Urology Journal

Purpose: Inflammatory myofibroblastic tumors are exceptionally rare mesenchymal neoplasms that often mimic malignancies clinically and radiologically, frequently leading to radical orchiectomy because of diagnostic uncertainty. The existing literature is limited to isolated reports with inconsistent follow-up and little discussion of conservative surgical approaches.

Materials and methods: We present a case of a 40-year-old man diagnosed with an anaplastic lymphoma kinase-negative inflammatory myofibroblastic tumor arising from the spermatic cord, successfully treated with testis-sparing excision. In addition, a focused literature review was performed using PubMed, Scopus, and Web of Science to identify previously reported adult cases of spermatic cord inflammatory myofibroblastic tumor. Clinicopathological features, immunohistochemical findings, treatment approaches, and outcomes were analyzed. Results: Including the present case, 12 adult patients with inflammatory myofibroblastic tumors of the spermatic cord were identified. The median age was 42.5 years (interquartile range, 32.5–54.0). Anaplastic lymphoma kinase status was reported, with negativity observed in 7 cases (58%) and positivity in 1 case (8%), while status was not assessed in the remaining 4 patients (33%). Radical orchiectomy was performed in 9 patients (75%), whereas testis-sparing mass excision was performed in 3 cases (25%). No local recurrence or distant metastasis was documented during a median follow-up of 36 months (interquartile range, 30–46) among the 11 cases with available follow-up data.

Conclusion: Adult spermatic cord inflammatory myofibroblastic tumors appear to follow an indolent clinical course after complete excision. Organ-preserving management may be considered in carefully selected patients, highlighting the importance of accurate pathological assessment and multidisciplinary decision-making.