adenomatoid tumors , although rare , are the most common tumors of the paratesticular tissues , accounting for approximately 30% of all paratesticular tumors . in men ,
they are located in the epididymis , testicular tunicae , and rarely , the spermatic cord with most arising in or adjacent to the lower or upper pole of the epididymis .
although benign in nature but because they are difficult to differentiate from testicular malignancy these men are often subjected to radical orchiectomy .
recently , some authors have tried to define the imaging characteristics of these tumors but since these tumors are rare and experience is limited imaging is still not considered as diagnostic .
we report a case that was diagnosed on the basis of clinical suspicion , biochemical investigations , fine - needle aspiration cytology findings and radiological tests and thereby high orchiectomy could be avoided .
a 52-year - old male presented with complaints of a painless nodule in right scrotal sac for last 2-years that was gradually but very slowly increasing in size .
there was no history suggestive of urinary infection , genitor - urinary tuberculosis or epididymo - orchitis .
examination revealed a pea - sized firm , well - marginated , smooth swelling present at the lower pole of testis but that could not be separated with epididymis .
scrotal ultrasonography revealed a solid mass at the lower pole of right testis that was relatively hyperechoic as compared to the testicular parenchyma [ figure 1 ] .
scrotal mri revealed a well - defined lenticular lesion at lower part of right testis .
the lesion displayed signals isointense to slightly hypointense on both t1- and t2-weighted images with adjacent hypointense band .
fine - needle aspiration from the mass revealed absence of malignant cells . in view of long clinical history , negative tumor markers ,
findings typical of adenomatoid tumor on sonography and mri , as reported previously , and absence of malignant cells on cytology local excision was performed under local anesthesia through inguinal incision . at exploration
scrotal ultrasonography shows a solid mass at the lower pole of righttestis that was relatively hyperechoic as compared to the testicular parenchyma scrotal mri shows a well - defined lenticular lesion at lower part of right testis .
the lesion displays signals isointense to slightly hypointense on both t1 and t2-weighted images with adjacent hypointense band
most of these tumors have been present for several years and uniformly behave in a benign fashion .
cellular atypia and local invasion have been observed occasionally . nonetheless , because of the long history of these tumors and benign nature surgical excision is adequate .
a practical problem faced by clinicians is to differentiate this condition preoperatively from the much commoner testicular malignancy so as to avoid high inguinal orchiectomy especially in younger men . because of
the adenomatoid tumor does not produce any characteristic pattern on ultrasound that would allow it to be distinguished from malignant testicular tumors because they can be hypo , hyper or even isoechoic as regards the adjacent parenchyma .
it provides additional morphological evidence to allow precise localization of the origin of the mass , may also show contrast - enhancement features that enable further confidence of a benign diagnosis , and may allow conservative management .
however , in our case we were able to diagnose this condition after thorough evaluation and thereby could conserve the testis .
 paratesticular tumors are rare tumors that are difficult to diagnose preoperatively and therefore , many patients are subjected to inguinal orchiectomy . however , radical orchiectomy can be avoided as the diagnosis of paratesticular tumor can be made on the basis of clinical suspicion , findings of tumor markers and radiological tests . 
INTRODUCTION
CASE REPORT
DISCUSSION