Rare presentation of paratesticular tumour in a teenager
The present case has been reported in the journal Urology Case Reports.

A fourteen-year-old male, with previous history of a surgically corrected proximal hypospadias. In the setting of an investigation for delayed onset puberty, a high left testicle was identified. On scrotal ultrasound, an inguinal left testicule was recognized, with normal morphology but smaller than the contralateral (18mm vs 21mm) and with small venous ectasias, the right testicle was normal. Pre-pubertal endocrinal profile was normal. He was proposed for a left orchidopexy.

On inguinal exploration, a small left testicule with a yellow-brown coloration was found, with epididymis-testicular dissociation and a homolateral varicocele (Fig. 1). No mass could be individualized from the testicule macroscopically therefore, to avoid an unnecessary orchidectomy in a patient with delayed puberty onset, a testicular biopsy was made before the orchidopexy was performed.

Histopathological analysis from frozen section showed a normal testicule and a paratesticular lesion suggestive of a benign adenomatoid tumour, with fibrous stroma, small cells with round nuclei, without atypia or mitosis, with vacuolated cytoplasm. Immunohistochemistry tests were positive for cytokeratin AE1/AE3, calretinin and beta-catenin and negative for CD34, S100, desmin, CD68 and CD45. Post-operative tumour markers were negative.

In the setting of microscopic disease without an identifiable macroscopic mass, excluding the possibility of a testicle sparing surgery, a conservative approach was chosen. He remains under Pediatric Urology surveillance without identifiable paratesticular mass on physical examination and ultrasound, at one-year of follow-up.

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