen in uterine leiomyomas, with a few foci of calcification within [Figure - 1]. The right testis was normal. Abdominal sonogram was also normal. A possible diagnosis of testicular leiomyoma was made, though malignancy could not definitely be ruled out.
The serum alpha-foetoprotein and human chorionic gonadotropin levels were undetectable. Other laboratory investigations were unremarkable.
Left orchidectomy through an inguinoscrotal approach was performed. Grossly, the tumour was encapsulated, and the testis could not be separately appreciated. Cut section [Figure - 2] revealed a normal looking testis with a greyish white tumour towards the lower pole of the testis.
Histopathological examination showed fascicles of smooth muscle fibres forming a leiomyoma [Figure - 3]. The testis was normal, with the vas seen going up to the tumour. Within the tumour, the vas could no longer be seen, and a diagnosis of leiomyoma arising from the muscle of the vas deferens was made.
Genitourinary leiomyomas are rare, benign smooth muscle tumours. Leiomyomas are rare, benign, smooth muscle tumours that may originate from any site in the genitourinary tract. The renal capsule is the most common site of origin of genitourinary leiomyomas, although there have been reports of leiomyomas arising from the renal pelvis, bladder, glans penis and tunica of the testis.,
Leiomyomas arising from the vas deferens are extremely rare tumours. To the best of our knowledge, there have been only two previously documented cases., The main difficulty lies in distinguishing these benign tumours from testicular malignancy. Ultrasound is used commonly in the preoperative assessment of testicular neoplasms, though the ultrasound features of leiomyoma at this site have never previously been documented, probably due to the rarity of the tumour. This case highlights the similarity of features of uterine leiomyoma with a similar tumour in this rare location.
There has always been a doubt as to the actual tissue of their origin. The smooth muscles of the cremaster, blood vessels of the cord and muscles of the vas have all been suggested as the tissues of primary origin.
The rarity of leiomyomas of the vas has been attributed to the smaller amount of smooth muscle present here as compared with other sites where leiomyomas are common (stomach or uterus).
Preoperatively, one cannot distinguish with certainty from malignant neoplasms of the testes. The similar appearance to uterine leiomyomas and calcifications on ultrasound may indicate the diagnosis, but the final diagnosis as to the exact nature and site of origin of the tumour can be made positively only on histopathological examination of the removed tissue.
[Figure - 1], [Figure - 2], [Figure - 3]