Adenomatoid tumor is a benign neoplasm that occurs in the male genital tract.[1
] The term was first coined by Godman and Ash in 1945.[2
] It is common in the third and fourth decades of life. Although epididymis remains the most common site of involvement, constituting 30% of paratesticular neoplasms; rarely does AT occur in the testis.[1
] The histogenesis has been argued for years with the proposed cells of origin being endothelial, mesothelial, mesonephric, mullerian, and epithelial. Evidence suggests mesothelial origin whereas the usual coexistence of chronic inflammatory cells and fibrosis suggests mesothelial hyperplasia.[1
The initial cytological descriptions of AT were described by Perez-Guillemro et al
] and are identical to the cytological features noted here for both the cases. Cytological differential diagnoses of AT include the reactive mesothelial hyperplasia, papillary cyst adenoma, spermatic granuloma, malignant mesothelioma, and adenocarcinoma.[5
Reactive hyperplasias are associated with hydrocele and unlike ATs, do not have a definitive cytological arrangement. Papillary cystadenomas show papillary structures without nuclear atypia in a mucoid background.[5
] Spermatic granulomas have spermiophages in a dirty background, whereas tuberculous epididymitis consists of epithelioid granulomas and Langhan's type giant cells in a necrotic background which can be confirmed by Zeihl Neelsen's stain and culture.[5
] Chronic epididymitis mimics AT and a definitive diagnosis depends on a combination of clinical examination, imaging studies, and cytomorphological features.[5
] Unlike AT, mesotheliomas show nuclear enlargement, macronucleoli, and multinucleation, whereas metastatic adenocarcinomas have cytological features of malignancy and show mucicarmine positivity.[5
] Benign Sertoli cell tumors, not otherwise specified (NOS) and sclerosing sertoli cell tumors (SSCT) are rarely considered for differential diagnosis.[6
] Terayema et al
] suggested that coffee-bean nuclei and nuclear indentations be made the diagnostic criteria for Sertoli cell tumor (NOS). However, the presence of monolayered sheets and the lack of the characteristic nuclear features favor a diagnosis of AT over SSCT.
USG findings along with cytological features help to evolve an organ-sparing surgical approach as noted in case 2.[8
] USG-guided aspiration cytology with immediate surgery including the excision of needle track can follow if malignancy is detected. This is because a delayed diagnosis of malignancy is more harmful than the hypothetical risk of tumor spread by aspiration cytology.[9
Hence, these cases have been presented to highlight the importance of FNAC in the preoperative diagnosis of adenomatoid tumors, which can help to plan surgery as complete excision of the benign tumor gives good prognosis without recurrence. Also, we report here testicular AT, which is a relatively rare site.