a 71-year - old man visited us with a chief complaint of a 1-year history of a mass in the right scrotum .
the patient had a 15-year - history of stroke and hypertension , for which he was receiving medical treatment .
the patient also had an 8-year - history of hypertensive end - stage renal disease , for which he was receiving hemodialysis three times a week .
on the physical examination at the time of admission , a hard , painless mass was palpated in the right scrotum that could not be differentiated from the testis . on hematology ,
tumor markers such as alpha - fetoprotein , beta - human chorionic gonadotropin , and lactate dehydrogenase were all found to be normal .
scrotal ultrasonography showed a giant mass of 12 cm in size in the right scrotum .
abdominal computed tomography scans showed a solid , contrast - enhanced mass in the right scrotum .
we suspected that a tumor had developed in the scrotum and made an incision in the right scrotum with the patient under spinal anesthesia .
we identified a tumor that was definitely separated from the right testicle and excised it .
the removed tumor was 13106 cm in size and had an oval shape ; it was encapsulated and its cross - section was composed of white mucoid components .
the sporadic presence of a solid part was confirmed , but there was no concurrent necrosis or bleeding inside .
small and medium - sized blood vessels were shown under light microscopy . in the adjacent area ,
two months postoperatively , the patient is currently being followed up in an outpatient setting and has had no local recurrence .
embryologically , various tissues such as the epithelium , mesothelium , and other tissues are derived from the mesoderm in the scrotum . for this reason ,
these tumors have different biological characteristics , for which a differential diagnosis between benign and malignant tumors and an accurate diagnosis can not be easily made . of the tumors occurring in the scrotum ,
angiomyofibroblastoma was first described by fletcher et al in 1992 , which is a tumor that occurs rarely in the reproductive system of middle - aged women .
it particularly occurs in the vulva , labium major , vagina , areas around the clitoris , and perineal region . despite a lower rate of local recurrence
, it has histopathological characteristics that are similar to those of cellular angiofibroma and infiltrative angiomyxoma .
histopathologically , there is a mixed presence of hypocellular or multi - cellular regions and the cellular morphology is diverse .
besides , there is also a mixed presence of spindle - shaped cells , satellite cells , epithelioid cells , and locally polygonal cells .
these cells are arranged around the blood vessels or epithelioid - shaped regions and are accompanied by the clear presence of myofibroblastic differentiation .
eight cases have been reported in the vulva of female patients in korea . to date , however , no cases have been reported in male patients .
compared with the angiomyofibroblastoma - like tumors that occur in women , those occurring in male patients are seen in elderly people and have immunohistochemical differences .
histopathologically , the cellular matrix of an angiomyofibroblastoma - like tumor is more dense and is abundant with collagen .
immunohistochemically , in more than half of the reported cases , tumor cells are positive for cd34 and are various for desmin . however , they are negative for s-100 protein . in the present case ,
because of the presence of histopathological characteristics that are similar to those of angiomyofibroblastomalike tumors , a differential diagnosis of infiltrative angiomyxoma can not be easily made .
an accurate diagnosis is therefore mandatory . to date , only a small number of cases of angiomyofibroma and infiltrative angiomyxoma have been reported .
it is assumed , however , that local surgical removal will be sufficient for a complete recovery .
angiomyofibroblastoma - like tumors occurring in male patients have not been reported in korea until now , and their incidence is extremely low . despite the presence of benign findings on histopathology , in cases in which such tumors occur in the scrotum , both a surgical removal and a histopathologic examination are mandatory for a differential diagnosis .
furthermore , in cases of infiltrative angiomyxoma , for which the histopathologic findings are similar , a meticulous monitoring of local recurrence is essential .
an appropriate follow - up observation of the long - term clinical course after the surgery is also essential .
 various tumors can occur in the scrotum . of them , 
 angiomyofibroblastoma - like tumors are very rare mesenchymal tumors . 
 angiomyofibroblastoma - like tumors can not be easily differentially diagnosed from other malignant tumors invading the male genital tract on the basis of clinical characteristics and imaging study . 
 therefore , surgical removal and a histopathologic diagnosis must also be performed . 
CASE REPORT
DISCUSSION