Spermatic Cord and Paratesticular Tumors

Slide 1 · Spermatic Cord and

Paratesticular Tumors

Anatomic localization • morphologic diagnosis • clinical significance

Pathology lecture

Dr Abu Suraih Sakhri

MBBS, MD (Pathology)

www.abusuraihsakhri.com

Slide 2 · Learning outcomes

Localize a scrotal lesion to testis, epididymis, tunics, or spermatic cord.

Recognize spermatic-cord adipose pseudolesions and adenomatoid tumor.

Differentiate the principal malignant tumors by age and lineage.

Choose pathology investigations that preserve diagnostic confidence and avoid overtreatment.

Slide 3 · The paratesticular compartment

Spermatic cord

Contains vas deferens, vessels, nerves and connective/adipose tissue.

Epididymis

Extratesticular ductal structure adjoining posterior testis.

Tunics and adjacent fascia

Tunica vaginalis/albuginea and surrounding soft tissue harbor distinct lesions.

The paratesticular compartment

Cord

Testicular parenchyma

Epididymis

Tunical investment

Slide 4 · Why the anatomic site changes interpretation

Intratesticular mass

Solid intratesticular lesions prompt high suspicion for malignancy and a germ-cell–focused evaluation.

Extratesticular mass

Many lesions are benign, but site alone cannot exclude sarcoma or mesothelioma.

Slide 5 · Four questions for every scrotal mass

Where?

Intra- vs extratesticular; Epididymal, tunical, or funicular origin.

What tissue?

Fat, cystic fluid, fibrous stroma, mesothelial, or solid soft tissue.

How does it behave?

Discrete vs infiltrative; Small stable vs enlarging / heterogeneous.

What can pathology establish?

Morphology, lineage markers, molecular features and margin status.

Slide 6 · The basic diagnostic map

Benign / tumor-like

Spermatic-cord fat; Adenomatoid tumor; Fibrous pseudotumor; Leiomyoma.

Malignant

Rhabdomyosarcoma in children; Liposarcoma in adults; Rarer sarcomas and tunical mesothelioma.

Slide 7 · Age is a useful clue—not a diagnosis

Children and adolescents: Consider paratesticular rhabdomyosarcoma in a suspicious solid mass.

Adults: Consider liposarcoma and other soft-tissue sarcomas when the cord mass is large or enlarging.

Adenomatoid tumor and tumor-like lesions can occur across adult age groups.

Age informs the differential; Imaging and tissue findings establish the final diagnosis.

Slide 8 · Presentation can be deceptively indolent

Painless scrotal or inguinoscrotal swelling is a frequent presentation.

An incidental small epididymal nodule may be discovered during examination or ultrasound.

Cord adipose masses may simulate an inguinal hernia.

A painless course or slow growth does not reliably establish benignity.

Slide 9 · First-line localization: Ultrasound

Define site

Determine whether the mass originates inside or outside the testicular parenchyma.

Characterize

Document size, solidity/cystic nature, vascularity and relation to adjacent structures.

Escalate judiciously

Use MRI when lesion characterization or local extent remains indeterminate.

Slide 10 · What imaging cannot do alone

An extratesticular site raises the prior probability of benign disease but does not prove it.

Ultrasound appearances of several benign and malignant solid masses overlap.

Imaging can map fat and anatomic extent; Morphology and molecular tests can still be decisive.

When malignancy is plausible, planning should involve an appropriate surgical / sarcoma team.

Slide 11 · Cord “lipoma”: Terminology may mislead

Adipose masses of the proximal cord found at inguinal hernia operations.

Many are displaced or protruding retroperitoneal adipose tissue—not clonal adipocytic neoplasms.

A true localized lipoma is a separate possibility.

Always reconcile the macroscopic fatty lesion with the operative anatomy.

Slide 12 · How a cord fat pseudolesion arises

Retroperitoneal fat

Adipose tissue is continuous with proximal inguinal anatomy.

Protrusion into canal

Fat extends alongside the hernia sac or spermatic cord.

Apparent “lipoma”

Fatty tissue appears as a discrete lesion during hernia repair.

Native schematic: Anatomical continuity, not a histologic specimen.

Slide 13 · Why the distinction is not semantic

Non-neoplastic cord fat may not require a tumor-specific biological diagnosis.

Confusing fat protrusion with a distinct soft-tissue tumor can distort documentation.

Conversely, calling an enlarging atypical fatty mass a “lipoma” can miss liposarcoma.

Assess operative findings, gross features, histology and imaging together.

Slide 14 · The proximal inguinal mass differential

Fat continuity

Protruding retroperitoneal adipose tissue / hernia-associated fat.

Benign tumor

Conventional lipoma or another benign adipocytic neoplasm.

Malignant tumor

Atypical lipomatous tumor / well-differentiated liposarcoma, sometimes with dedifferentiation.

Slide 15 · When “fatty” should trigger further work-up

Large, deep, recurrent or progressively enlarging adipocytic mass.

Thickened fibrous septa or nonfatty nodular components on imaging / gross inspection.

Hyperchromatic atypical stromal cells or atypical septa histologically.

Concerning features favor deliberate sampling and, where indicated, MDM2 testing.

Slide 16 · Do not equate lipoblasts with liposarcoma

Lipoblast-like cells alone are not sufficient to assign a malignant adipocytic diagnosis.

Overall architecture and atypical stromal-cell population are important.

Benign mimics may include reactive atypia and vacuolated cells.

Molecular analysis helps selected equivocal deep-site tumors, but must be interpreted with morphology.

Slide 17 · Adenomatoid tumor: The key benign neoplasm

Mesothelial-derived benign tumor, emphasized by Robbins as the commonest benign paratesticular neoplasm.

Typically a small, well-demarcated lesion near the epididymis; Tunical and other locations occur.

Clinically important because accurate recognition permits local excision in suitable cases.

Do not label the lesion “mesothelioma” merely because it expresses mesothelial markers.

Slide 18 · Where an adenomatoid tumor may arise

Epididymis

Often near its head/upper testicular pole; Other locations including tail are reported.

Tunica albuginea / vaginalis

May abut or indent testis and mimic an intratesticular neoplasm.

Spermatic cord

Less common paratesticular location; Requires attention to the anatomical origin.

Slide 19 · Adenomatoid tumor: Gross recognition

Usually a small, solid, white-to-tan, firm, relatively well-circumscribed nodule.

The main diagnostic task is establishing its relation to epididymis and testicular parenchyma.

Gross appearance is not by itself specific for mesothelial differentiation.

Submit the interface with adjacent structures when the lesion is close to the testis.

Slide 20 · Adenomatoid tumor: The classic pattern

Tubules, cords, nests and slit-like or microcystic spaces of bland mesothelial cells.

Flattened to cuboidal cells may show conspicuous intracytoplasmic vacuoles.

Variable collagenized stroma frequently separates the cellular elements.

This architectural combination is more useful than any single isolated cell feature.

Adenomatoid tumor: The classic pattern

Conceptual microscopic pattern

Tubules / microcysts

Interconnected bland spaces lined by mesothelial cells

Vacuolated cytoplasm

May resemble endothelial or gland-like spaces

Schematic illustration — not a histologic specimen.

Slide 21 · Why the vacuoles matter

Intracytoplasmic vacuoles and attenuated cell borders can create pseudovascular or signet-ring–like appearances.

Look for bridging cytoplasmic strands and mesothelial-lined clefts in appropriate examples.

Bland chromatin and absent destructive malignant cytology favor a benign lesion.

Correlate the morphology with a lineage panel rather than interpreting a vacuole alone.

Slide 22 · Adenomatoid: Useful stromal clues

Dense fibrous or smooth-muscle–containing stroma may dominate some sections.

Lymphoid aggregates and focal inflammation may occur around tumor structures.

Other cases are more cellular, with relatively inconspicuous microcysts.

Overly restricted sampling can create a misleading spindle-cell or gland-forming differential.

Slide 23 · Mesothelial differentiation: A panel, not one stain

Frequently positive

Calretinin, WT1, pancytokeratin, D2-40/podoplanin; Expression varies by sample.

Interpretation

Combined cytomorphology, mesothelial immunophenotype and low-grade architecture support adenomatoid tumor.

Slide 24 · Exclusion markers are context-specific

SALL4 and other germ-cell markers help when a germ-cell tumor is morphologically plausible.

Inhibin may help distinguish selected sex cord–stromal tumors.

CD31 / CD34 support a vascular differential when pseudovascular spaces dominate.

Epithelial carcinoma panels and clinical context help evaluate possible metastasis.

Slide 25 · Adenomatoid vs sex cord–stromal mimic

Adenomatoid tumor

Mesothelial tubules, vacuoles; Keratin and WT1 usually positive; Inhibin often negative.

Sex cord–stromal tumor

Morphology and hormonal lineage markers differ; Calretinin may be shared and is NOT a discriminator alone.

Slide 26 · Adenomatoid vs metastatic carcinoma

Favor adenomatoid

Localized paratesticular mass, bland tubules/vacuoles, mesothelial markers and compatible architecture.

Favor carcinoma

Destructive atypical epithelium, relevant primary tumor history and an epithelial-marker profile supporting a site of origin.

Slide 27 · Adenomatoid vs malignant mesothelioma

A shared calretinin/WT1/D2-40 phenotype establishes lineage—not benign behavior.

Complex atypical growth, significant invasive malignant cytology, and clinical/radiologic extent warrant concern.

Interpret BAP1 or MTAP loss only as supplementary evidence in the correct context.

Malignant mesothelioma of tunica vaginalis is uncommon but clinically consequential.

Slide 28 · Frozen section: A management-changing step

Intraoperative question

Does a clearly localized mass show benign adenomatoid morphology?

If confidently benign

Local excision may preserve the testis rather than prompting orchiectomy.

If uncertain

Defer definitive classification; Avoid false reassurance on limited frozen material.

Slide 29 · Limits of frozen section

Crush, freezing artefact and limited sampling may obscure vacuoles and stromal relationships.

A rare malignant or mixed tumor can be underrepresented in a small sample.

Permanent sections allow fuller architectural assessment and immunohistochemistry.

The frozen-section report should explicitly communicate diagnostic confidence.

Slide 30 · Adenomatoid tumor: Clinical consequence

After confident histopathological confirmation, local excision is generally adequate.

Diagnosis may avoid removal of otherwise uninvolved testicular parenchyma.

The lesion is benign; Atypical morphology should prompt reassessment rather than automatic malignant labeling.

Careful localization and consultation matter most before irreversible surgery.

Slide 31 · Checkpoint: A classic epididymal nodule

An adult has a small, circumscribed, solid nodule adjacent to the epididymis.

H&E: Bland cords and pseudoglands in fibrous stroma, with conspicuous vacuoles.

IHC: Calretinin+, WT1+, keratin+; No compelling atypical malignant features.

Interpretation: Adenomatoid tumor; Preservation of testis can be considered when anatomically feasible.

Slide 32 · Fibrous pseudotumor: A neoplastic mimic

Benign fibrosing mass or multinodular process, often related to the testicular tunics.

H&E may show dense hyalinized collagen with scattered fibroblasts and inflammation.

Prior inflammation, trauma or hydrocele may be part of the clinical history.

Its firmness and irregular surface can imitate malignancy despite benign biology.

Slide 33 · Fibrous pseudotumor and IgG4

Some lesions show lymphoplasmacytic inflammation and increased IgG4-positive plasma cells.

An IgG4-rich infiltrate alone does not establish systemic IgG4-related disease.

Evaluate morphology and systemic context; Do not force all fibrous pseudotumors into one etiology.

Tissue preservation may be possible after an accurate diagnosis.

Slide 34 · Leiomyoma: A smooth-muscle benign lesion

An uncommon epididymal or cord neoplasm may form interlacing bland smooth-muscle bundles.

Elongated nuclei, eosinophilic cytoplasm and low proliferative activity support benignity.

SMA, desmin and h-caldesmon may support smooth-muscle lineage.

Exclude atypia, necrosis, mitotic activity and infiltration suggestive of leiomyosarcoma.

Slide 35 · Papillary cystadenoma: A separate epididymal pattern

Usually a cystic/papillary epithelial neoplasm rather than a solid mesothelial tumor.

Papillary clear-cell morphology should not be mistaken for adenomatoid vacuoles.

Consider von Hippel–Lindau context, especially with bilateral epididymal lesions.

Pathologic lineage and clinical context distinguish it from metastatic clear-cell renal carcinoma.

Slide 36 · Benign lesions: Decisive differentiators

Adipose pseudolesion

Mature fat anatomically continuous with retroperitoneal tissue.

Adenomatoid tumor

Bland mesothelial tubules/cords and cytoplasmic vacuoles.

Fibrous pseudotumor

Hypocellular hyalinized collagen with inflammatory features.

Leiomyoma

Bland intersecting smooth-muscle fascicles.

Slide 37 · Malignant lesions: Organize by lineage

Skeletal-muscle lineage

Rhabdomyosarcoma; Particularly relevant in childhood.

Adipocytic lineage

Well-differentiated / dedifferentiated liposarcoma; Adult cord tumors.

Smooth-muscle lineage

Leiomyosarcoma; Less common adult paratesticular sarcoma.

Mesothelial lineage

Malignant mesothelioma of tunica vaginalis.

Slide 38 · Paratesticular rhabdomyosarcoma

The childhood counterpart emphasized among malignant paratesticular neoplasms.

Usually presents as a suspicious paratesticular or spermatic-cord solid mass.

Morphology and skeletal-muscle lineage markers establish diagnosis.

Final risk assessment incorporates anatomical extent and molecular subgroup—not histology alone.

Slide 39 · Rhabdomyosarcoma: Microscopic clues

Embryonal forms may show primitive round-to-spindle cells in variable myxoid stroma.

Rhabdomyoblasts, when present, have elongated/straplike or eosinophilic cytoplasm.

Cellularity, atypia, mitotic activity and necrosis vary by subtype and sampling.

Morphology requires immunophenotypic confirmation in diagnostically difficult tumors.

Rhabdomyosarcoma: Microscopic clues

Conceptual microscopic pattern

Primitive mesenchymal cells

Round-to-spindle cells with variable atypia

Myogenic differentiation

Strap-shaped rhabdomyoblasts may be present; Confirm with nuclear myogenin / MYOD1

Schematic illustration — not a histologic specimen.

Slide 40 · Myogenic differentiation on immunohistochemistry

Desmin supports muscular lineage but is not specific for rhabdomyosarcoma.

Nuclear myogenin and/or MYOD1 support skeletal-muscle differentiation.

Staining pattern must be interpreted with age, site, morphology and controls.

Exclude non-rhabdomyoblastic spindle/round-cell lesions with a differential-driven panel.

Slide 41 · Molecular subtype changes interpretation

Fusion-negative RMS

Includes most embryonal rhabdomyosarcomas; Heterogeneous alterations.

FOXO1 fusion–positive RMS

Usually PAX3::FOXO1 or PAX7::FOXO1; Key prognostic/risk variable.

Spindle/sclerosing spectrum

MYOD1 variants or VGLL2/NCOA2 rearrangements in relevant subgroups.

Slide 42 · Why “alveolar” histology is not enough

FOXO1 rearrangement refines classification and risk stratification.

Fusion-negative alveolar-appearing tumors may biologically resemble embryonal disease.

Use validated molecular testing when subtype is clinically relevant.

Avoid assigning prognosis from a pattern on one tissue section.

Slide 43 · Rhabdomyosarcoma: Pathology and staging interface

Identify precise origin and extent along cord/epididymis and proximity to inguinal canal.

Document involvement of adjacent testis, tunics, scrotal soft tissue and margins.

Communicate regional node concerns to the treating multidisciplinary team.

Age, site, size, nodal status and FOXO1 status contribute to overall risk assessment.

Slide 44 · Pediatric operative principles are specialist-led

When a paratesticular sarcoma is strongly suspected, operative approach is part of staging and local control.

NCI describes inguinal orchiectomy with spermatic cord resection for appropriate paratesticular primaries.

The need for regional nodal assessment depends on risk features and treatment protocol.

Pathology should not imply a single universal intervention for every patient.

Treatment details here are supplementary NCI guidance, not from the Robbins paratesticular excerpt.

Slide 45 · Rhabdomyosarcoma: Applied interpretation

An adolescent has a rapidly enlarging extratesticular mass extending toward the inguinal canal.

Primitive spindle/round cells infiltrate soft tissue; Desmin and nuclear myogenin are positive.

Diagnosis: Rhabdomyosarcoma; Pursue subtype / molecular clarification as indicated.

Report local extent and margin relationships for specialist risk assessment.

Slide 46 · Liposarcoma: The adult cord malignancy

Liposarcoma as a leading malignant paratesticular tumor in adults.

Usually an inguinoscrotal soft-tissue/adipocytic mass that may masquerade as a hernia or lipoma.

Classification requires attention to adipocytic atypia and dedifferentiation.

Location makes complete excision and local recurrence particularly important.

Slide 47 · Well-differentiated liposarcoma: Architecture

Mature adipocytes with variation in size and fibrous septa.

Atypical hyperchromatic stromal cells, sometimes multinucleated, may be scattered or focal.

Lipoblasts can be seen but are neither mandatory nor independently diagnostic.

Broad sampling is necessary when large fatty lesions are heterogeneous.

Well-differentiated liposarcoma: Architecture

Conceptual microscopic pattern

Varying adipocyte size

Mature adipose cells; Enlarged or variable septa

Atypical septal nuclei

Scattered hyperchromatic stromal cells require deliberate sampling

Schematic illustration — not a histologic specimen.

Slide 48 · Dedifferentiated liposarcoma: What changes?

A nonlipogenic sarcomatous component occurs in association with WDL-like tissue or its molecular background.

Microscopy may show higher-grade spindle/pleomorphic tumor or a lower-grade-appearing component.

Dedifferentiation introduces metastatic potential beyond well-differentiated liposarcoma.

Image-guided and gross sampling should target nonfatty, solid areas.

Slide 49 · MDM2 amplification: A biological marker

WDL and DDL commonly harbor amplification of 12q13–15 material including MDM2 (often CDK4).

MDM2 amplification by FISH is valuable in selected histologically equivocal adipocytic masses.

This is a diagnostic adjunct, not a stand-alone assessment of grade or local extent.

Interpret molecular results in the precise sampled lesion and morphologic context.

MDM2 amplification: A biological marker

Amplified chromosomal region: 12q13–15

MDM2

CDK4

HMGA2

Diagnostic role

MDM2 amplification supports WDL/DDL in an appropriate histologic and clinical context.

Interpretation limit

Amplification status does not itself define grade, tumor extent or local resectability.

Schematic: Selected loci, not a scaled chromosome map.

Slide 50 · MDM2 IHC is not equivalent to amplification

Immunostaining may show nuclear MDM2/CDK4 in lesional atypical stromal cells.

Sensitivity is limited in subtle, sparsely atypical lesions; Occasional false positives occur.

FISH for amplification may be more reliable than IHC in a challenging benign-vs-WDL differential.

Use selective testing and verify whether the sample actually contains diagnostic atypical cells.

Slide 51 · Lipoma vs well-differentiated liposarcoma

Lipoma / cord fat

Mature adipose tissue; No diagnostic stromal atypia; Hernia-related continuity may be present.

WDL

Atypical hyperchromatic septal stromal cells; Variable thick septa; Often MDM2 amplified.

Slide 52 · WDL vs dedifferentiated liposarcoma

Well differentiated

Locally recurrent potential; Does not metastasize without dedifferentiation.

Dedifferentiated

Contains sarcomatous nonlipogenic tissue; Metastatic risk and local recurrence are greater.

Slide 53 · Liposarcoma specimen: What to sample?

Orient the spermatic-cord / soft-tissue specimen and ink relevant surfaces as appropriate.

Map adipocytic, fibrous, and any firm nonadipocytic components.

Sample mass-to-cord, testis and adjacent tissue interfaces; Inspect margin proximity.

Document any dedifferentiated component, necrosis and lymphovascular invasion if identified.

Slide 54 · Leiomyosarcoma: The smooth-muscle malignancy

Uncommon paratesticular sarcoma, including spermatic-cord and epididymal examples.

Atypical eosinophilic spindle cells grow in intersecting fascicles.

Mitotic activity, atypical mitoses, tumor necrosis and infiltrative growth support malignancy.

SMA, desmin and h-caldesmon help establish lineage; No one stain is absolute.

Slide 55 · Mesothelioma of the tunica vaginalis

Rare malignant tumor arising from mesothelial lining of paratesticular tunics.

Papillary, tubulopapillary, solid or biphasic morphologies may overlap benign mesothelial lesions.

WT1, calretinin and cytokeratins support mesothelial lineage but are not markers of malignancy.

Assess destructive growth, cytologic features and ancillary findings in clinical context.

Slide 56 · BAP1 and MTAP: Interpret absences carefully

Loss of BAP1 or MTAP may support malignant mesothelial proliferation in relevant cases.

Tunica vaginalis mesotheliomas can retain these markers: Sensitivity is not sufficient to rule out malignancy.

Retained expression is NOT proof that a lesion is an adenomatoid tumor.

Integrate histology, morphology, immunophenotype and expert review.

Slide 57 · Other malignant considerations

Additional rare soft-tissue sarcomas arise in the paratesticular region.

A mass may secondarily extend from testis or represent metastasis from an extratesticular primary.

Clinical history, imaging and a broad morphologic survey shape the work-up.

For unusual patterns, expert genitourinary/soft-tissue pathology consultation improves reliability.

Slide 58 · The differential in one table

Entity

Dominant pattern

Discriminating adjunct

Adenomatoid

Bland vacuolated mesothelial tubules

Calretinin / WT1; architecture

Rhabdomyosarcoma

Primitive myogenic round/spindle cells

Myogenin / MYOD1; FOXO1 when relevant

WDL/DDL

Adipocytic atypia ± nonlipogenic sarcoma

MDM2 amplification

Leiomyosarcoma

Atypical smooth-muscle fascicles

SMA / desmin / h-caldesmon

Slide 59 · Histology must be linked to surgical anatomy

Confirm extratesticular origin whenever possible; The testis may be compressed or secondarily involved.

Correlate with imaging and operative description before assigning the organ of origin.

A “testicular mass” label at accession does not prove intratesticular tumor origin.

Preserve orientation and document relationship to cord and surgical margins.

Slide 60 · A diagnostic decision sequence

Localization

Confirm extra- vs intratesticular origin and identify the involved structure.

Morphologic lineage

Mesothelial, adipocytic, muscular, fibrous or other pattern.

Targeted ancillaries

IHC, amplification/fusion testing or additional sampling when indicated.

Slide 61 · Pathology report: Minimum high-value elements

Anatomic site and histologic entity, with uncertainty transparently stated.

Tumor size, grade when applicable, and relevant molecular diagnostic findings.

Extent and involvement of testis, epididymis, tunics, cord and adjacent soft tissue.

Margin assessment with anatomical orientation and limitations of specimen sampling.

Slide 62 · Case exercise: Preserve or remove testis?

Circumscribed epididymal nodule; Testicular parenchyma separately identifiable.

Frozen: Bland mesothelial tubes and vacuolated cells; No destructive malignant features.

Question: What diagnosis can support testis-sparing excision?

Answer: Confident adenomatoid tumor identification, with permanent-section correlation.

Slide 63 · Case exercise: The recurrent “lipoma”

Older adult with a recurring inguinoscrotal fatty mass after prior surgery.

Multiple thick fibrous septa and focal atypical hyperchromatic stromal cells are present.

Question: Which molecular result could support WDL over lipoma?

Answer: MDM2 gene amplification, interpreted with the histologic findings.

Slide 64 · Case exercise: Pediatric spindle-cell mass

Child with an enlarging extratesticular mass; Small atypical spindle/round cells.

Tumor shows desmin and nuclear myogenin immunoreactivity.

Question: What lineage is supported, and what molecular issue may matter?

Answer: Rhabdomyoblastic differentiation; Assess clinically relevant RMS subgroup / FOXO1 status.

Slide 65 · Five avoidable diagnostic errors

Assuming every paratesticular mass is benign because it is outside the testis.

Calling retroperitoneal cord fat a neoplastic lipoma without assessing anatomy.

Using calretinin positivity alone to diagnose a benign adenomatoid tumor.

Equating MDM2 IHC positivity with proven gene amplification.

Failing to sample firm, nonfatty areas in a suspicious adipocytic mass.

Slide 66 · Integrated clinicopathologic summary

Adult, small epididymal nodule

Think adenomatoid tumor; Histology + mesothelial IHC may enable conservation.

Cord fat during hernia repair

Determine if it represents contiguous retroperitoneal fat rather than neoplasm.

Child with enlarging cord mass

Consider rhabdomyosarcoma; Myogenic pathology and risk stratification.

Adult atypical fatty mass

Consider liposarcoma; Sample heterogeneous areas and assess MDM2 when needed.

Slide 67 · What the lecture should change in practice

Localization is the beginning of diagnosis, not its endpoint.

Know the three Robbins anchors: Cord fat, adenomatoid tumor and age-linked sarcomas.

Target ancillary investigations to the relevant histologic differential.

The correct diagnosis can either preserve a testis or prevent undertreatment of malignancy.

Slide 68 · Selected reference sources

Robbins, Cotran & Kumar. Pathologic Basis of Disease. 11th ed. 2026.

Ulbright et al. Morphological approach to tumours of the testis and paratestis. J Clin Pathol. 2007; PMCID: PMC1994505.

NCI. Childhood Rhabdomyosarcoma Treatment (PDQ), current online clinical summary.

Well-differentiated and dedifferentiated liposarcoma review. PMID: 30852045.

Mesothelial lesions of the testis review. PMID: 41582881.