Tsili et al. Journal of Medical Case Reports 2011, 5:169 http://www.jmedicalcasereports.com/content/5/1/169 C A S E R E P O R T JOURNAL OF MEDICAL CASE REPORTS Open Access Conventional and diffusion-weighted magnetic resonance imaging findings of benign fibromatous paratesticular tumor: a case report Athina C Tsili1*, Maria I Argyropoulou1, Dimitrios Giannakis2, Nikolaos Sofikitis2 and Konstantine Tsampoulas1 Abstract Introduction: The vast majority of paratesticular masses are benign. Magnetic resonance imaging of the scrotum may provide valuable information in the pre-operative work-up of scrotal masses, by allowing the precise localization of the lesion and helping in characterizing its nature. Diffusion-weighted magnetic resonance imaging is an evolving technique that can be used to improve tissue characterization, when interpreted with the findings of conventional magnetic resonance sequences. We present the case of an adenomatoid tumor of the tunica albuginea, with abundant fibrosis evaluated by magnetic resonance imaging of the scrotum, including both conventional and diffusion-weighted sequences. To the best of our knowledge, there are very few reports in the English literature regarding the magnetic resonance imaging features of this rare benign paratesticular tumor and no report on the diffusion-weighted magnetic resonance findings. We discuss the value of magnetic resonance imaging in the pre-operative diagnosis of benign fibromatous paratesticular tumors and differential diagnosis. Case presentation: A 45-year-old Caucasian man was referred to us with a palpable left scrotal mass. Magnetic resonance imaging of his scrotum revealed the presence of a multilobular left paratesticular mass, mainly detected with very low signal intensity on T2-weighted images and restricted diffusion on apparent diffusion coefficient maps. These findings were suggestive of a fibrous component, and were confirmed on histology following lesion excision. Conclusion: Magnetic resonance imaging of the scrotum, by using both conventional and diffusion-weighted sequences, could have a potential role in the evaluation of scrotal masses. Introduction Determining the accurate location of a scrotal mass, whether intratesticular or paratesticular is extremely important pre-operatively, to ensure adequate treatment planning. Most paratesticular masses are benign, there- fore radical orchiectomy may be obviated [1,2]. Mag- netic resonance imaging (MRI) of the scrotum may represent a useful diagnostic tool for the morphologic assessment and tissue characterization in the pre-surgi- cal work-up of scrotal masses [1,2]. Adenomatoid tumors are benign mesothelial neo- plasms, accounting for approximately 30% of all parates- ticular neoplasms [1-4]. The majority (77%) of these * Correspondence: a_tsili@yahoo.gr 1Department of Clinical Radiology, University Hospital of Ioannina, Leoforos S Niarchou, 45500, Ioannina, Greece Full list of author information is available at the end of the article tumors arise from the epididymis. They may also arise from the testicular tunica (14%) and, less often, from the spermatic cord and the testicular parenchyma [1-4]. We present a case of an adenomatoid tumor of the tunica albuginea, with abundant fibrotic component, evaluated by conventional and diffusion MRI. Case presentation A 45-year-old Caucasian man presented to our Urology department with a palpable left scrotal mass, known for two years, which had progressively enlarged during the last three months. He reported no history of epididymi- tis, torsion or trauma. On clinical examination the mass was painless, firm and mobile. His serum tumor mar- kers, including alpha-fetoprotein, beta-human chorionic gonadotropin and lactate dehydrogenase, were normal. © 2011 Tsili et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.