Intratesticular leiomyoma: A case report and a literature review

INTRODUCTION: Leiomyomas are benign tumors that originate from smooth muscles cells. Intratesticular leiomyoma is a very rare type of benign testicular masses. Through the literature, only 11 cases were reported. PRESENTATION OF CASE: A 36 years old man presented with painless right scrotal mass. Clinical examination showed right upper polar testicular mass, well circumscribed and highly vascularized on sonography. Serum tumor markers were normal. Patient was explained the possibility of an organ sparing surgery if frozen section shows no sign of malignancy. Midline incision with frozen section was performed, with wide local excision. Pathological examination of the specimen confirmed intratesticular leiomyoma. Two years after the surgery, patient showed no sign of recurrence. DISCUSSION: Intratesticular Leiomyoma is usually revealed as a non-tender firm scrotal mass that increases in size. Sonography is the imaging modality of choice for assessing intrascrotal pathology, and cannot distinguish benign from malignant tumor. Surgical management is subject of debate. While some authors recommend radical orchiectomy, others suggest the use of frozen section intraoperatively, and perform conservative treatment by mass excision in the absence of signs of malignancy. CONCLUSION: Intratesticular leiomyoma is a very rare finding. When suspected, conservative management using frozen section followed by mass excision can be done, but final diagnosis remains on pathological examination and immunohistochemistry of the specimen.