Benign Mimics and Tumor-like Lesions in Urologic Pathology
Moderators: Dr. Mahul Amin and Dr. Liliane Boccon-Gibod
Section 4 -
Tumor-like and Benign Mimics of Testis and Paratesticular Structures
Pathology section. Fundacio Puigvert
Department of Morphological Sciences, School of Medicine
Universitat Autónoma de Barcelona (UAB)
There are many lesions that can imitate a neoformation and its incidence among the masses within the
scrotal sac would vary according to the series between 6% and 30%
since a tumor-like or benign
mimic being confused with true neoplasia depends on many circumstances.
These pseudo-neoplastic lesions can be divided into those that form masses that macroscopically
imitate neoplasia, but that the microscopic study easily shows that they are not truly neoformations
(tumor-like lesions) (Table 1) and those that microscopically imitate a neoplasia, whether or not they
form a macroscopic mass (benign mimics) (Table 2). This latter group is the one that causes more
problems to the pathologist.
From this it is understood that this type of lesions is formed by a group of very diverse processes,
and of different etiopathogenies. In order to avoid an exposure with disordered appearance the lesions
are grouped according to their principal pathogenesis, with it being impossible to avoid the existence of
a miscellaneous group.
Tumor-like Testicular and Paratesticular Structures
Given that this group of lesions refers to those that macroscopically imitate a neoplasia, and that in
turn the anatomical relationship between testicle and paratesticular structures is very narrow, they are
not going to be differentiated, since both compartments are sometimes affected.
The majority of the vascular disorders of the masculine gonad are not confused with a tumor because in
addition to being characterised by being acute phenomena they usually affect the entire structure;
however, upon occasion the vascular lesion is segmentary and can manage to imitate a neoplasia, and they
have been described in this way:
HEMORRHAGE, simulating a tumor through sonography, which can be spontaneous  as well as being
in the context of a anticoagulating treatment .
- SEGMENTAL TESTICULAR INFARCTION, which clinically can be expressed by a slight
local pain without the patient relating it to any acute episode . In some cases, the study of the
testicle has shown isolated or systemic vasculitis
both in the form of polyarteritis nodosa 
and of giant cell vasculitis 
or Wegener granulomatosis , having been reported in the literature,
up to the year 2000, 83 cases of systemic vasculitis with testicular tumor-like lesion . In other
occasions there is a hemopathy (sickle cell disease)
 and other times only moderate unspecified
fibrosis of the surrounding vessels is observed.
TESTICULAR HEMATOCELE and other vaginal hemorrhages are rarely confused with a neoplasia ,
although in cases of long evolution, the thickening with Cholesterol granuloma of
the tunica vaginalis can make one suspect a neoplasia .
Similar to what was stated for vascular tumor-like lesions, the inflammatory lesions that imitate a
neoplasia usually have very special shapes or have an atypical clinical expression.
- NON-SPECIFIC INFECTIOUS
INFLAMMATORY LESIONS with a tumor-like aspect are usually chronic processes that in a sub-clinical
manner evolve towards a phenomenon of progressive fibrosis that can be confused clinically  and with
sonography  with a neoformation. Occasionally a testicular and epididymal abscess and
chronic xantogranulomatous inflammations in testis 
or spermatic cord  can look like a
neoplasia. Very occasionally testicular neoplasia can clinically imitate an acute inflammatory process
- SPECIFIC INFECTIOUS INFLAMMATORY LESIONS.
The entities of this group that with greatest frequency have been confused with neoplasias are
granulomatous diseases and were described in Tuberculosis ,
Syphillis  Fungal
and Parasites . All these lesions are not usually problematic for the pathologist.
- NON INFECTIOUS INFLAMMATORY LESIONS. This group
of tumor-like lesions include different entities among which can be highlighted: (a) Idiopathic
granulomatous orchitis, probably of autoimmune etiology, is characterised by tubular granulomas
(tubular orchitis) or interstitial granulomas (interstitial orchitis), the presence of intratubular giant
cells differentiate this entity from the infectious granulomatous orchitis .
Malakoplakia. This lesion is characterised by an inflammatory reaction with eosinophilic
macrophages with Michaelis-Gutman bodies, without or very occasional giant cells, the
epididymal-testicular involvement is not frequent (only 12% of the genital malakoplakia)
been correlated with the idiopathic granulomatous orchitis  and it is exceptional that it only
affects the epididymis .
(c) Sarcoidosis. Much rarer than the lesions described above is the
testicular location in a systemic sarcoidosis , very exceptional is the primary form and in these
cases the epididymis is that which is affected more with the testicle being involved by contiguity
- MECHONIUM PERIORCHITIS . This is an
infrequent situation that can be presented in the first months of life and the majority of times there is
a clinical history of some obstetric problem that has caused the passing of mechonium towards the
testicular surrounding structures . The macroscopic appearance is a mixoid material with calcified
pearls resulting from the calcification of the remains of squamous cells or lanugo hairs . The
suspicion of a neoplasia, although in this period of life it is very infrequent, it is a consequence of
the scrotal mass and the sonographically detectable calcifications .
- SPERM GRANULOMA . As its name indicates, this granulomatous lesion with few giant
cells is the consequence of the post-vasectomy (40%) or other causes of extravasation of spermatozoa. When it produces a tumor-like lesion, it usually does
it in the deferent duct or the epididymis , they are usually firm nodes of 0.7 to 4 cm with
A large part of the cysts with a tumor-like appearance are of the paratesticular structures, but the
testicle can occasionally have some cystic lesions that can be confused with a neoplasia.
- TESTICULAR CYSTS
occur in approximately 8%-10% of patients, including those of the tunica albuginea or the parenchyma
. The Tunica albuginea cysts do not usually cause any diagnostic problem, unless if they are
complex cysts , while the Parenchyma testicular cysts can be more difficult to distinguish
from a neoplasia and if there is the slightest suspicion of an intracystic content one must suspect a
malignant neoplasia . The Epidermoid cyst, which must only be constituted by squamous
epithelium represents a special situation that must be fully studied in order to discard any element of
teratoma (especially among the adults), or of intratubular germ cell neoplasia since sonographically it
is impossible to distinguish both lesions
represents 1% of the tumor masses and its origin is
unknown. Finally, another cystic variant of interest the Tubular ectasia of the rete testis
secundary to obstruction and generally located in the mediastinum testicular area , is usually
bilaterial and very rarely manages to constitute a Cystic displasia of the rete testis as a
congenital lesion within complete testicular parenchyma substitution .
- EPIDIDYMAL CYSTS AND SPERMATOCELES are relatively frequent and the majority are in
relation to the inflammatory processes. The differential diagnosis with other entities are related to
its size and similar to the other cystic formations an authentic neoplasia must be suspected in case of
observing any content in its interior .
- SPERMATIC CORD
CYSTS. The majority of these cysts do not cause any diagnostic doubts, only the occasional
Epidermoid cysts described  can simulate a neoplasia.
- ADRENAL CORTICAL
RESTS are relatively frequent both in tunica albuginea and in rete testis, epididymis and
spermatic cord, with an incidence that oscillates between 3.8% to 15%  but it is present in 5-mm
nodes that are not palpable, only in case of congenital adrenal hyperplasia or Cushing syndrome these
remains can be prominent and appear as a tumor-like lesion .
- SPLENIC-GONADAL FUSION, as its name indicates, is the fusion of spleen and gonad,
is somewhat more frequent in ailments and as can be expected it appears on the left side. In cases of
complex malformations, there is an actual cord that joins the normal spleen with the testicle, but in
cases without other malformations the splenic node is presented like a tumor-like lesion in the head of
the epididymis or upper pole of the testis
There are five testicular appendages but
for surgical pathology only three can be interesting (Appendix testis or hydatid of Morgagni, Appendix
epididymis, Paradidymis or organ of Giraldes). These structures are not usually origin of a tumor-like
lesion, only in the case of large-sized cysts can be presented as a paratesticular mass .
Miscellaneous other lesions
FIBROUS PSEUDOTUMORS. This name refers to a fibrosis phenomenon with paucicellular hyalinized
collagen in a nodular (single or multiple)
or diffuse way of the testicular tunics
node can be free (scrotal moues)
. This broad spectrum has received very diverse names .
Although radiologically it is not difficult to recognize, upon occasion an intraoperative frozen section
AMYLOIDOSIS The testicular infiltration is usually bilateral in a patient with a prior history of
amyloidosis , more rarely it is a primary form that by being a cryptorquidic patient simulates a
testicular tumor .
POLYORCHIDISM or supernumerary testes is a rare condition, easy to recognize, but upon occasion
the sonography can be different as the normal testis in this situation can looks like a tumor .
Benign Mimics of Testicular and Paratesticular Structures
As was said at the beginning, those lesions or
cellular changes that macroscopically imitate a neoplasia are included under this name, whether or not
they make a macroscopical mass. Given that these changes are usually closely related to the structure of
each of the organs, its exposure shall be done according to them.
- INFLAMMATORY-REACTIVE LESIONS
Although in this group those already described xantogranulomatous orchitis, idiopathic granulomatous
orchitis and malakoplakia could be considered, their microscopic confusion with a neoplasia (seminoma
for example) is not currently a usual event, which is why it is preferred to include them in the
tumor-like lesions. Another different situation is that called lymphocitic orchitis or
characterized by a lymphocytic and plasmocelular polyclonal
reaction that can be confused with a pymphoma, but the immunohistochemical study will show us its
polyclonality. Among these idiopathic lesions we can include the Rosai-Dorfman disease, the
histological examination of the testicular mass revealed an inflammatory lesion comprising lymphocytes,
plasma cells and sheets of pale staining histiocytes, some containing lymphocytes within their ample
cytoplasm, suggestive of emperipolesis. S100 immunohistochemistry stained the histiocytes, while
ultrastructural examination confirmed emperipolesis .
- SERTOLI CELL HYPERPLASIA In a
series of situations nodular accumulations of Sertoli cells can be found, especially in cryptoquidic
testicles, catalogued as Pick's adenomas , because of their appearance these should be distinguished
from the actual Sertoli cell tumors, and sometimes there are areas that recall Call-Exner bodies,
although a deferential diagnosis with a yolk-sac tumor is not usually posed.
- INTERSTITIAL CELL HYPERPLASIA
In testicles with marked tubular atrophy, such as in the Klinefelter syndrome, it is possible to see
Leydig cell nodules that must be distinguished from the Leydig cell tumors. Nodules appearing to be
Leydig cells are found in the patients with adrenogenital syndrome are usually bilateral and of a large
OF THE RETE TESTIS The normal rete testis epithelium is flat, but in some hyper estrogenic
situation (treatment or hepatic dysfunction) a columnar aspect can acquire and rarely a micropapillary
growth of bland cells can be observed, for these reasons almost always the diagnosis of hyperplasia of
the rete testis is subjective and only very infrequently a macroscopic expression is present with
In some cases there are intracytoplasmic hyaline eosinophilic globules that
looks-like a yolk sac tumor, but the no AFP or PLAP expression distinguishes both lesions .
Pseudohyperplasia of the rete testis and epithelial reaction in case of germ cell invasion must be
differentiated from real hyperplasia of the rete testis .
Very rarely there are benign
mimics in the epididymis and when be observed a cystic occupied lesion a neoplasm most be considered, but
some cases of adenomatoid hyperplasia of the rete testis can involve the epididymis and occasionally it
may be macroscopic .
Tunica albuginea and vaginalis
Mesothelial lesions involving the paratesticular region
include mesothelial cysts, reactive mesothelial hyperplasia, adenomatoid tumors, benign cystic
mesothelioma, well-differentiated papillary mesothelioma, and malignant mesothelioma . The MESOTHELIAL HYPERPLASIA is the most important benign mimic of the testicular
tunicas. It is present in the reactive situations as hydrocele or hernia but it is possible to find
(microscopically] in older men . The microscopic aspect is epithelial, and rarely spindle cell
proliferation can be present. In the differential diagnosis with mesothelioma the bland nucleus, no true
invasion and associated inflammatory elements, can be useful
There is published a recent case
with "atypical" mesothelial hyperplasia in a site and "well differentiated" mesothelioma in the
contalateral , This case is an example of the subjective interpretation of some proliferativo lesion
of the mesothelio because in some mesothelioma lacks the cellular atipia, in these cases an extensive
confluence or prominent infiltration favors the malignant diagnosis. Unfortunately the
immunohistochemical reaction of benign and malignant mesothelium is similar  and only subtle
differences with the intermediate filaments are referred .
The vas deferens and the soft tissues of spermatic cord can have benign mimics.
- VASITIS NODOSA Is a ductular
proliferation, generally after vasectomy , with a microglandular aspect with mild nuclear atipia and
perineural growth  that may be mistaken for malignancy. In some cases a tumor-like aspect can be
observed . The frequent
hyperplasia of nerve fibers in the adventitia can explain the painful symptoms in some patients .
The coincidence with microscopic sperm granulomas and inflammatory reaction can help in the correct
diagnosis. An analogous epididymal lesion also occur . We have a similar observation in seminal
FUNICULITIS . The inflammation of the spermatic cord usually as the result of the extension of a
vasitis, but the soft tissues of the spermatic cord are also the most common site in the male genital
tract of the Inflammatory pseudotumor present in many other places
The lesion is
ill defined, mixoid and white-grey color with a moderate cellular proliferation with a loose collagen
fibers and irregular inflammatory cells infiltration. In some cases a prominent spindle cell
proliferation mimics a sarcoma (pseudosarcomatous myofobroblastic proliferation) but no atypical mitosis,
low mitotic index, the capillary pattern and the presence of inflammatory cells is against the sarcoma
diagnosis. unfortunately the immunohistochemistry is partly helpful.
Miscellaneous other lesions
But in spite of all these tumor-like and benign
mimics we most remember that the patient with one o these lesions can have a concomitant or ulterior true
EMBRYONIC REMNANTS . The presence of seminiferous tubules within the tunica albuginea ,
Leydig cells in rete testis, albuginea, spermatic cord, or within sclerotic tubules. Prostate
gland in the epididymis 
and special circumstances with muscular hypertrophy  can mimics a
Table 1: Tumor-like Lesions of Testis and Paratesticular Structures
Segmental testicular infarction
Organizad testicular hematocele
Cholesterol granuloma of the tunica vaginalis
Non-specific infectious inflammatory lesions
Specific infectious inflammatory lesions
Non-infectious inflammatory lesions
Idiopathic inflammatory lesions
Idiopathic granulomatous orchitis
Parenchymal cysts (Epidermoid cysts)
Rete-testis cysts- Cystic displasia of the rete testis
Epididymal cysts and Spermatoceles
Spermatic cord cysts.
Adrenal cortical rests
MISCELLANEOUS OTHER LESIONS
Fibrous pseudotumors; (Fibromatous periorchitis-Nodular periorchitis)
Table 2: Benign Mimics of Testis and Paratesticular Structures
Lymphocitic orchitis (Testicular pseudolymphoma)
Sertoli cell hyperplasia
Hamartomatous proliferation testicular feminization syndrome
Interstitial cell hyperplasia
Leydig cell hyperplasia
Testicular "tumor" of the adrenogenital syndrome
Hyperplasia of the rete testis
Inflammatory pseudotumor (Funiculitis proliferans)
MISCELLANEOUS OTHER LESIONS
- Collins DH, Pugh RC.: Classification and frequency of testicular tumors. Br. J. Urol. 1964; 36 (Suppl): 1-11.
- Haas GP, Shumaker BP, Cerny JC.: The high incidente of benign testicular tumors. J. Urol. 1986; 136: 1219-1220.
- Evans KJ, Teddi RJ, Weatherby E.: Spontaneous intratesticular hemorrhage masquerading as a testis tumor. J Urol. 1985 Dec;134(6):1211.
- Chong J, Flynn JT.: Spontaneous anticoagulant-induced testicular haemorrhage mimicking a testicular tumour.Br J Urol. 1998 May;81(5):777.
- Doebler RW, Norbut AM.:Localized testicular infarction masquerading as a testicular neoplasm. Urology. 1999 Aug;54(2):366.
- Warfield AT, Lee SJ, Phillips SM, Pall AA.: Isolated testicular vasculitis mimicking a testicular neoplasm. J Clin Pathol. 1994 Dec;47(12):1121-1123.
- Joudi FN, Austin JC, Vogelgesang SA, Jensen CS.: Isolated testicular vasculitis presenting as a tumor-like lesion. J Urol. 2004 Feb;171( 2 Pt 1):799.
- Dotan ZA, Laufer M, Heldenberg E, Langevitz P, Fridman E, Duvdevani M,Ramon J. Isolated testicular polyarteritis nodosa mimicking testicular neoplasm-long-term follow-up. Urology. 2003 Aug;62(2):352.
- Sundaram S, Smith DH.¨: Giant cell arteritis mimicking a testicular tumour. Rheumatol Int. 2001 Jul;20(5):215-216.
- Kariv R, Sidi Y, Gur H.: Systemic vasculitis presenting as a tumorlike lesion. Four case reports and an analysis of 79 reported cases. Medicine ( Baltimore ) 2000; 79: 349-359.
- Li M, Fogarty J, Whitney KD, Stone P. : Repeated testicular infarction in a patient with sickle cell disease: a possible mechanism for testicular failure. Urology. 2003 Sep;62(3):551.
- Shamsa A, Kadkhodayan A, Feiz-zadeh B, Rasulian H.: Testicular hematocele mimicking a testicular tumor: a case report and review of literature. Transplant Proc. 2002 Sep;34(6):2141-2142.
- Nativ O, Mor Y, Nass D, Leibovitch I, Goldwasser B.: Cholesterol granuloma of the tunica vaginalis mimicking a neoplasm. Isr J Med Sci. 1995 Apr;31(4):235-236.
- Honore LH.: Nonspecific peritesticular fibrosis manifested as testicular enlargement. Clinicopathological study of nine cases. Arch. Surg. 1978; 113: 814-816.
- Einstein DM, Paushter DM, Singer AA, Thomas AJ, Levin HS. : Fibrotic lesions of the testicle: sonographic patterns mimicking malignancy. Urol Radiol. 1992;14(3):205-210.
- Yap RL, Jang TL, Gupta R, Pins MR, Gonzalez CM.: Xanthogranulomatous orchitis. Urology. 2004 Jan;63(1):176-1777.
- Vaidyanathan S, Mansour P, Parsons KF, Singh G, Soni BM, Subramaniam R, Oo T, Sett P.: Xanthogranulomatous funiculitis and epididymo-orchitis in a tetraplegic patient. Spinal Cord. 2000 Dec;38(12):769-772.
- Kao HW, Wu CJ, Chen CY, Sun GH, Lee SS, Peng YJ. : Malignant tumor of testis imitating epididymo-orchitis. Arch Androl. 2005 Sep-Oct;51(5):407-411.
- Saw KC, Hartfall WG, Rowe RC.: Tuberculous prostatitis: nodularity may simulate malignancy. Br J Urol. 1993 Aug;72(2):249
- Int J Urol. 2004 Aug;11(8):683-685.
- Archimbaud A, Bonvalet D, Levy-Klotz B, Vallet C, Civatte J.: Syphilitic orchiepididymitis. Apropos of a pseudotumoral case .Ann Dermatol Venereol. 1984;111(2):169-171.
- Jani AN, Casibang V, Mufarrij WA.: Disseminated actinomycosis presenting as a testicular mass: a case report.J Urol. 1990 May;143(5):1012-1014.
- Bambirra EA, Andrade Jde S, Bamberg A, de Souza EA, Mitidiero CE, de Souza AF. Testicular schistosomiasis mansoni: a differential diagnostic problem with testicular neoplasias. Am J Trop Med Hyg. 1986 Jul;35(4):791-792.
- Osca Garcia JM, Alfaro Ferreres L, Ruiz Cerda JL, Moreno Pardo B, Martinez Jabaloyas J, Jimenez Cruz JF.: Idiopathic granulomatous orchitis. Actas Urol Esp. 1993 Jan;17(1):53-56.
- McClure J. : Malakoplakia of the testis and its relationship to granulomatous orchitis. J Clin Pathol. 1980 Jul;33(7):670-678.
- Dieckmann KP, Henke RP, Zimmer-Krolzig G.: Malacoplakia of the epididymis. Report of a case and review of the literature. Urol Int. 1995;55(4):222-225.
- Green WO Jr.: Malacoplakia of the epididymis (without testicular involvement). The first reported case. Arch Pathol. 1968 Oct;86(4):438-441.
- Hurd DS, Olsen T.: Cutaneous sarcoidosis presenting as a testicular mass. Cutis. 2000 Dec;66(6):435-438.
- Ryan DM, Lesser BA, Crumley LA, Cartwright HA, Peron S, Haas GP, Bower G. : Epididymal sarcoidosis. J Urol. 1993 Jan;149(1):134-136.
- Garat JM, Algaba F, Parra L, Gomez L.: Meconium vaginalitis. Br J Urol. 1991 Oct;68(4):430- 431.
- Williams HJ, Abernethy LJ, Losty PD, Kotiloglu E. : Meconium periorchitis--a rare cause of a paratesticular mass. Pediatr Radiol. 2004 May;34(5):421-423
- Bach AM, Hann LE, Hadar O, Shi W, Yoo HH, Giess CS, Sheinfeld J, Thaler H. : Testicular microlithiasis: what is its association with testicular cancer?. Radiology. 2001 Jul;220(1):70-75.
- Dunner PS, Lipsit ER, Nochomovitz LE.: Epididymal sperm granuloma simulating a testicular neoplasm. J Clin Ultrasound. 1982 Sep;10(7):353-355.
- Hamm B, Fobbe F, Loy V. : Testicular cysts: differentiation with US and clinical findings. Radiology. 1988 Jul;168(1):19-23.
- Poster RB, Spirt BA, Tamsen A, Surya BV.: Complex tunica albuginea cyst simulating an intratesticular lesion.Urol Radiol. 1991;13(2):129-132.
- Woodward PJ, Sohaey R, O'Donoghue MJ, Green DE . : From the archives of the AFIP: tumors and tumorlike lesions of the testis: radiologic-pathologic correlation. Radiographics. 2002 Jan-Feb;22(1):189-216.
- Wiesenthal JD, Ettler H, Razvi H.: Testicular epidermoid cyst: a case report and review of the clinicopathologic features. Can J Urol. 2004 Feb;11(1):2133-2135.
- Maizlin ZV, Belenky A, Baniel J, Gottlieb P, Sandbank J, Strauss S. Epidermoid cyst and teratoma of the testis: sonographic and histologic similarities. J Ultrasound Med. 2005 Oct;24(10):1403-9; quiz 1410-1411.
- Older RA, Watson LR.: Tubular ectasia of the rete testis: a benign condition with a sonographic appearance that may be misinterpreted as malignant. J Urol. 1994 Aug;152(2 Pt 1):477-478.
- Nistal M, Regadera J, Paniagua R.: Cystic dysplasia of the testis. Light and electron microscopic study of three cases. Arch Pathol Lab Med. 1984 Jul;108(7):579-583.
- Woodward PJ, Schwab CM, Sesterhenn IA. : From the archives of the AFIP: extratesticular scrotal masses: radiologic-pathologic correlation. Radiographics. 2003 Jan-Feb;23(1):215-240.
- Wegner HE, Herbst H, Dieckmann KP.: Paratesticular epidermoid cyst and ipsilateral spermatic cord dermoid cyst: case report and discussion of pathogenesis, diagnosis and treatment.J Urol. 1994 Dec;152(6 Pt 1):2101-2103.
- Dahl EV, Bahn RC.: Aberrant adrenal contical tissue near the testis in human infants. Am J Pathol. 1962 May;40:587-598.
- Shawker TH, Doppman JL, Choyke PL, Feuerstein IM, Nieman LK. : Intratesticular masses associated with abnormally functioning adrenal glands. J Clin Ultrasound. 1992 Jan;20(1):51-58.
- Gouw AS, Elema JD, Bink-Boelkens MT, de Jongh HJ, ten Kate LP.: The spectrum of splenogonadal fusion. Case report and review of 84 reported cases. Eur J Pediatr. 1985 Nov;144(4):316-323.
- Tank ES, Forsyth M.: Splenic gonadal fusion. J Urol. 1988 Apr;139(4):798-799.
- Srigley JR, Hartwick RW.: Tumors and cysts of the paratesticular region. Pathol Annu. 1990;25 Pt 2:51-108.
- Thompson JE, van der Walt JD.: Nodular fibrous proliferation (fibrous pseudotumour) of the tunica vaginalis testis. A light, electron microscopic and immunocytochemical study of a case and review of the literature. Histopathology. 1986 Jul;10(7):741-748.
- Parveen T, Fleischmann J, Petrelli M.: Benign fibrous tumor of the tunica vaginalis testis. Report of a case with light, electron microscopic, and immunocytochemical study, and review of the literature. Arch Pathol Lab Med. 1992 Mar;116(3):277-280.
- Handelsman DJ, Yue DK, Turtle JR.: Hypogonadism and massive testicular infiltration due to amyloidosis. J Urol. 1983 Mar;129(3):610-612.
- Casella R, Nudell D, Cozzolino D, Wang H, Lipshultz LI.: Primary testicular amyloidosis mimicking tumor in a cryptorchid testis. Urology. 2002 Mar;59(3):445.
- Rifkin MD, Kurtz AB , Pasto ME , Goldberg BB.: Polyorchidism diagnosed preoperatively by ultrasonography. J Ultrasound Med. 1983 Feb;2(2):93-94.
- Agarwal V, Li JK, Bard R.: Lymphocytic orchitis: a case report. Hum Pathol. 1990 Oct;21(10):1080-1082.
- Algaba F, Santaularia JM, Garat JM, Cubells J.: Testicular pseudolymphoma. Eur Urol. 1986;12(5):362-363.
- Fernandopulle SM, Hwang JS, Kuick CH, Lui J, Tan PH, Siow WY, Wong M.: Rosai-Dorfman disease of the testis: an unusual entity that mimics testicular malignancy. J Clin Pathol. 2006 Mar;59(3):325-327.
- Ricco R, Bufo P.: Histologic study of 3 cases of so-called tubular adenoma of the testis . Boll Soc Ital Biol Sper. 1980 Oct 30;56(20):2110-2115.
- Davis JM, Woodroof J, Sadasivan R, Stephens R.: Case report: congenital adrenal hyperplasia and malignant Leydig cell tumor. Am J Med Sci. 1995 Jan;309(1):63-65.
- Knudsen JL, Savage A, Mobb GE.: The testicular 'tumour' of adrenogenital syndrome--a persistent diagnostic pitfall. Histopathology. 1991 Nov;19(5):468-470.
- Hartwick RW, Ro JY, Srigley JR, Ordonez NG, Ayala AG. : Adenomatous hyperplasia of the rete testis. A clinicopathologic study of nine cases. Am J Surg Pathol. 1991 Apr;15(4):350-357.
- Nistal M, Castillo MC, Regadera J, Garcia-Cabezas MA. : Adenomatous hyperplasia of the rete testis. A review and report of new cases. Histol Histopathol. 2003 Jul;18(3):741-52.
- Ulbright TM, Gersell DJ.: Rete testis hyperplasia with hyaline globule formation. A lesion simulating yolk sac tumor. Am J Surg Pathol. 1991 Jan;15(1):66-74.
- Perez-Ordonez B, Srigley JR.: Mesothelial lesions of the paratesticular region. Semin Diagn Pathol. 2000 Nov;17(4):294-306.
- Rosai J, Dehner LP. Nodular mesothelial hyperplasia in hernia sacs: a benign reactive condition simulating a neoplastic process. Cancer. 1975 Jan;35(1):165-175.
- Bolen JW, Hammar SP, McNutt MA.: Reactive and neoplastic serosal tissue. A light-microscopic, ultrastructural, and immunocytochemical study. Am J Surg Pathol. 1986 Jan;10(1):34-47.
- Tyagi G, Munn CS, Kiser LC, Wetzner SM, Tarabulcy E.: Malignant mesothelioma of tunica vaginalis testis. Urology. 1989 Aug;34(2):102-104.
- Tolhurst SR, Lotan T, Rapp DE , Lyon MB , Orvieto MA, Gerber GS, Sokoloff MH. : Well-differentiated papillary mesothelioma occurring in the tunica vaginalis of the testis with contralateral atypical mesothelial hyperplasia. Urol Oncol. 2006 Jan-Feb;24(1):36-39.
- Friedman MT , Gentile P, Tarectecan A, Fuchs A.: Malignant mesothelioma: immunohistochemistry and DNA ploidy analysis as methods to differentiate mesothelioma from benign reactive mesothelial cell proliferation and adenocarcinoma in pleural and peritoneal effusions. Arch Pathol Lab Med. 1996 Oct;120(10):959-966.
- Hirschowitz L, Rode J, Guillebaud J, Bounds W, Moss E.: Vasitis nodosa and associated clinical findings. J Clin Pathol. 1988 Apr;41(4):419-423.
- Balogh K, Travis WD. : The frequency of perineural ductules in vasitis nodosa. Am J Clin Pathol. 1984 Dec;82(6):710-713.
- Warner JJ, Kirchner FK Jr, Wong SW, Dao AH.: Vasitis nodosa presenting as a mass of the spermatic cord. J Urol. 1983 Feb;129(2):380-381.
- Schned AR , Selikowitz SM.: Epididymitis nodosa. An epididymal lesion analogous to vasitis nodosa. Arch Pathol Lab Med. 1986 Jan;110(1):61-64.
- Hollowood K, Fletcher CD. :Pseudosarcomatous myofibroblastic proliferations of the spermatic cord ("proliferative funiculitis"). Histologic and immunohistochemical analysis of a distinctive entity. Am J Surg Pathol. 1992 May;16(5):448-454.
- Lai FM, Allen PW, Chan LW, Chan PS, Cooper JE, Mackenzie TM. : Aggressive fibromatosis of the spermatic cord. A typical lesion in a "new" location. Am J Clin Pathol. 1995 Oct;104(4):403-407.
- Milanezi MF, Schmitt F. : Pseudosarcomatous myofibroblastic proliferation of the spermatic cord (proliferative funiculitis). Histopathology. 1997 Oct;31(4):387-8.
- Nistal M, Paniagua R, Leon L, Regadera J.: Ectopic seminiferous tubules in the tunica albuginea of normal and dysgenetic testes. Appl Pathol. 1985;3(3):123-128.
- Lee LY, Tzeng J, Grosman M, Unger PD.: Prostate gland-like epithelium in the epididymis: a case report and review of the literature. Arch Pathol Lab Med. 2004 Apr;128(4):e60-62.
- Fridman E, Skarda J, Ofek-Moravsky E, Cordoba M.: Complex multilocular cystic lesion of rete testis, accompanied by smooth muscle hyperplasia, mimicking intratesticular Leydig cell neoplasm. Virchows Arch. 2005 Oct; 447(4):768-771.