Müllerian serous cystadenoma of the scrotum following orchiopexy

Our plain-English summary of Müllerian serous cystadenoma of the scrotum following orchiopexy, by S.C. van der Putte, J. Toonstra, D.M. Sie-Go (Advances in Urology, 2009).

The study

• Authors: S.C. van der Putte, J. Toonstra, D.M. Sie-Go
• Journal: Advances in Urology
• Published: 2009;2009:610453
• Type of article: Case report
• Cited by: 8 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

A 24-year-old man presented himself with a nodular lesion of about 1 cm diameter at the site of a previous orchiopexy associated with surgery for cryptorchism. Histopathology revealed the lesion to be adenomatous and confined to the scrotum. Histological and immunohistological features were not consistent neither with median raphe cysts or cutaneous adenomas nor with the intrascrotal adenomas of the rete testis, epididymis, nor with (malignant) mesotheliomas. However, the lesion did compare well with serous (papillary) cystadenomas of the testis or paratestis. These adenomas are thought to originate in remnants of the Müllerian system or of peritoneal lining altered by Müllerian metaplasia. This implies that the scrotal adenoma may have developed from an implant of such elements during orchiopexy 14 years ago. Complete excision of the lesion appears to be an adequate therapy.

In plain English

This case report described a 24-year-old man with a swelling in the skin of his left scrotum at the site of an orchiopexy performed for cryptorchism (undescended testis) 14 years earlier. The article does not concern asbestos; mesothelioma appears only as a diagnosis the authors ruled out. The nodule measured 1.5 cm on examination, and the removed tissue held a firm 1 cm tumor. Under the microscope the growth looked bland, with rare dividing cells and no microinvasion. Its staining pattern did not match median raphe cysts, skin gland tumors or the epididymis. It also differed from the rete testis and mesothelium, which react for calretinin while this tumor did not. It resembled serous (papillary) cystadenoma of the ovary. The authors classified the lesion as a serous cystadenoma and suggested it arose from Müllerian tissue implanted during the operation. They rejected the earlier label of median raphe cyst given to two similar published cases. The patient was disease-free after 14 months. The authors concluded that the still-limited data suggest complete excision may be adequate therapy, and they added that more data are needed.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: case report (single patient), with comparison staining of tissue from other lesion types
• Who was studied: one 24-year-old man with a swelling in the skin of the left scrotum
• Exposure: No asbestos exposure is described. The relevant history was an orchiopexy performed for cryptorchism 14 years earlier, at the site where the nodule appeared.
• Main results:
  • In this patient, the excised 2.5 by 1.5 by 1 cm specimen contained a firm 1 cm tumor. The tumor was completely removed, with a very narrow free margin.
  • The tumor's lining cells looked bland, dividing cells were rare, and there was no microinvasion.
  • Staining showed the tumor reacted for CK 7, vimentin, Ca-125, estrogen receptor and progesterone receptor. It did not react for CK 20, calretinin or alpha-smooth muscle actin.
  • The tumor's profile was inconsistent with scrotal median raphe cysts, which do not react for vimentin, and with cutaneous papillary hidradenomas, which react for SMA in myoepithelium (three cases of each tested).
  • The tumor's staining profile did not match the rete testis or mesothelium, which did not react for Ca-125, ER and PR but did react for calretinin. It also did not match the epididymis, which did not react for Ca-125 and reacted variably for vimentin, ER and PR.
  • The tumor's profile was similar to that of serous (papillary) cystadenoma of the ovary (three cases tested).
  • The MIB1 cell proliferation index of the tumor was 1.5%.
  • The authors rejected the diagnosis of median raphe cyst and classified the lesion as a serous cystadenoma.
  • The authors suggested that, because the lesion was confined to the scrotum, it arose from Müllerian tissue implanted during the orchiopexy.
  • The patient had a disease-free follow-up of 14 months.
• The authors' conclusion: The authors concluded that the earlier designation of such lesions as median raphe cysts is incorrect, and that the still-limited data suggest complete excision may be an adequate therapy.
• Limitations the authors state:
  • The authors stated that the precise nature of the tumor remains unclear.
  • The authors stated that more data are needed to judge whether complete excision is adequate.
  • The authors stated it is unclear whether the external opening of the lesion was a primary or secondary event.

Topics

Medical terms in this study, explained in our Lexicon: Histopathology, Rete Testis, Epididymis, Mesothelioma.

Related studies

• Is PAX2 a reliable marker in differentiating diffuse malignant mesotheliomas of peritoneum from serous carcinomas of müllerian origin? — F.F. Gao, A.M. Krasinskas, et al. (2012)
• Rab25 is overexpressed in Müllerian serous carcinoma compared to malignant mesothelioma — K. Brusegard, H.T. Stavnes, et al. (2012)
• Sarcomatoid mesothelioma of tunica vaginalis testis in the right scrotum of a dog — N.V. Son, J.K. Chambers, et al. (2018)
• Well-Differentiated Papillary Mesothelial Tumor of the Scrotum with Suspicious Invasion — S. Im, J.M. Yoo, et al. (2024)
• PAX8 reliably distinguishes ovarian serous tumors from malignant mesothelioma — A.R. Laury, J.L. Hornick, et al. (2010)
• Peritoneal malignant mesothelioma versus serous papillary adenocarcinoma. A histochemical and immunohistochemical comparison — D.J. Bollinger, M.R. Wick, et al. (1989)

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