Testis-Sparing Surgery for Multiple Fibrous Pseudotumors of the Epididymis: A Case Report.
Di Xue, Aijun Zhu, Huaijie Yang et al.
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Case in brief
A 44-year-old man had multiple firm, nontender left epididymal nodules. Ultrasound showed hypoechoic lesions without testicular invasion, and tumor markers were negative. At surgery, the masses were distinct from the testis and the tunica albuginea was intact, allowing complete testis-sparing resection without frozen section. Histology showed a fibroblastic and myofibroblastic proliferation with lymphoplasmacytic inflammation, consistent with fibrous pseudotumor; the IgG4/IgG ratio was below 40%. He recovered uneventfully, with no recurrence and normal testicular morphology and blood flow at follow-up.
What made this case unusual
The lesion arose in the epididymis and presented as multiple nodules, an uncommon origin for paratesticular fibrous pseudotumor. Their clear separation from the testis permitted complete resection while preserving it.
Diagnostic / clinical pearl
For multiple epididymal masses without testicular invasion, include fibrous pseudotumor in the differential. Intraoperative assessment of separation from the testis can support testis-sparing resection; frozen section may help when the diagnosis remains uncertain.