Journal of Surgical Oncology 27:116-118 (1984)

Fibromyxomatous Pseudotumor of the Scrotum

DEBA P. SARMA, MD THOMAS G. WEILBAECHER, MD AND MARSHALL WIENER, MD

From the Department of Pathology, VA Medical Center and Louisiana State University Medical School, and the Department of Urology, Tulane University Medical School,

New Orleans

An unusual scrotal mass occurring in a 72-year-old man is described. Clinically and grossly, the lesion appeared to be a neoplasm. However, microscopically the mass was composed of fibromyxomatous tissue that appeared to be degenerative rather than neoplastic in nature.

KEY WORDS: scrotal tumor, scrotal mass, scrotal pseudotumor, benign lesion of scrotum, fibromyxomatous scrotal mass

INTRODUCTION mitosis. The cystic spaces were not lined by an epithe-

fibrocollagenous tissue. Bundles of smooth muscle rep- of the tumors arise from the skin or adrexal structures.

gioma, lipoma. leiomyoma, and extremely rare sarcomas cated from the adjacent myxomatous tissue (Fig. 3). Occasional small foci of lymphocytic infiltration were have been described.

The purpose of our paper is to describe an unusual noted in the soft tissue (Fig. 3). The overlying scrotal scrotal lesion occurring in an elderly man. Though c h i - epidermis was

An ultrastructural study did not add any additional cally and grossly the lesion appeared to be a neoplasm,

rnyxomatous areas showed nonfibrillary, amorphous ma- process. terial. The identified cells in the lesion were fibroblastic in nature.

Scrota1 tumors and tumorlike conditions are rare, Most and they blended gradually with the surrounding

Mesenchymal tumors are considered very rare. Heman- resenting dams muscle were intact and sharply demar-

1nicroscopically it was a nonneoplastic fibromyxomatous information regarding the nature Of the lesion. The

CASE REPORT A 72-year-old black man was admitted with acute uri-

nary obstruction. On physical examination, in addition to prostatic hypertrophy, an 8 X 6-cm soft tissue mass involving the right hemiscrotum was palpated. The pa- tient stated that the lesion had been present for many years and had not caused any problem. The lesion was slightly indurated, nontender, and separate from the tes- ticle. The overlying skin surface was free of erythema, evidence of infection, or sinus tracts.

The patient underwent a transurethral prostatic resec: tion revealing benign prostatic hyperplasia. The scrotal mass was excised revealing soft, gray-white, somewhat gelatinous tissue occupying the dermis and subcutaneous tissue of the scrotal skin (Fig. 1). Several fluid-filled cysts, 2-8 mm in size, were noted on the cut surface. There was no hemorrhage or necrosis. The skin surface was intact.

Microscopically (Fig. 2), the lesion showed multiple ill-defined cystic spaces filled with basophilic myxoid material. The myxomatous areas contained cells with spindle- to oval-shaped nuclei showing no atypism or

@ 1984 Alan R. Liss, Inc.

DISCUSSION Review of the English literature reveals only a few

benign fibroblastic mesenchymal tumors of the scrotum variously reported as fibroma [ 11. myxofibroma [2], myxoma [3,4]. and lipomyxofibroma [ 5 ] . These tumors are slow-growing painless masses which on excision are usually well circumscribed or encapsulated with a lobu- lated cut surface. The tumor may be firm and rubbery because of the presence of fibroblasts and collagen as in fibroma and fibromyxoma. The myxomas are soft and translucent and are composed of homogeneous fibrillary matrix containing small spindle or star-shaped cells. These tumors are usually cured by surgical excisions; however, myxomas may recur.

The gross appearance of the scrotal mass that we de- scribed resembled that of a myxoma or a fibrornyxoma.

Accepted for publication November 21, 1983. Address reprint requests to D. Sarrna, MD. 1601 Perdido Street, New Orleans, LA 70146.

Pseudotumor of the Scrotum

Fig. 1 . Cut surface showing lobular. glistening tissue with cystic areas

Fig. 2. collagen blending with the myxoid tissue. H&E, X 100.

Myxoid matrix containing few cells with oval or spindle nuclei. Note the thick

118 Sarma, Weilbaecher, and Wiener

Fig. 3 tissue. H&E. X 100.

Sheletal muscle bundles and foci of chronic inflammation blending with myxomatous

However, microscopic appearance of the lesion showing presence of hypertrophic dartos muscle bundles and foci of chronic inflammation mixed with myxomatous and fibrous tissue indicate a nonneoplastic process. Though no specific etiology could be determined, the lesion is probably due to chronic inflammation leading to fibrosis with subsequent myxomatous degeneration.

ACKNOWLEDGMENTS We thank Ms. Karen Dunn for excellent secretarial

help.

REFERENCES 1 . Kretschmer HL: Fibroma of the scrotum. JAMA 1?2:143-144.

2. Rogers H: Large intrascrotal myxotibroma. Br J Surg 35:323-

3. Summers JE: Sciatic hernia. Ann Surg 75:672-676, 1922. 4. Menville JG: Primary inyxoma of scrotum. J Urol 32:125-129,

5 . Livcrniorc GR: Lipo-myxo-fibroma of scrotum; report of a case.

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