Para-testicular florid cystic müllerianosis in an elderly patient: Case report of a rare metaplastic change of tunica vaginalis with unusual clinical presentation (mass forming lesion)

Abstract

Müllerian metaplasia/florid cystic Müllerianosis of the tunica vaginalis is one of the metaplastic changes described in the testis. Others include urothelial metaplasia, epidermoid metaplasia, and gastric metaplasia. Florid cystic Müllerianosis shares similar histo-morphological features and immunohistochemical profile with female counterpart endosalpingiosis. Herein, we report a case of para-testicular florid cystic Müllerianosis presented as a painless testicular mass in a 66-year-old male with normal tumor markers.

Keywords: Benign; Müllerian metaplasia; Para-testis.

Fig. 1

MRI Testis demonstrating a small hypodense lesion of the right testis (arrow).

Fig. 2 (A)

Hematoxylin and eosin (H&E) stained section: A low power view shows variable-sized glands within the tunica vaginalis; some are cystically dilated (black arrows) with juxtaposed histiocytic reaction with cholesterol clefts (asterisk) (H&E; 10x).

Fig. 2 (B)

Hematoxylin and eosin (H&E) stained section: The glands are lined by simple flat to cuboidal epithelium comprised of three types of cells: ciliated columnar cells (black arrow), Non-ciliated secretory cells (yellow arrow), and ‘peg’ cells (red arrow) ((H&E; 20x). (For interpretation of the references to colour in this figure legend, the reader is referred to the Web version of this article.)

Fig. 3 (A)

(20x): Immunohistochemistry studies: Nuclear immunoreactivity for PAX-8.

Fig. 3 (B)

(20x): Immunohistochemistry studies: Negative reactivity against SALL-4.