PMC10450914_01
The enhanced CT scan reveals patchy fat density shadows on the left scrotum. (A) Axial view. (B) Front view. (C) Side view.
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Pelvic CT plain scan and enhancement showed a left inguinal hernia, with content being a small amount of mesenteric fat tissue in the left inguinal region., a mass-like fatty density lesion was seen in the left testicle, which was considered to be a vascular muscle adipose tumor or a fatty tumor ( Figures 1A-C ).
(A) A fatty tumour in the left inguinal region that surrounded the testicular vein and spermatic cord. (B) Preserve the spermatic cord and testicles. (C) The tumor envelope is intact, with some areas nodular, greyish-yellow in texture and soft.
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During the surgery, the laparoscopic exploration excluded an inguinal hernia, while the testicular exploration revealed a fatty tumour in the left inguinal region that surrounded the testicular vein and spermatic cord ( Figure 2A ). The tumour was then resected completely ( Figure 2B ). The gross pathological examination showed a 18 x 8 x 5 cm tumour ( Figure 2C ), the tumor envelope is intact, with some areas nodular, greyish-yellow in texture and soft.
(A) HEx200, the tumor is composed of mature fat, with thin-walled capillaries visible in the stroma. (B) HEx400, high magnification display of enlarged nuclei and atypical adipocytes. (C) S-100 immunohistochemistry shows positive tumor nuclei and cytoplasm. (D) P16 immunohistochemistry showed positive cytoplasm of tumor cells. (E) WDLPS MDM2 FISH: MDM2/CSP12: 9.10, MDM2 mean copy number: 18.20.
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The pathological examination showed well-differentiated adipocytes in most of the tumour, with a few cells showing slightly abnormal nuclei ( Figures 3A, B ). MDM2 gene amplification was detected in the molecular pathological examination ( Figure 3E ). Immunohistochemical findings: S-100 (+) ( Figure 3C ), P16 (marked 2 places, all+) ( Figure 3D ), P53 (-), Ki67 (<1%), CD34 (partially+).