The hamartoma word is originated from “hamartia” in Greek alphabet and meaning “scribal error or mistake”. Hamartomas may be seen anywhere in the body and are often seen in infancy and childhood. Therefore, it has been believed that these lesions are developmental aberrations
2. It is often seen in the head and neck region (especially around ear), gastrointestinal system and lungs and rarely seen in corpus cavernosum, larynx, urinary bladder, hypothalamus and retina
3-7. To date, paratesticular fibrous hamartoma in adults has not been reported in the English literature.
Tumors of the spermatic cord and paratesticular region are uncommon. The paratesticular area is a complex anatomical area which includes the contents of the spermatic cord, testicular tunics, epididymis and vestigial remnants, such as the appendices epididymidis and testis. Histogenetically, this area is composed of a variety of epithelial, mesothelial and mesenchymal elements. Neoplasms arising from this region therefore form a heterogeneous group of tumors with different behavioural patterns and have a wide differential diagnosis. The clinical presentation is almost always a mass or swelling, which may or may not be painful and is occasionally accompanied by hydrocele. These clinical findings do not help to distinguish a benign tumor from a malignant tumor. Paratesticular tumors can present at any age, which may sometimes give a clue to the histological diagnosis8.
Lioe et al.8, in 36 years period, reported 85 paratesticular tumors in which 66 (78%) were benign lesions and the remaining 19 were malignant. The most common benign lesion was the adenomatoid tumour. Lipomas are also seen frequently9,10. Other much rarer benign lesions included leiomyoma, haemangioma, fibroma, neurofibroma and papillary mesothelioma. While lipomas are seen at a large interval of age (2-71 age), adenomatoid tumors are often seen between 20 to 50 ages and rarely seen in childhood. Sizes of these tumors are variable. While adenomatoid tumors are rarely over 10 cm, diameters of lipomas and malignant tumors are usually over 10 cm8.
In another study11, twenty two patients with tumours or tumour-like conditions of the paratesticular region were evaluated over a 5 years period. Of these, 16 (73%) were benign with only one true neoplasm (papillary cystadenoma). The tumor-like conditions were comprised of 6 cases of adenomatous hyperplasia of epididymis, 4 cases of spermatic granuloma, 2 cases each of spermatocele and nodular-fibrous proliferation and one mesothelial cyst11.
To date, paratesticular hamartoma cases have been reported in English literature. The first case was reported by Srigley and Hartwick, in a two years old child1. They described that the tumor consisted of a disorganized cluster of tubules embedded in a loose connective tissue stroma and tubules were lined by cells that were cytologically similar to normal rete testis. This tumor is called as hamartoma of rete testis and is morphologically different from fibrous hamartoma.
Histopathologic features of our case were compatible with fibrous hamartomas described in the literature. On contrary to the literature, in our case, focally dense chronic inflammatory reaction, lymphoid aggregations, foreign body reaction and cholesterol clefts were seen. We believe that the most of these changes are developed secondary to lipid extraction from cells, due to chronic trauma or surgical operation.
The second case is reported in childhood by Jimenes and et al.12 and was diagnosed as “paratesticular fibrous hamartoma”. However, we could not get information about morphological features of this case. According to these reports, our case is the first paratesticular fibrous hamartoma in adulthood.
Finally in the differantial diagnosis of the paratesticular tumors, paratesticular fibrous hamartomas should have been taken into consideration. These tumors may be confused with malignant tumors of testis and paratesticular region. Preoperative diagnosis of the paratesticular hamartomas prevents unnecessary orchiectomy.