A case of leiomyoma of the testis is reported. The origin of the intratesticular leiomyoma is controversial, but recently it is thought to arise from the contractile cells in the tunica propria of the seminiferous tubules. This is the first case reported in Japan and the fifth in the world literature

Shinagawa, Toshihito

Takahashi, Go

Takahashi, Hiroshi

Kyoto University Research Information Repository

Title Intratesticular leiomyoma: a case reportAuthor(s)Takahashi, Go; Takahashi, Hiroshi; Shinagawa, ToshihitoCitation泌尿器科紀要 (1991), 37(11): 1551-1553Issue Date1991-11URL http://hdl.handle.net/2433/117356RightType Departmental Bulletin PaperTextversionpublisherKyoto UniversityActa Urol. Jpn. 37: 1551-1553, 1991 1551 INTRATESTICULAR LEIOMYOMA: A CASE REPORT Go Takahashi, Hiroshi Takahashi From the Department of Urology, Yokohama West Hospital of St. Marianna University Toshihito Shinagawa From the Department of Pathology, Yokohama West Hospital of St. Marianna University A case of leiomyoma of the testis is reported. The origin of the intratesticular leiomyoma is controversial, but recently it is thought to arise from the contractile cells in the tunica propria of the seminiferous tubules. This is the first case reported in Japan and the fifth in the world literature. Key words: Leiomyoma, Testis INTRODUCTWN Leiomyoma may arise anywhere III the body from tissues contallllllg smooth muscle. It is relatively uncommon in the genitourinary tract, and rarely arises from the testis. CASE REPORT A 36-year-old man was admitted to our hospital because of a firm non-tender nod-ule in the right testis for more than a year. His past history was unremarkable except for the suspicion of male infertility and cholecystectomy 2 years earlier. Physical examination revealed a hen's egg sized, firm, well-demarcated, non-tender nodule in the lower portion of the right testis which failed to transmit light. Ultrasonography revealed a hypoechoic mass within the tunica albuginea of the right testis. Tumor markers such as (1'-fetoprotein and ,a-subunits of human chorionic gonadotropin were within normal levels. Right orchiectomy after high ligation of the spermatic cord was performed under the diagnosis of malignant testicular tu-mor on March 24, 1989 and post-opera-tive course was uneventful. The intrates-ticular tumor, measuring 4.6 x 3.5 cm, was firm, grayish-white and myomatous in ap-pearance displacing normal testicular tis-sue to the upper part within the tunica al buginea of the right testis (Fig. 1). (Acta Uro!' Jpn. 37: 1551-1553, 1991) Microscopically on haematoxylin and eosin stain and on electron microscopy, the tumor consisted of interlacing bundles of smooth muscle cells with no mitotic figures nor atypical nuclei (Fig. 2,3). Therefore the tumor was diagnosed as leiomyoma. A few types of immunohistochemical stains were performed, but we failed to obtain any specific findings probably because of poor initial fixation of the specimen. The testicular tissue was normal. The tumor was partly covered by the tunica albuginea with which no connection nor infiltration were found. These findings suggested that the tumor arose from the testicular tissue. DISCUSSION Intrascrotal leiomyomas may arise from the epididymis, the spermatic cord or the dartos muscle of the scrotum, but that arising from the testis itself is rare. The origin of the intratesticular leio-myoma is controversial. It is thought to be caused by the proliferation of muscle bundles from the smooth muscle in the vascular tree. In reported cases, the tu-mors originating from the tunica albuginea tend to have a stalk or to protrude outwardsl - 3) Such tumors are thought to arise from the vascular structures in the tunica albuginea. Recently it is postulated that the lesion arises from the contractile cells present in 1552 Acta Urol. Jpn. Vol. 37, No. II, 1991 Fig. I. Macroscopic a ppearance of longitudi-nally opened testicle, note the tumor displacing testicular tissue to the upper part Fig. 2. Typical smooth muscle bundles with interlacing pattern Fig. 3. Electron microscopic appearance of tu-mor, note the characteristic myo-filaments, dense bodies, pinocytic vesi-cles and basement membranes, x 3,000 (right lower corner, apparent pinocytic vesicels, x 8,000) the tunica propria of the semineferous tubules 4) Our case is the fifth reported case of leiomyoma in the world litera-ture l - 4) and the first in Japan. Of the five reported cases, the tumor proliferated from the tunica albuginea in 3 cases and from the testicular tissue in 2 cases. Our case is thought to proliferate from the testicular tissue. The differential diagnosis includes ma-lignant testicular tumors, fibroma, Leydig cell tumor, and Sertoli cell tumor. De-spite its benign nature, orchiectomy after high ligation of the spermatic cord remains the treatment of choice, simply because this lesion cannot be distinguished clinical-ly from more common testicular malig-nancies or leiomyosarcomasS) No other adjuvant therapy is needed for leiomyoma. REFERENCES I) Albert PS and Mininberg DT: Leiomyoma of the tunica albuginea . J Urol 107: 869-871, 1972 2 ) Maria Nuova S and Emilia R: Leiomyoma della tunica albuginea. Urologia 46: 768-771, 1979 3) Chiaramonte RM: Leiomyoma of tunica al-buginea of testis. Urology 31: 344-345, 1988 4) Honore LH and Sullivan LD: Intratesti-cular leiomyoma: a case report with discus-sion of differential diagnosis and histogenesis. J Urol 114: 631-635, 1975 5) Yachia D and Auslaender L: Primary leio-myosarcoma of the testis . J Urol 141: 955-956, 1989 (Received on January 7, 1991) Accepted on April 12, 1991 1553和文抄録精 巣 平 滑 筋 腫 の1例聖マリアンナ医科大学横浜市西部病院泌尿器科(副部長 ：高橋　剛)　　　　　　　　 高橋 　 　剛,高 橋　 　浩聖マリアンナ医科大学横浜市西部病院臨床病理部(副部長 ：品川俊人)　　　　　　　　　品　 　 川　 　 俊　　 人　陰嚢内無痛性腫瘤を主訴とした36歳男性の右精巣腫瘍症例について報告した.術 前腫瘍マーカーはすべて正常であったが,悪 性を否定できないため高位除睾術を行った.病 理組織学的 診断は精巣平滑筋腫 であった.本症の発生原基については精巣組織内血管壁の平滑筋線維から発生したものと考えられているが最近,精細管固有層内にある括約筋細胞から発生するという説も出ている.本症例は世界5例 目で,本邦では1例目と考えられる.　　　　　　　　 (泌尿紀要37:1551-1553,1991)

精巣平滑筋腫の1例

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精巣平滑筋腫の1例

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