Fibrothecoma of the Right Testis in a 44-year-old at the Tamale Teaching Hospital, Ghana: A Case Report.

Abstract

Purpose: Fibrothecomas, a subset of sex cord-stromal tumors, represent 4-5% of all gonadal neoplasms and are typically benign. These tumors predominantly affect the ovaries in post-menopausal women but have also been reported in the testes. Testicular fibrothecomas are rare, presenting as painless masses and often discovered incidentally. Their diagnosis requires a multidisciplinary approach due to their nonspecific clinical presentation and rarity.

Methodology: We present a case of a 44-year-old man with chronic kidney disease who developed a progressively increasing, painful right scrotal swelling over six months. Upon examination, a firm, non-tender mass was found in the right testis. Diagnostic assessments revealed normal blood counts, significant renal impairment, and tumor markers suggestive of a non-seminomatous germ cell tumor. Ultrasound indicated a right testicular tumor with hydrocele. A right radical inguinal orchiectomy was performed successfully, and histopathology confirmed a fibrothecoma of the right testis.

Findings: This case underscores the rarity and clinical significance of testicular fibrothecomas. These tumors are characterized histologically by spindle-shaped cells in storiform or fascicular patterns with variable collagen. Immunohistochemically, they are positive for inhibin, Melan-A, and SMA. Similar cases reported in the literature share characteristics with our case in terms of patient age, diagnostic findings, treatment methods, and outcomes. The benign nature of fibrothecomas suggests that a testis-sparing surgical approach could be considered to preserve testicular function in suitable cases.

Unique Contribution to Theory, Policy and Practice: Testicular fibrothecoma is a rare benign tumor that requires careful diagnostic evaluation for accurate diagnosis and treatment. This case highlights the importance of considering testicular tumors in differential diagnoses of scrotal swellings, particularly in patients with chronic medical conditions. Early diagnosis and appropriate surgical intervention are crucial for optimal outcomes. The rarity of these tumors emphasizes the need for thorough reporting to enhance understanding and management strategies.