Annals of Diagnostic Pathology 50 (2021) 151658 Available online 5 November 2020 1092-9134/© 2020 Elsevier Inc. All rights reserved. Original Contribution Paratesticular tumors. A clinicopathological study from a single tertiary hospital in North India Preethi A.M. Paul a, * , Nalini Calton a , Sarah Arnestina a , Kim J. Mammen b a Department of Pathology, Christian Medical College and Hospital, Ludhiana, Punjab, India b Department of Urology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India A R T I C L E INFO Keywords: Adenomatoid tumor Cellular angiofbroma Malignant mesothelioma Paratesticular tumor Rhabdomyosarcoma ABSTRACT Objective: Paratesticular tumors (PTT) are rare and form a heterogenous group, ranging from benign to malignant high grade sarcomas. This study was undertaken to describe the clinicopathological spectrum of PTTs received over a 20-year period. Methods: All primary and secondary PTTs diagnosed from 2000 to 2019 in the pathology department of a tertiary care hospital in North India were retrospectively reviewed. Gross, histopathological features and immunohis- tochemistry (IHC) fndings were correlated with clinical details. Results: A total of 169 intra-scrotal tumors were diagnosed during the study period, out of which there were 30 PTTs (in 27 patients) comprising 17.75%. Age range was 4 to 85 years (median 58 years). Benign PTTs were the commonest (n = 21, 70%), followed by metastasis to the paratesticular region (n = 6, 20%) and then primary malignant PTTs (n = 3, 10%). The commonest benign PTT was lipoma (n = 16, 76.19%), followed by adeno- matoid tumor (n = 3, 14.28%) with one case each (4.76%) of cellular angiofbroma and hemangioma. Among primary malignant PTT, there were two cases of rhabdomyosarcoma, and one case of biphasic malignant me- sothelioma. Metastatic tumors included four cases of prostatic adenocarcinoma, and one case each of pancreatic signet ring cell carcinoma and clear cell renal cell carcinoma. Conclusion: PTTs show a wide clinicopathological spectrum. Benign PTTs are commoner than malignant PTTs. Meticulous grossing and histopathological examination supplemented by IHC is essential for an accurate diag- nosis of this heterogenous class of tumors, which infuences the role of adjuvant therapy and patient prognosis. 1. Introduction Paratesticular tumors (PTTs) form a heterogenous group of rare tu- mors. The paratesticular (PT) region consists of the testicular collecting system, epididymis, spermatic cord, testicular tunics and remnants of the embryonic Müllerian and Wolffan ducts, hence a variety of epithelial, mesothelial and mesenchymal elements are encountered here [1]. Among these, soft tissue neoplasms are the commonest and account for 52% [2]. An estimated 70% of PTTs are benign, the commonest being lipoma and adenomatoid tumor [3]. Malignant PTTs account for around 30% of all PTTs. The common PT sarcomas are rhabdomyosarcoma (RMS) and leiomyosarcoma [4,5]. Malignant mesothelioma (MM), epididymal and rete testis adenocarcinoma have also been described [6]. Tumors from distant sites may rarely metastasize to the PT region [7]. This study was undertaken to describe the clinicopathological spectrum of PTTs often described as case reports in literature. 2. Patients and methods 2.1. Patients All cases diagnosed as PTTs, primary and secondary, over a period of 20 years (2000 to 2019) in the department of pathology of a tertiary care hospital were retrospectively reviewed, described and classifed ac- cording to the fourth edition of World Health Organization (WHO) classifcation of testicular and PT tumors [6]. The study protocol was approved by the Institutional Research Committee. Tumor-like lesions and cysts of the PT region, and tumors arising from the scrotal skin and skin appendages were excluded from this study. * Corresponding author at: Dept of Pathology, Christian Medical College & Hospital, Brown Road, Ludhiana 141008, Punjab, India. E-mail address: paulpreethi123@gmail.com (P.A.M. Paul). Contents lists available at ScienceDirect Annals of Diagnostic Pathology journal homepage: www.elsevier.com/locate/anndiagpath https://doi.org/10.1016/j.anndiagpath.2020.151658