Testis-Sparing Surgery for Multiple Fibrous Pseudotumors of the Epididymis: A Case Report
- 1Department of Urology, Affiliated Central People’s Hospital, China Three Gorges University, Yichang, Hubei, PR China
- 2Yichang Central People’s Hospital, Yichang, Hubei, PR China
- 3Standardized Residency Training Office, Affiliated Central People’s Hospital, China Three Gorges University, Yichang, Hubei, PR China
Abstract
Patient: Male, 44-year-old
Final Diagnosis: Testis-sparing surgery for multiple fibrous pseudotumors of the epididymis
Symptoms: History of multiple firm, nontender left epididymal nodules. Scrotal ultrasonography showed multiple hypoechoic lesions without testicular invasion, and tumor markers were negative
Clinical Procedure: —
Specialty: Urology
Objective: Rare disease
Background: Fibrous pseudotumor of the epididymis is a rare benign reactive lesion that accounts for approximately 10% of paratesticular fibrous pseudotumors. Its etiology is unclear but is often associated with trauma or inflammation. Although it is the second most common paratesticular tumor after adenomatoid tumor, its epididymal origin is particularly uncommon. The nonspecific clinical and imaging features frequently lead to a preoperative misdiagnosis of malignancy, potentially resulting in unnecessary radical orchiectomy.
Case Report: We present the case of a 44-year-old man with a 4-year history of multiple firm, nontender left epididymal nodules. Scrotal ultrasonography showed multiple hypoechoic lesions without testicular invasion, and tumor markers were negative. Intraoperatively, the masses were well-demarcated from the testis, with an intact tunica albuginea, enabling direct testis-sparing complete resection; frozen section was deemed unnecessary. The resected specimen comprised an aggregate 8-cm mass of gray-white nodules. Histopathology revealed a fibrous pseudotumor composed of proliferating fibroblasts and myofibroblasts in a storiform pattern, accompanied by prominent lymphoplasmacytic infiltration. Immunohistochemistry showed an IgG4/IgG ratio < 40%, excluding IgG4-related disease. The differential diagnoses of adenomatoid tumor, inflammatory myofibroblastic tumor, and paratesticular sarcoma were ruled out. The patient recovered uneventfully, and at 3-, 6-, and 12-month follow-up no recurrence was observed, with normal testicular morphology and blood flow.
Conclusions: This case underscores that when multiple epididymal masses are well-demarcated from the testis, fibrous pseudotumor should be considered, enabling testis-sparing surgery and avoiding unnecessary orchiectomy. Intraoperative frozen section can be a helpful adjunct if the diagnosis is uncertain. Given the benign nature of the lesion, the long-term prognosis is excellent; nonetheless, regular ultrasonographic follow-up is recommended to monitor for potential recurrence.
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BibTeX
@article{xue2026testissparing,
title = {{Testis-Sparing Surgery for Multiple Fibrous Pseudotumors of the Epididymis: A Case Report}},
author = {Di Xue and Aijun Zhu and Huaijie Yang and Cheng Yi and Man Zhang and Renguang Hu and Xiangyun You},
journal = {The American Journal of Case Reports},
year = {2026},
month = oct,
doi = {10.12659/ajcr.953555},
url = {https://doi.org/10.12659/ajcr.953555},
note = {CC BY-NC-ND 4.0},
}
RIS
TY - JOUR
TI - Testis-Sparing Surgery for Multiple Fibrous Pseudotumors of the Epididymis: A Case Report
AU - Di Xue
AU - Aijun Zhu
AU - Huaijie Yang
AU - Cheng Yi
AU - Man Zhang
AU - Renguang Hu
AU - Xiangyun You
PY - 2026
DA - 2026/10/26
JO - The American Journal of Case Reports
DO - 10.12659/ajcr.953555
UR - https://doi.org/10.12659/ajcr.953555
AB - Patient: Male, 44-year-old Final Diagnosis: Testis-sparing surgery for multiple fibrous pseudotumors of the epididymis Symptoms: History of multiple firm, nontender left epididymal nodules. Scrotal ultrasonography showed multiple hypoechoic lesions without testicular invasion, and tumor markers were negative Clinical Procedure: — Specialty: Urology Objective: Rare disease Background: Fibrous pseudotumor of the epididymis is a rare benign reactive lesion that accounts for approximately 10% of paratesticular fibrous pseudotumors. Its etiology is unclear but is often associated with trauma or inflammation. Although it is the second most common paratesticular tumor after adenomatoid tumor, its epididymal origin is particularly uncommon. The nonspecific clinical and imaging features frequently lead to a preoperative misdiagnosis of malignancy, potentially resulting in unnecessary radical orchiectomy. Case Report: We present the case of a 44-year-old man with a 4-year history of multiple firm, nontender left epididymal nodules. Scrotal ultrasonography showed multiple hypoechoic lesions without testicular invasion, and tumor markers were negative. Intraoperatively, the masses were well-demarcated from the testis, with an intact tunica albuginea, enabling direct testis-sparing complete resection; frozen section was deemed unnecessary. The resected specimen comprised an aggregate 8-cm mass of gray-white nodules. Histopathology revealed a fibrous pseudotumor composed of proliferating fibroblasts and myofibroblasts in a storiform pattern, accompanied by prominent lymphoplasmacytic infiltration. Immunohistochemistry showed an IgG4/IgG ratio < 40%, excluding IgG4-related disease. The differential diagnoses of adenomatoid tumor, inflammatory myofibroblastic tumor, and paratesticular sarcoma were ruled out. The patient recovered uneventfully, and at 3-, 6-, and 12-month follow-up no recurrence was observed, with normal testicular morphology and blood flow. Conclusions: This case underscores that when multiple epididymal masses are well-demarcated from the testis, fibrous pseudotumor should be considered, enabling testis-sparing surgery and avoiding unnecessary orchiectomy. Intraoperative frozen section can be a helpful adjunct if the diagnosis is uncertain. Given the benign nature of the lesion, the long-term prognosis is excellent; nonetheless, regular ultrasonographic follow-up is recommended to monitor for potential recurrence.
SN - 1941-5923
ER -