A Patient Presenting with Concurrent Testis Torsion and Epididymal Leiomyoma

Leiomyomas are the second most common tumors of epididymis. Patients with leiomyomas are sometimes misdiagnosed with testicular tumors. A Case of a patient with a scrotal mass presenting with testicular torsion is reported. Concurrent occurrence of testicular torsion and epididymal leiomyoma is an extremely rare condition. 1. Introduction Leiomyomas may arise from any tissue that contains smooth muscle. In genitourinary system, their most common locations are mentioned to be uterus and renal capsule [1]. Epididymal leiomyomas are well-defined intrascrotal tumors with a fibrous capsule [1]. Although they are slowly growing tumors which tend to occur in adult age, patients with young age have been reported [1, 2]. These rare benign intrascrotal tumors may lead to orchiectomies because of suspicion of testicular malignity. However, testis torsion due to these paratesticular tumors has never been reported. 2. Case Report A 42 year-old man presented to emergency department because of sudden left scrotal pain and a scrotal mass. He stated that he had had the mass for one year but the pain had started 4 hours ago and gradually increased. He defined the pain as sharp and continuous in nature which radiated to left inguinal region. Past medical history of the patient was unremarkable. Physical examination revealed a tender, erythematous right scrotum with a nontransilluminating mass of 4？cm which was contiguous to testis. Routine laboratory tests, including total blood count, blood biochemistry, and urinalysis showed no pathologic results. Testicular tumor markers (alfa-fetoprotein, beta human chorionic gonadotropin) were also evaluated owing to the palpated testicular mass. However, the results were within normal limits. Scrotal doppler ultrasonography assessment indicated findings consistent with a solid scrotal mass and concurrent testis torsion but the origin of the mass, whether testis or epididymis, could not be delineated. The patient was informed and prepared for an operation with the prediagnosis of testicular torsion and testis tumor. An inguinal approach was preferred for observation of testis and paratesticular structures. On gross examination during operation the mass was observed to be fixed to both testis and epididymis and radical orchiectomy was performed. Gross pathological examination revealed a white mass in which a whorled pattern could be easily observed on the cut surface (Figure 1). Microscopic evaluation of the material showed interlacing uniform spindle cells without cellular atypia or mitosis (Figure 2). The materials were also desmin